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Complex duodenal fistulae: a surgical nightmare
Ari Leppäniemi1,2, Matti Tolonen3, Panu Mentula3
1Abdominal Center, Division of Emergency Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland. Leppis54@outlook.com.
World Journal of Emergency Surgery : WJES
|May 19, 2023
Summary
Surgical closure with duodenal decompression is the most effective treatment for complex duodenal fistulas. While nonoperative management can be attempted, many patients ultimately require surgery for successful fistula closure.
Area of Science:
- Gastroenterology
- Surgical Gastroenterology
- Abdominal Surgery
Background:
- External duodenal fistulas cause severe complications due to digestive enzymes.
- Therapy-resistant local and systemic issues are common.
Purpose of the Study:
- To analyze management options for complex duodenal fistulas.
- To determine successful fistula closure rates for different treatments.
Main Methods:
- Retrospective study of 50 adult patients over 17 years.
- Descriptive and univariate analyses of management outcomes.
Main Results:
- Surgical closure achieved a 76% fistula closure rate (29/38).
- Initial nonoperative management had a lower success rate when surgery was ultimately required (5/12).
- Overall in-hospital mortality was 40%.
Conclusions:
- Surgical closure with duodenal decompression offers the highest success rate for complex duodenal fistulas.
- Nonoperative management may be considered for select cases, with potential for later surgical intervention.
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