A post-op patient presents with peritonitis and massive contamination because of duodenal leak. Management of choice is:
Ans. (b) Duodenostomy+ FJ + Peritoneal lavageDuodenal leak with massive contamination:* After some surgery probably Billroth 1 or Billroth 2 or perforation closure of Duodenal ulcer perforation there may be a leak from Duodenum.* The history clearly mentions the patient is having massive contamination.* Immediately shift the patient to Operation theatre with resuscitation and do emergency laparotomy.* Damage control surgery is done in massive Contamination- Thorough peritoneal lavage is done, Duodenal leak point is inserted with a Foley's catheter and brought outside (Duodenostomy) and always in such patients a feeding Jejunostomy is done to provide nutrition via enteral route* TPN will be needed only if the patient cannot tolerate Enteral nutrition
Four quadrant peritoneal lavage
Duodenostomy + Feeding jejunostomy + Peritoneal lavage
Total parenteral nutrition
Duodeno jejunostomy
Peritoneum