July 1973

Whither Goest the Duodenal Stump Blowout?

Arch Surg. 1973;107(1):11. doi:10.1001/archsurg.1973.01350190003001

The term duodenal stump blowout is an apt description of the breakdown of a duodenal closure following gastric resection. The patient has complicated duodenal ulcer disease treated by a gastric resection, duodenal closure which may be "difficult," and gastrojejunostomy as reconstitution. He does well for the first few postoperative days and then develops overwhelming sepsis and prostration due to leakage from the duodenal stump. The seemingly sudden occurrence of this complication made the use of the term "blowout" most appropriate. Moreover, the 50% mortality associated with this condition led to innumerable publications explaining its pathogenesis.

Within the past decade, articles about duodenal blowout have virtually disappeared from the literature. There are numerous reasons for this: The popularity of vagotomy and pyloroplasty has reduced the number of gastric resections for duodenal ulcer and the need to contend with the difficult closure of the duodenal stump. A better understanding of the nutritional

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