Minimally invasive treatment of a duodenal perforation after EndoBarrier® implantation
Aims: According to the increasing incidence of overweight and the consequences like Type 2 Diabetes mellitus (T2DM) it's necessary to improve the therapie of obsesity. The EndoBarrier® system is a Duodenal-Jejunal Implant, anchored in the duodenum, that prevents food from contacting the intestinal wall. It is proposed to have the comparable effects as gastric bypass surgery. In this case report we describe the complication of a duodenal perforation after EndoBarrier® implantation, and the minimally invasive treatment. In the literature theres is, to our knowlede no description of a comparable case.
Case description: A 49 year old man with a BMI of 40.9 kg/m2 (185 cm, 140 kg) and a poorly regulated T2DM (HbA1c 9,6%) received an EndoBarrier® implant for improving the T2DM. After 4 weeks the Patient came in the emergency room with an acute abdomen. In the clinical examination the patient presented peritonism in the right epigastric region. Laboratory work up showed CRP of 280 mg/l and the CT scan showed free air in the abdomen suspicious for perforation in the duodenum.
We decided to perform a combined endoscopic and laparoscopic treatment procedure in general anasthesia. As a first step the implant was removed endoscopically. In the laparoscopy, a peritonitis of the right upper quadrant was seen. After dissection of adhesions the perforation was located at the duodenal bulb. The perforation was closed laparoscopically using a running suture and the abdominal cavity was rinsed and drained.
Recovery from surgery and peritonitis was quikly. The patient was discharged from hospital 9 days after surgery with normal laboratory values.
Discussion: This case shows a serious complication of the EndoBarrier® system which was exceptionally well treated by our interdisciplinary team of surgeons and endoscopists. We strongly propose a minimally invasive treatment like described in this case. Patients with diabetes and obesity are at high risk for complications after major abdominal operations, a minimally invasive treatment can reduce the risk for wound infections and allows early mobilisation. Furthermore will be preserve the possibility to perform laparoscopic metabolic surgery (gastric bypass) after complete recovery of the patient.
CAMIC: Komplikationsmanagement bei laparoskopischen Eingriffen (Videositzung)
Donnerstag, 12. September 2013/17:00 – 18:30/St. Petersburg