The effectiveness of primary repair, jejunal serosal patch, rouxeny duodenojejunostomy, or expanded polytetrafluoroethylene patch repair techniques were investigated on the basis of survival and. Other options include jejunal serosal patch, tube duodenostomy and pyloric exclusion. Gastroduodenoplasty performed by distal gastric transection. Presentation mode open print download current view. To the best of our knowledge, the use of this technique for choledochoplasty in mirrizi syndrome has not been reported. Isolated duodenal perforation idp in pediatric trauma is rarely reported. In this experimental study, we treated large duodenal defects by an expanded polytetrafluoroethylene eptfe, goretex. We decided on jejunal serosal patch for this patient. Duodenojejunostomy, an old technique but novel solution for. The management of large perforations of duodenal ulcers bmc. Wf ballinger ii, ed mclaughlin, eg baranskijejunal overlay closure of the. The onlay jejunal serosal patch has been commonly used to cover defects because of duodenal ulcer perforations and injuries.
To evaluate the outcomes of jejunal serosal patch and jejunal pedicled flap procedures for the repair of duodenal injuries. Cosecsaasea publication east and central african journal of surgery. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Experimentally, various techniques have been reported for repair of large duodenal defects. Ten mixedbreed male dogs were selected and randomly divided into groups a and b. A duodenal defect about 50% of the total circumference was created in the second portion of the duodenum in 20 dogs. Techniques for closing small inflamed duodenal detects, a, small mucosal pedicle patch, b, rouxy serosal patch, c, gastric island patch. However, duodenal perforation repair in presence of large defect of with a delayed article figure 3. Two cases of laparoscopic direct spiral closure of large. For this rare but critical situation, surgical practice techniques as using rouxeny reconstruction, omental patchplasty, jejunal serosal patch, and stomach transection by using a stapler or furthermore draining the duodenum and stomach by using catheters, combined with a possible bile drainage are recommended.
The experimental animalmodel study was conducted at shiraz university of medical sciences, iran, in february 20. Since the experimental report regarding the jejunal serosal patch procedure by koboldin in 1963, authors have reported its use with encouraging outcome. Perforated peptic ulcer ppu is relatively rare, but lifethreatening with the mortality varying from 10% to 40% 2, 46. Ef wolfman jr, g trevino, dk heaps, gd zuidemaan operative technique for the. He used the jejunum as a pedicled flap to reconstruct the thoracic esophagus. A jejunojejuno anastomosis was created with a 75cm biliopancreatic limb and a 100cm roux limb figure 5. Use of the falciform ligament pedicle flap is not the only alternative surgical approach currently utilised in lieu of the classical greater omental patch graham technique. We suggest use of techniques such as jejunal serosal patch or roux eny duodenojejunostomy or pyloric exclusion to protect the duodenal suture line, in case of large postbulbar duodenal defects not amenable to resection i. Since most of the children with blunt trauma are managed expectantly, timely diagnosis is imperative to avoid morbidity and mortality. The technique of omentopexy was essentially the same in all the cases. The tumours were excised and the resulting duodenal defects closed satisfactorily using the jejunal serosal patch technique. We report a case of idp and emphasize on certain specific clinical features indicating possibility of duodenal injury. The effectiveness and gross and histological examinations of the eptfe patch technique was compared with the jejunal serosal patch. Jejunal overlay closure of the duodenum in the newborn.
These modalities generally faired better with comparable results than primary closure in giant perforation. A few perforations however result in lifethreatening retroperitoneal necrosis and require surgical intervention. Duodenal fistulas that are associated with the recurrence of crohns disease at an ileocolic. After general anaesthesia, a large duodenal defect was. The use of an isolated jejunal loop as serosal patch is the preferred technique, concurrently others have adduced duo denal diversion claiming the technical complexity in the severe peritonitis scenario as well 7,8,10. However some obstacles such as limitation of the operation site segmental blood supply and alkaline content of duodenum prevented surgeons from following a clearcut algorithm to approach this problem. Jejunal definition of jejunal by medical dictionary. Utilising pedicled jejunal flap pjf has been an acceptable technique to deal with large duodenal defects.
Services on demand scielo scientific electronic library. Duodenostomy definition of duodenostomy by medical dictionary. We believe jejunal serosal patch is rarely done in. Jejunal interposition as a definitive treatment for gastric. The two ends of the jejunal defect were reanastomosed. Diverticulization duodenal distal technique for injury. The main objective of this paper is to describe our experience with the jejunal serosal patch procedure in patients with failed omental patch procedure following perforated peptic ulcer disease. Coleman iii editorial comment the jejunal free flap for esophageal reconstruction is an elegant and attractive technique. Serosal tears in small bowel medical billing and coding. We also stress upon the role of early contrastenhanced. A successful technique for managing difficult peptic ulcer perforation. However, in cases of large and giant ulcers, other surgical techniques such as a jejunal serosal patch, jejunal pedicled graft, free omental plug, suturing the omentum to the nasogastric tube, and pyloric exclusion with gastrojejunostomy, may be. A successful technique for managing difficult peptic ulcer perforation article pdf available december 2016 with 3,657 reads how we measure reads. Jejunal serosal onlay flap for repair of large common bile.
The surgical technique used for the management of all patients consists of 3 steps. In 1907, roux, in france, described a successful staged reconstruction of the esophagus using the jejunum. A high incidence of dehiscence 1050% and gastric outlet obstruction has been reported in most of the papers. A 30yearold man seen for a bloody stool was diagnosed with bleeding from a submucosal tumor in the contralateral of papilla by gastrointestinal endoscopy. The difference between blumgarts and lees method for pj is that the minor pancreatic ducts are exposed and covered by a jejunal serosal patch with blumgarts method. However, jejunal slow wave frequency cpm, control vs patch. The selection of the most appropriate technique for the repair of peptic ulcer perforations, especially when the initial attempt of closure has failed have been the concern of many surgeons. A simple method for the management of experimental wounds of the duodenum. Six days later an abscess in the righllower quadrant was evacuated. Its lining is specialized for the absorption by enterocytes of small nutrient molecules which have been previously digested by enzymes in the duodenum. An early aggressive approach to intestinal perforation using the serosal patch technic. We report a case of jejunal serosal patch for repair of duodenal wall defect after local excision of duodenal leiomyoma. Jejunal mucosal patch described by jones and joergenson this patch can be constructed by using a proximal segment of jejunum, which can be carried up in a. Duodenal perforation is an uncommon complication of endoscopic retrograde cholangiopancreatography ercp and a rare complication of upper gastrointestinal endoscopy.
May 08, 2018 jejunal serosal patch the technique of jejunal serosal patch was first described by kobbold and thall to prevent severe narrowing which may occur due to primary closure. Introduction in 1904, wiilstein, in germany, reported the first case of a jejunal flap. For this rare but critical situation, surgical practice techniques as using rouxeny reconstruction, omental patch plasty, jejunal serosal patch, and stomach transection by using a stapler or furthermore draining the duodenum and stomach by using catheters, combined with a possible bile drainage are recommended. Effectiveness of behavioural management on migraine in. Repairing large duodenal injuries in dogs by expanded. More than half of the cases are female and they are usually older and. An initial suture closure of the duodenal defect was reinforced with a jejunal serosal patch and the area area drained. The rationale of this procedure, introduced by jones et al,1 is the same as that of the serosal. Bekele a, kassa s, taye m 2016 the jejunal serosal patch procedure. Introduction omental patching began in 1937, when dr. The management of large perforations of duodenal ulcers.
Repair most injuries primary closure in one or two layers longitudinal duodenotomies closed transversely if length of duo injury 05 and idmec frequency 0. Some suggested techniques include omental patch with pyloric exclusion, controlled tube duodenostomy, jejunal pedicled graft or serosal patch, gastric disconnection and partial gastrectomy 25. Five days after this proceuure an abscess in the right upper quadrant was drained and severe necrotic pancreatitis found. One of the most challenging problems in clinical surgery is management of injured duodenum. An innovative duodenal perforation surgical repair technique. Serosal patch vs duodenojejunostomy in duodenal stump closure. The most common complication was necrosis of the most cephalad portion of. Little consistency on nomenclature of omental technique. Kobold and thal10 described the use of a jejunal serosal patch. Every year peptic ulcer disease pud affects 4 milion people around the world. Jan 24, 2014 duodenal perforation is an uncommon complication of endoscopic retrograde cholangiopancreatography ercp and a rare complication of upper gastrointestinal endoscopy. Comparison of various techniques for repair of large duodenal. Traditionally, duodenal perforations are repaired with an omental patch or graham patch 35. An early aggressive approach to intestinal perforation using the serosal patch.
Exploratory laparotomy w extensive lysis of adhesions that took about an hour in order to be able to get to the pathology, also several small bowel serosal tear repairs, small bowel resection w primary anastomosis, reduction and repair of internal hernia, omentectomy. Duodenostomy definition of duodenostomy by medical. Jejunal interposition as a definitive treatment for. Most are minor perforations that settle with conservative management. A case of jejunal serosal patch for repair of local. Sep 01, 2017 a jejunojejuno anastomosis was created with a 75cm biliopancreatic limb and a 100cm roux limb figure 5. Motor and absorptive function of the canine intestine. Dec 01, 2015 repair most injuries primary closure in one or two layers longitudinal duodenotomies closed transversely if length of duo injury serosal patch clinical use in 12 animals crowe, dennis t. Its lining is specialized for the absorption by enterocytes of small nutrient molecules which have been previously digested by enzymes in the duodenum the jejunum lies between the duodenum and the ileum and is considered to start at.
A great interest in serosal patch procedures began with the management of. Afterwards, the roux limb was placed over the fistula as an interposed segment, fixing it to the anterior and posterior part of the fistula with pds 00 polydioxanone sutures, creating a serosal patch figures 6 and 7. Other options are exclusion or diverticulization of duodenum, including partial gastrectomy or gastric dissociation and rarely pancreaticoduodenal resect10n. Diverticulization duodenal distal technique for injury angle. Gore, elkton, md softtissue patch and compared it with the jejunal serosal patch. Diagnosis and treatment of perforated or bleeding peptic. The passage of the stich through the biological patch. Overlying suturing of an intact segment of the jejunum over the open end of. Complications are encountered in 10%20% of these patients and 2%14% of the ulcers will perforate 2, 3. Difficult duodenal closure has been managed by either a jejunal serosal patch or. The duodenal perforation evidenced by the tip of the surgical instrument. Kobold and thal 15 demonstrated successful healing of experimentally induced duodenal injuries by using serosal patch with jejunal loop.