Recovery from a severe duodenal fistula after gastric cancer surgery

What happened, in summary

A 70-year-old man was diagnosed with advanced gastric cancer after presenting with anemia. He underwent distal gastrectomy with lymph-node dissection and Billroth II reconstruction. Final pathology classified the gastric cancer as Stage III.

His postoperative course became unusually complicated. Pancreatic leakage led to severe abdominal infection, repeated operations and drainage procedures. The leakage then contributed to failure of the gastrointestinal reconstruction and rupture of the duodenal stump, producing a persistent duodenal-cutaneous fistula with large amounts of digestive fluid loss.

Conservative drainage and nutritional support continued for months, but the fistula became difficult to control. At about 5 months after the original gastrectomy, surgeons used a pedicled rectus abdominis muscle flap together with a specialized drainage system to cover and manage the fistula. The secondary fistula gradually matured and then closed, with the drainage system removed on postoperative day 201 and complete closure by day 231.

He was eventually discharged after the prolonged recovery. At 2 years after the original gastric-cancer operation, he was in good health with no recurrence or metastasis.