A Case of a Duodenal Stump Fistula Developing Two Months after Distal Gastrectomy with Roux-en-Y Reconstruction

Abstract

A 65-year-old male patient presented with advanced gastric cancer involving duodenal bulb. He underwent laparoscopic distal gastrectomy with Roux-en-Y reconstruction two months prior to the current visit. Sufficient margin for buried suturing at the duodenal stump was not available, thus duodenal stump burial was not possible. Instead, the duodenal stump was dissected using an automated stapler with the use of reinforcement material. The pathological diagnosis was pT3N2M0 stage IIIA, and adjuvant chemotherapy (S1 + docetaxel therapy, referred to as DS therapy) was initiated.

On the day following the start of the second course of DS therapy, the patient presented to the emergency clinic with epigastric pain and was diagnosed with suspected duodenal stump fistula, necessitating urgent surgery. The patient underwent an external fistula (stoma) procedure for peritonitis caused by a duodenal stump leak. The postoperative course was favorable, and the patient was discharged on the 19th day after surgery.

Duodenal stump fistulas can develop in a delayed onset and should be considered even during the implementation of adjuvant chemotherapy.