Triple-Tube-Ostomy: A Novel Technique for the Surgical Treatment of Iatrogenic Duodenal Perforation

Abstract

Although duodenal perforation is currently an infrequent complication of medical procedures, its incidence in the future predictably will increase as endoscopic treatment of duodenal neoplasms becomes more frequently used. In some cases, duodenal perforation is difficult to treat even surgically. We report here a novel technique called ‘triple-tube-ostomy’ for the treatment of iatrogenic duodenal perforation. Since November 2009, there have been three cases of iatrogenic perforation of the duodenum, due to various causes, which we have treated with our novel technique. The main principles of the technique are biliary diversion, decompression of the duodenum, and early enteral nutrition. All patients who underwent the triple-tube-ostomy procedure had good postoperative courses, with few complications. The novel surgical technique we describe in this report is safe, reliable, easy to learn and perform, and led to a good postoperative course in all cases where we performed it.

Cerrahi̇ Tekni̇k: Endoskopi̇k Sfi̇nkterotomi̇ye Bağli Peri̇ampullar Retroperi̇toneal Perforasyonda Transduodenal T-Tüptekni̇ği̇

“…Hastaya en az cerrahi stresi yükleyen bu teknikle aynı anda kolesistektomi, koledok eksplorasyonu ve taş ekstraksiyonu yapıldıktan sonra koledok, pankreas kanalı ve duodenumun tek yerden drenajı sağlanabilir. Bu tip yaralanmalarda uygulanan bir yaklaşım ise triple-tube-ostomi şeklin-de adlandırılan T tüp-tüp duodenostomi-gastrostomi drenaj kateterlerinin konulmasıdır (13). Ancak bu teknikte 3 adet tüp drenaj kateteri hasta ile birlikte uzun süre kalmakta ve morbiditeye neden olmaktadır.…”

Ten-Year Experience of Managing Giant Duodenal Ulcer Perforations with Triple Tube Ostomy at Tertiary Hospital of North India

“…Later, several modifications were done in this procedure. Nobuaki and Kazuaki et al [18] performed the cholecystectomy and inserted the C tube through the cystic duct for biliary drainage, a retrograde duodenostomy and a feeding jejunostomy was done following duodenorrhaphy. Onur C et al [19] inserted Malecot catheter through the duodenal defect and secured it with purse string sutures along with decompressive gastrostomy and feeding jejunostomy.…”

A Novel Approach to Managing Giant Duodenal Ulcer Perforations: Minimizing Ostomies, Maximizing Decompression. A Case Report

“…However, this drainage technique is not feasible when the duodenal tissue is friable or if there is extensive fibrosis of the duodenum limiting its mobilization as seen in Agarwal's 2017 study [9]. Another option is the Triple-Tube-Ostomy technique in which a tube gastrostomy, a retrograde tube duodenostomy, and a feeding jejunostomy are created to protect the fragile duodenal repair from pancreaticobiliary and gastric secretions, while providing enteral nutrition [10,11]. This technique has shown promising results for reducing hospital stay and mortality.…”