Giant Duodenal Perforation: Review of Various Techniques
Keywords:Large Duodenal Perforation (LPD), Giant Duodenal Perforation (GDP), Cellan-Jone technique, Graham technique, Partial Gastrectomy, Proximal GastroJejunostomy, T-Tube, Duodenostomy, Jejunal Serosal Patch, Gastric Disconnection
Background: Very few data exist regarding the incidence, definition and treatment of Large Duodenal Perforations (LDP). Duodenal perforation represents a rare but potentially life-threatening condition. The mortality rate ranges from 8% to 25%.
Aim: The aim of this paper is to report useful aspects in the practice about treatment options in LPD.
Methods: From Cellan-Jones in 1929 to Graham in 1937 a number of surgical techniques have developed from closure small defect to complex techniques to close large defect using other surgical options such as partial gastrectomy, proximal gastrojejunostomy, T-Tube duodenostomy, jejunal serosal patch, exclude biliary tree with a T-Tube plus gastrojejunostomy or plus partial gastrectomy.
Results: In the literature research, we have difficult to find a definition of large or giant duodenal perforation. Following some authors large giant seems to be >2 cm. Most of the duodenal ulcer perforations are less than 1 cm and the technical option as closure the defect associated by omentopexy as Graham techniques or pedicle omentopexy as Cellan-Jones technique, is the best choice. Large and giant perforations are considered at higher risk of leak with the use of omental patch. In such types, surgeon must think to search other technical options such as partial gastrectomy plus Billroth II anastomosis, gastrostomy, lateral duodenostomy, T-Tube duodenostomy and feeding jejunostomy, biliary tree disconnection with T-Tube plus partial gastrectomy.
Conclusion: The aim of this paper is to report useful aspects in the practice about treatment options in LPD to obtain low morbidity and mortality rate. Literature results seem to advise the use of suture plus omentopexy Cellan-Jones or Graham techniques, in small and large sized perforations mx 2 or 2.5 cm. For large/giant duodenal perforation from 2.5 cm or over 3 cm various technical options are performed.