# The ingenious drainage system controls persistent duodenal stump fistula due to pancreatic fistula after subtotal gastrectomy for advanced gastric cancer

## TL;DR

A patient with a severe stomach surgery complication was successfully treated using a novel drainage system to manage persistent fistulas.

## Contribution

A novel drainage system combining intraluminal and biliary diversion is proposed for managing persistent duodenal stump fistulas.

## Key findings

- A dual drainage system with continuous suction improved outcomes in a patient with persistent DSF.
- Diligent debridement and biliary diversion may be effective in managing DSF after gastrectomy.
- The patient recovered and was discharged after 59 days with this approach.

## Abstract

Duodenal stump fistula (DSF) is a dangerous complication after gastrectomy. There is no consensus on the management of DSF. Sometimes, emergency surgery may be necessary. We present the case who underwent subtotal gastrectomy with Roux-en-Y reconstruction for advanced gastric cancer. After that surgery, we diagnosed DSF due to pancreatic fistula, and performed reoperation because of hemodynamic instability due to diffuse peritonitis and sepsis. We resected the stump and closed with handsewn suturing and inserted three intra-abdominal drainage tubes, including a dual drainage tube around the duodenal stump. Although there was a recurrence of DSF, because of the continuous and absolute drainage, the patient improved and discharged on postoperative Day 59. From this experience, diligent debridement and a continuous suction dual drainage system, intraluminal drain of the duodenum, and biliary diversion may be an effective surgical management for DFS.