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Kelm M, Seyfried F, Reimer S, et al. Proximal jejunal stoma as ultima ratio in case of traumatic distal duodenal perforation facilitating successful EndoVAC. Int J Surg Case Rep. 2017;41:401-403doi: 10.1016/j.ijscr.2017.11.022.
Kelm, M., Seyfried, F., Reimer, S., Krajinovic, K., Miras, A. D., Jurowich, C., Germer, C. T., & Brand, M. (2017). Proximal jejunal stoma as ultima ratio in case of traumatic distal duodenal perforation facilitating successful EndoVAC. International journal of surgery case reports, 41401-403. https://doi.org/10.1016/j.ijscr.2017.11.022
Kelm, M, et al. "Proximal jejunal stoma as ultima ratio in case of traumatic distal duodenal perforation facilitating successful EndoVAC." International journal of surgery case reports vol. 41 (2017): 401-403. doi: https://doi.org/10.1016/j.ijscr.2017.11.022
Kelm M, Seyfried F, Reimer S, Krajinovic K, Miras AD, Jurowich C, Germer CT, Brand M. Proximal jejunal stoma as ultima ratio in case of traumatic distal duodenal perforation facilitating successful EndoVAC. Int J Surg Case Rep. 2017 Nov 16;41:401-403. doi: 10.1016/j.ijscr.2017.11.022. eCollection 2017. PMID: 29546001; PMCID: PMC5699878.
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Int J Surg Case Rep. 2017 Nov 16;41:401-403. doi: 10.1016/j.ijscr.2017.11.022. eCollection 2017.

Proximal jejunal stoma as ultima ratio in case of traumatic distal duodenal perforation facilitating successful EndoVAC.

International journal of surgery case reports

M Kelm, F Seyfried, S Reimer, K Krajinovic, A D Miras, C Jurowich, C T Germer, M Brand

Affiliations

  1. Department of General, Visceral, Vascular and Pediatric Surgery, University of Würzburg, Germany.
  2. Department of General, Visceral, Vascular and Pediatric Surgery, University of Würzburg, Germany. Electronic address: [email protected].
  3. Department of Internal Medicine, Division of Gastroenterology, University of Würzburg, Germany.
  4. Department of Investigative Medicine, Imperial College London, UK.
  5. Department of General, Visceral and Thoracic Surgery, Kreiskliniken Altoetting-Burghausen, Germany.

PMID: 29546001 PMCID: PMC5699878 DOI: 10.1016/j.ijscr.2017.11.022

Abstract

INTRODUCTION: During damage control surgery for blunt abdominal traumata simultaneous duodenal perforations can be missed making secondary sufficient surgical treatment challenging. Endoluminal vacuum (EndoVAC™) therapy has been shown to be a revolutionary option but has anatomical and technical limits.

PRESENTATION OF THE CASE: A 59-year old man with hemorrhagic shock due to rupture of the mesenteric root after blunt abdominal trauma received damage control treatment. Within a scheduled second-look, perforation of the posterior duodenal wall was identified. Due to local and systemic conditions, further surgical treatment was limited. Decision for endoscopic treatment was made but proved to be difficult due to the distal location. Finally, double-barreled jejunal stoma was created for transstomal EndoVAC™ treatment. Complete leakage healing was achieved and jejunostomy reversal followed subsequently.

DISCUSSION: During damage control surgery simultaneous bowel injuries can be missed leading to life-threatening complications with limited surgical options. EndoVAC™ treatment is an option for gastrointestinal perforations but has anatomical limitations that can be sufficiently shifted by a transstomal approach for intestinal leakage.

CONCLUSION: In trauma related laparotomy complete mobilization of the duodenum is crucial. As ultima ratio, transstomal EndoVAC™ is a safe and feasible option and can be considered for similar cases.

Keywords: Duodenal perforation; Duodenal trauma; EndoVAC and small bowel; Transstomal endoluminal vacuum therapy

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