THE LEAKING duodenal stump following gastric resection presents a definite problem in gastric surgery. Though much has been said, and fittingly so, about the prevention of this complication, so far as we have been able to determine nothing has been said of early recognition of the lesion once it has occurred. The leaking duodenal stump causes characteristic symptoms and signs which permit an early diagnosis. The purpose of this paper is to describe the syndrome.
A review of the case records of 500 subtotal gastric resections revealed the incidence of proved disruption of the duodenal stump to be 3%, or a total of 15 cases. Duodenal stump disruption was proved at operation, or by the development of an external bile fistula, or at autopsy. Of the 15 patients, only two had their symptoms correctly diagnosed early, and only these two were operated on for the express purpose of relieving this