management of duodenal stump disruption (blow-out) after truncal vagotomy, antrectomy, and Billroth II reconstruction.
Patients presenting with postoperative localized right upper quadrant tenderness are managed by aggressive percutaneous drainage of the abscess under radiologic guidance. An acute abdomen with free perforation and leakage of duodenal contents into the peritoneal cavity may require surgical management. This includes reclosure of the duodenal stump over a tube duodenostomy as well as wide external drainage. Mortality from stump blowout approaches 10%.