Manejo de fístula duodenal de alto flujo en paciente postoperado por isquemia duodeno-yeyunal

Abstract

Patient with past medical history of cerebral thrombosis, without regular anticoagulant medication 5 months before admission, with symptoms of acute abdomen with tomographic and intraoperative findings of portal vein thrombosis with ischemia of the duodenum in its third and fourth portions, in addition to ischemia of the proximal jejunum; resection and duodenal-jejunal anastomosis were performed. In the postoperative period, he developed partial dehiscence of the anastomosis, later a high-output duodenal fistula and severe necrotic pancreatitis. Reoperated due to signs of sepsis and persistence of duodenal fistula, performing a gastro-enteric anastomosis, placement of a naso-jejunal tube and debridement of pancreatic tissue with pancreatic tamponade. He receives TPN (fifteen days), then starts with EN formula by NJ tube after the second re-intervention (twenty days). He received anti-secretory therapy with octreotide. He received antibiotic therapy: imipenem, vancomycin, and caspofungin for ten days, then piperacillin/tazobactam for ten days. After meeting his requirements through EN, oral feeding is started, presenting a favorable evolution and subsequent medical discharge.