Modified duodenal diverticulization technique for the management of duodenal fistulas

BackgroundDuodenal leaks can still occur in up to 25% of trauma patients who have undergone duodenal diverticulization and pyloric exclusion with gastrojejunostomy (PE). We herein describe an alternative technique of duodenal diverticulization used to treat 3 patients that sustained posttraumatic duodenal fistula.MethodsThe modified duodenal diverticulization entails stapling of the first and third parts of the duodenum, a distal gastrectomy and a side-to-side duodenojejunostomy. The gastrointestinal transit reconstruction can be performed either with a standard Billroth II gastrojejunostomy, or, preferably, with a Roux-en-Y anastomosis.ResultsWe did not observe any postoperative complications related to the procedure itself in any of the 3 cases treated by our group.ConclusionsThe technique described offers a relatively simple and an apparently safe approach for the treatment of posttraumatic duodenal fistulas. This technique can be used even if the patient was subjected previously to diverting procedures, including duodenal diverticulization or PE.