Double Tube Drainage for the Management of Large Proximal Jejunal Blowout Perforation - A Novel Proposition.

ABSTRACT

Isolated Jejunal peroration in a case of blunt trauma abdomen is less encountered and variably dealt with. Being rare, its diagnosis itself is very late clinically and hence carries very high rate of morbidity & mortality. Here we attempted a novel technique to manage the dreaded proximal intestinal leak and avoid stoma at a very proximal site. High output proximal fistula that follows leak is still a nightmare for the resident.Isolated Jejunal blowout injuries are easily missed and diagnosed late. The management involves a primary repair which has a very high risk of leak. This further increases the financial burden and emotional trauma, to the patient & family, as it involves multiple surgeries and prolonged hospital stay following leak and / or high output proximal fistula. This can be avoided by addition of a retrograde duodenostomy to secure the anastomosis without much expense. This reduces the overall stay and expense. Bile collected from the Retrograde Duodenostomy tube was further utilized and replaced to the patient, thus alleviating the need for total parenteral nutrition also. Here we present our technique.