case_images: PMC11811898_01
case_images: Preoperative and intraoperative findings of duodenal perforation and reconstruction. Preoperative CT- scan of the abdomen delineating the amount of free intra-peritoneal air (arrow) and the location of the biliary metallic stent (arrow).
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case_images: PMC11811898_01_rjaf050f1.jpg
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case_images: He underwent a complex ERCP procedure to extract a common bile duct stone and place a biliary stent. However, due to a deformed duodenum and complex biliary anatomy, the procedure was complicated by a large combined duodenal and bile duct perforation confirmed on CT-scan imaging (Fig. 1) 4 days later and necessitated urgent surgical intervention.
case_images: Intraoperative findings and final reconstruction using vascularized isolated distal gastric pouch. (A) Intraoperative findings of the duodenal perforation (dotted circle) and the metallic stent protruding through the bile duct (arrow). (B) Final reconstruction using vascularized isolated distal gastric pouch (black arrow) maintaining the gastroepiploic vascular pedicle to the pouch (arrow).
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case_images: A 40% circumferential perforation of the proximal second portion of the duodenum was identified with a metallic stent protruding from the supra-pancreatic common bile duct (CBD) into the perforation (Fig. 2). A Roux-en-Y gastrojejunostomy was then constructed in standard fashion (Figs 2 and 3).
case_images: Schematic delineating the reconstruction technique for the vascularized, isolated gastric pouch. (A) Depiction of the site of the duodenal and bile duct injury. (B) Creation of the distal gastric pouch. (C) Final anastomoses of the pouch to the duodenal and bile duct defect.
case_images: rjaf050f3.jpg
case_images: PMC11811898_01_rjaf050f3.jpg
case_images: f3
case_images: A Roux-en-Y gastrojejunostomy was then constructed in standard fashion (Figs 2 and 3).