Surgical treatment for septic complications in patients with duodenal perforation following endoscopic retrograde transpapillary interventions

• Main Authors: V. L. Korobka, S. V. Tolstopyatov, A. M. Shapovalov
• Format: Article
• Language: Russian
• Published: Kubankurortresurs, OOO 2019-06-01
• Series: Инновационная медицина Кубани
• Subjects: transpapillary interventions; duodenal perforation; sepsis
• Online Access: https://inovmed.elpub.ru/jour/article/view/191

Background. The most severe clinical cases following transpapillary endoscopic interventions are duodenal perforation with damage to the common bile duct and pancreatic duct, entrance into the abdominal cavity and retroperitoneum the aggressive contents of intestine and the infections. They usually lead to higher mortality.Aim. Evaluation of the optimal management for duodenal perforation in patients who have undergone transpapillary endoscopic interventions.Material and methods.A retrospective analysis of surgical treatment in thirty-two patients with duodenal perforation after transpapillary endoscopic interventions from the year 2007 to 2018 in one center was carried out. Nineteen cases (59.4%) were diagnosed less than 24 hours, 13 (40.6%) – more than 24 hours after injury. Twenty patients had the primary reconstruction of duodenum with various drainage options of injury area. In 19 cases there were a two-stage surgical procedure according the original method: 12 had a primary surgery, 7 were reoperated. Results. After primary reconstruction of duodenum 11 patients (55.0%) had complications, seven (63.6%) – were re-operated, in four we have applied efferent treatments and symptomatic therapy. Three patients (15.8%) died. After two-stage surgery procedure 7 patients (36.8%) had surgical complications, five (26.3%) – were re-operated. Three patients (15.8%) – were died.Conclusion. Primary duodenum reconstruction can be performed if the injury occurred less than 24 hours before surgery. Two-staged surgery is justified in cases with purulent inflammation in abdominum and reproperitoneal cavity because procedure allows reducing mortality from abdominal sepsis.