Management of Duodenal Stump Leakage After Gastrojejunostomy
Using Fluoroscopy-Guided Foley Catheter

Authors: Jung Suk Oh

Clinical History

A 77-year-old man admitted to our hospital on March 8th 2010 due to postoperative leakage after gastrojejunostomy on follow up CT. It was 16th days after operation. The patient presented localized tenderness without generalized peritonitis signs, as imaging study found the localized abscess. Follow-up CT, performed postoperative 10th days, shown the fluid collection at duodenal stump and lesser sac (Fig 1). After localization of the abscess or localized fluid collection in the sub-capsular portion of left hepatic lobe and lesser sac, using US and CT, the abscess cavities were punctured with an 18 G Chiba needle and then much amount of pus was aspirated. After dilation, two 8 Fr pigtail catheters were inserted over the introduced 0.035-inch guide-wire under fluoroscopy control. A 10mL of pus was more drained and requested for bacteriologic examination. The two catheters were anchored to the skin with anchoring device (Fig 2). One week later when reduced external drainage via previous inserted pigtail catheters, Tubogram was performed through the indwelling catheter. The previous fluid cavity was collapsed and contrast back flow to the duodenum was seen (Fig 3A). After a 0.035-inch guide wire (Terumo, Tokyo, Japan) was introduced through the 5 Fr guide catheter to the duodenal lumen, a Foley catheter (Sewoon Medical, Seoul, Korea) sized 10 Fr was inserted over the guide-wire and ballooned (Fig 3B). We confirmed catheter placement by tubogram through the Foley catheter (Fig 3C). Finally, the catheter was anchored with mild tension. After one month, the patient’s symptom was subsided and disappeared the loculated fluid collection. Thus, Foley catheter was removed.

Figure 1

Fluid collection at duodenal stump and lesser sac is noted. The wall of duodenal stump is not clearly delineated with adjacent tiny air bubbles

Figure 2

Raising the possibility of duodenal stump leakage.

Figure 3

After localization of the abscess or localized fluid colletion in the subcapsular portion of left hepatic lobe and lesser sac

The abscess cavities were punctured with an 18 G Chiba needle. After dilation:

  1. In the percutaneous simple drainage method – the tip of the drainage catheter would be located near the leakage site, and a fistula tract would be made around the catheter and close spontaneously within two to six weeks with proper management if drainage is effective.
  2. Foley Catheter Enterostomy First, the proper size of the ballooning could obstruct the leakage site, and it is easy to prevent local fluid collection . Also, it is possible to form the fistula tract faster than in a simple procedure. Second, effective drainage through the catheter allowed the patients to orally intake their nutrition. Finally, this method allows reduced hospitalized days and admission cost.
  3. The application of fluoroscopy-guided Foley catheter insertion and drainage on the control of leakage sites of anastomosis or suture line showed good results in a short hospital stay, with the possibility of outpatient follow up, maintenance of oral intake and normal activity, effective control of the leakage site and protection