Duodenal Stump Leak Post Curative Gastrectomy for Early Gastric Cancer Patient Treated With Endoscopic Stent which Complicated by Migration and Perforation

Purpose: This report was designed to review the critical complication following gastrectomy that can cause devastating problems in duodenal stump leakage patients. Although a non-operative approach might effectively manage such a complication without compromising patients’ clinical conditions, it is not always uneventful. Presentation of case: A 47 year old male with not known comorbidities diagnosed to have early gastric cancer and underwent a laparoscopic distal gastrectomy with Billroth-1 reconstruction. On postoperative day 9, the patient visited emergency department with a new history of persistent nausea, fatigue, and severe abdominal pain. His diagnostic workup revealed evidence of anastomotic site leak, which was initially treated by an endoscopic stent. Unfortunately, the clinical condition of the patient worsens and complicated by stent migration. One day later, the patient underwent laparoscopic exploration; drainage and gastrojejunostomy were performed uneventfully. Discussion: The leaking duodenal stump following gastric resection presents a definite and critical problem in gastric surgery and especially with gastric cancer. An anastomotic leak is one of the most serious complications following gastric surgery cases. It is associated with intra-abdominal sepsis which can result in significant morbidity and mortality. Early appropriate management should be categorized and management strategy should be implemented according to the size of the leak, extent of the abscess, and clinical status of the patient of the patient. It can be planned with a less invasive procedure. This is no always an uneventful procedure and close observation is mandatory. Conclusion: Anastomosis or duodenal stump leaks must be diagnosed as early as possible, and treated appropriately with non-operative methods if possible. Non-operative methods not always uneventful intervention and complication of each procedure should be always expected. Regardless of the operative technique the key to appropriate treatment stabilizes the patient, repair the anastomosis leak site, and adequate drainage.