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Total duodenectomy with detachment of the ampulla of Vater. Proximal transection at point A is distal stomach just proximal to the pylorus. Distal transection at point B is at the junction of fourth portion of the duodenum and jejunum.
Source publication
Background:
Local or regional recurrence of colon or rectal cancer frequently occurs if there is a positive margin of resection or spillage of cancer cells during the operation.
Methods:
The clinical course of a patient with right colon cancer recurrent within the resection site and on the anterior aspect of the duodenum was reviewed.
Results:...
Context in source publication
Context 1
... The duodenum was opened widely anteriorly to separate the spared ampulla from the remainder of the duodenum. All cancer was resected with a positive margin (R-1 resection) on the right common iliac artery. The resection required 6 units of packed red blood cells and 4 units of fresh frozen plasma. The limits of the duodenal resection are shown in Fig. 2. To reconstruct a routine ileocolic anastomosis was performed with end of proximal colon sutured to antimesenteric aspect of the terminal ileum. The proximal jejunum was advanced and its end turned in with sutures over the staple line. A jejunostomy the width of the patch of ampulla of Vater was made. The inferior aspect of the ...
Citations
... Although there is no ample evidence that supports ampullo-jejunostomy for patients who undergo duodenectomy, we could find a single case report published by Paul who had done jejunal advancement and anastomosis of jejunum to a patch of duodenum containing ampulla of Vater following subtotal duodenectomy for recurrent colon carcinoma. 16 In the present case, ampullojejunostomy was performed to restore the bilio-pancreatoenteric continuity. ...
Corrosive poisoning is common in South East Asian countries than in the West. It can be accidental or suicidal and can cause gastrointestinal tract injuries. The grade of injuries depends on several factors related to the patient and the substance causing injury. Dilemmas arise at different management levels, whether to resort to a radical surgical approach or consider more conservative approaches. We present a case of suicidal corrosive acid injury in a 23-year-old male with extensive upper gastrointestinal tract injury managed surgically. Ampullojejunostomy may be a feasible option in patients with stomach and duodenal necrosis following corrosive acid poisoning if ampulla is normal. However, its role in the emergency setting may be questionable.
