Interventional Options to Treat Postoperative Duodenal Stump Leaks

Excerpt

We read with great interest the paper by Oh et al. [1] entitled “Percutaneous Management of Postoperative Duodenal Stump Leakage with Foley Catheter,” published in the October 2013 issue of Cardiovascular and Interventional Radiology. Postoperative leaks represent a nonnegligible complication of the upper digestive tract that may be associated with increased hospital stay and high postoperative morbidity and mortality [2]. Interventional radiology plays a crucial role in the management of postsurgical complications, providing a minimally invasive approach to obtain treatment avoiding a highly invasive surgical reoperation [3‐10]. Percutaneous transhepatic biliary drainage, by diverting the bile from the site of the fistula, reduces the fistula output and consequently the healing time even in high-output duodenal stump fistulae [3]. The addition of an occlusion balloon in the biliary system to block the bile flow completely may further reduce the fistula output and the recovery time [7, 8]. Imaging-guided percutaneous drainage has been proven as a feasible, safe, and effective treatment of intra-abdominal collections, even when associated with gastrointestinal leakage [3, 4]. However, simple drainage may require long time for fistula healing and in some cases be ineffective in obtaining the closure of the fistula. By injecting contrast material from the percutaneous drainage, leakage can be demonstrated and the duodenal lumen can be reached using angiographic guidewires and catheters [1, 9]. Once precisely demonstrated the origin of the fistula and obtained the access to the duodenum with a guidewire, some different techniques may be used to obtain the fistula healing. …