Improvement of a duodenal leak: Two-way vacuum-assisted closure

A 55-year-old male patient developed a duodenal re-leak, which caused severe peritonitis, on the second postoperative day after surgery to treat an acutely perforated duodenal ulcer. Relaparotomy was performed 2 days after surgery for the re-leak after omentoplasty. The necrotic omentum was dissociated from the bulbus duodeni. Viable omentum for reinsertion of the omental patch was not found. The turned-outward duodenal mucosa was excised and the duodenal perforation was sutured. Two-way vacuum-assisted closure (VAC) was carried out by taking a liquid culture of the abdomen and washing the abdomen. The two-way VAC exchange procedures were continued every 3 days until the re-leak was terminated. The whole treatment process occurred in the intensive care unit. The duodenal leak was completely stopped by 41 days after surgery. The subcutaneous layer was dissected from the fascial layer of the anterior wall of the abdomen; thus, the abdominal skin was closed without tension and the patient was subsequently discharged. In conclusion, since primary source control is often difficult when treating duodenal leaks, the two-way VAC system is a convenient solution for localizing the source of the peritonitis and removing toxic peritoneal material.

Duodenal kaçaðýn iyileþtirilmesi: Ýki yönlü vakum yardýmlý kapama

Elli beþ yaþýnda erkek hastada, perfore duodenal ülserin tedavisi için yapýlan ameliyattan sonraki ikinci günde ciddi peritonite neden olan duodenal kaçak geliþti. Omentoplasti sonrasý tekrar sýzýntý nedeniyle ameliyattan iki gün sonra relaparotomi yapýldý. Nekrotik omentum, bulbus duodeniden ayrýlmýþtý. Omental yamanýn yeniden yerleþtirilmesi için canlý omentum bulunamadý. Dýþa dönmüþ duodenum mukozasý kesildi ve duodenum perforasyonu dikildi. Ýki yönlü vakum yardýmlý kapama (VYK), karýn sývý kültürü alýnarak ve karýn yýkanarak yapýldý. Ýki yönlü VYK deðiþim iþlemleri, sýzýntý sonlandýrýlana kadar her üç günde bir sürdürüldü. Tüm tedavi süreci yoðun bakýmda gerçekleþti. Duodenal sýzýntý ameliyattan 41 gün sonra tamamen durdu. Cilt altý tabakasý karýn ön duvarýnýn fasiyal tabakasýndan ayrýþtýrýldý; böylece, karýn cildi gergin olmadan kapatýldý ve hasta daha sonra taburcu edildi. Sonuç olarak, primer kaynak kontrolü duodenal sýzýntýlarý tedavi ederken sýklýkla zor olduðu için, iki yönlü VYK sistemi, peritonit kaynaðýný lokalize etmek ve toksik peritoneal materyali uzaklaþtýrmak için uygun bir çözümdür.