In most instances of partial gastric resection of the Billroth II type performed for duodenal ulcer, management of the duodenal stump presents no unusual problem. However, in some cases of duodenal ulcer, closure of an edematous, deeply scarred, or deformed duodenum, particularily when associated with a penetrating posterior ulcer, may be somewhat hazardous even to the skilled experienced gastric surgeon.
The successful management of the duodenal stump has become largely the determining factor in the frequency of serious or fatal complications following gastrectomy for duodenal ulcer. Avola1 reported 10 deaths in 13 cases of duodenal fistula following gastric resection. McKittrick,2 in 179 cases of gastric resection, reported 50% of the mortality to be due to peritonitis attributable to duodenal leakage.
To obtain satisfactory healing of the closed duodenal stump, the gastric surgeon must pay meticulous attention to certain details. He must preserve a sufficient length of transected duodenum
McEACHERN CG, SULLIVAN RE, ARATA JE. Duodenostomy: A Method of Management of the Difficult Duodenal Stump in Certain Cases of Partial Gastrectomy for Duodenal Ulcer. AMA Arch Surg. 1956;72(6):942–947. doi:https://doi.org/10.1001/archsurg.1956.01270240054008
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