Which of the following is the management of choice in a patient presenting with peritonitis and massive contamination because of duodenal leak?
Duodenal leakage occurs through the stump that is left after operations for duodenal ulcer and gastric ulcer. Treatment: Adequate drainage: It is achieved by inseion of large stump catheter through subcostal incision. This catheter is passed down to the duodenal stump area and a constant suction is applied. Total parenteral nutrition: Should be instituted and attention must be directed towards fluid and electrolyte therapy. This will lead to healing of fistula within 2-3 weeks. Ref: Schwaz 7/e, Page 468.
Four quadrant peritoneal lavage
Duodenostomy + feeding jejunostomy + Peritoneal lavage
Total parenteral nutrition
Duodenojejunostomy