A post-op pt. presents with peritonitis and massive contamination because of duodenal leak. Management of choice is -
Duodenal leakage occurs through the stump that is left after operations for duodenal ulcer and gastric ulcer. Treatment (1) 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. (2) 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, 7th/e, p 468
Four quadrant peritoneal lavage
Total parenteral nutrition
Duodenojejunostomy
Duodenostomy + feeding jejunostomy
G.I.T