Suture Failure of Duodenum after Surgery for Complications of Duodenal Ulcer

INTRODUCTION: The incidence of failure of intestinal sutures in the early postoperative period reaches 26%. The failure of the duodenal sutures leads to formation of high duodenal fistulas, the treatment of which is one of the most complicated surgical tasks. The article describes a clinical case of failure of duodenal suture after surgery for a duodenal ulcer complicated with bleeding. The failure of the duodenal suture could be provoked by hypoproteinemia and anemia, despite the attempts of their compensation. The presented case demonstrates complexity of the clinical course of this pathology and the possibility of successful application of draining surgery with creation of a controllable duodenal fistula, the subsequent healing of which led to recovery of the patient. To create the controllable duodenal fistula, we used a method of external-internal triple drainage of the duodenal zone (retrograde duodenostomy, gastroenteroanastomosis with a short loop, nasogastral probe). At the initial stage, after surgery, the patient received full parenteral feeding, after restoration of the intestinal peristalsis, feeding was continued through a nasointestinal probe. Infusion therapy, transfusion of blood components were conducted, drugs suppressing gastric and pancreatic secretion, were used. On the 35^th postoperative day, the discharge through the duodenal fistula and the nasogastral probe significantly decreased, and completely stopped on the 54^th day (immediately after X-ray of stomach with barium sulfate as contrast substance). The patient was discharged with improvement for outpatient follow-up at the place of residence on the 60^th day after surgery. In the follow-up period – no complaints, good appetite, rapid gaining of weight, complete rehabilitation. In one-year follow-up, no long-term complications and consequences for health were observed.

CONCLUSION: A choice of the surgical treatment method of duodenal suture failure remains a subject of discussion. In the presented clinical case, draining surgery with creation of a controllable duodenal fistula proved to be effective. The complete closure of the residual fistula of the duodenum was facilitated by stomach X-ray with use of barium sulfate.