Muhammedoğlu B, Ay OF. Endoscopic clipping of gastrojejunostomy leakage following Whipple procedure: A case report. World J Gastrointest Surg 2024; 16(9): 3041-3047 [DOI: 10.4240/wjgs.v16.i9.3041]
Corresponding Author of This Article
Bahtiyar Muhammedoğlu, MD, Assistant Professor, Surgeon, Department of General Surgery, Kahramanmaras Sutcu İmam University Medical Faculty, Avşar Mah. Batı Çevreyolu Blv. No. 251/A 46040-Onikişubat, Kahramanmaras 46040, Türkiye. baha197647@gmail.com
Research Domain of This Article
Surgery
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Sep 27, 2024; 16(9): 3041-3047 Published online Sep 27, 2024. doi: 10.4240/wjgs.v16.i9.3041
Endoscopic clipping of gastrojejunostomy leakage following Whipple procedure: A case report
Bahtiyar Muhammedoğlu, Oguzhan Fatih Ay
Bahtiyar Muhammedoğlu, Department of General Surgery, Kahramanmaras Sutcu İmam University Medical Faculty, Kahramanmaras 46040, Türkiye
Oguzhan Fatih Ay, Department of General Surgery, Kahramanmaras Necip Fazıl City Hospital, Kahramanmaras 46140, Türkiye
Author contributions: Muhammedoğlu B performed endoscopic intervention on the complications that developed in this case and collected the patient's data and clinical findings; Ay O supported the literature review and case writing. We reviewed the literature and wrote the manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Bahtiyar Muhammedoğlu, MD, Assistant Professor, Surgeon, Department of General Surgery, Kahramanmaras Sutcu İmam University Medical Faculty, Avşar Mah. Batı Çevreyolu Blv. No. 251/A 46040-Onikişubat, Kahramanmaras 46040, Türkiye. baha197647@gmail.com
Received: March 5, 2024 Revised: June 6, 2024 Accepted: July 16, 2024 Published online: September 27, 2024 Processing time: 196 Days and 15.3 Hours
Abstract
BACKGROUND
Currently, perioperative complications of classic Whipple surgery occur at a rate of approximately 40%. Common complications include delayed gastric emptying, pancreatic fistula, and bile leakage, whereas gastrojejunostomy (GJ) leakage is rare.
CASE SUMMARY
This case report will assess the management of a GJ leak in a 71-year-old male patient following the Whipple procedure. After surgery, the patient was transferred to the clinic after four days of intensive care, where vacuum therapy was used to handle a developing subcutaneous collection. The patient, who had bile in the drains and incision during follow-up, underwent endoscopic examination on the 21st day after the operation. An opening of approximately 4 mm was observed in the GJ anastomosis during endoscopy. Five titanium clips were used to close the openings. The drainage of bile decreased to less than 50 mL on the first day after the procedure, and the patient's oral intake was opened.
CONCLUSION
Current literature reports a GJ leakage rate of 0. 54% following Whipple surgery, with clinical findings lasting on average between 4-34 days. Surgery was the main form of therapy for this case, with a success rate of 84%, and percutaneous drainage was also utilized as a treatment option. This case report is the first to document endoscopic treatment of GJ leaks following the classic Whipple procedure.
Core Tip: Gastrojejunostomy leakage post-Whipple procedure, although rare, presents significant management challenges. This case highlights the successful endoscopic application of titanium clips to close leakage in a 71-year-old patient, marking a novel approach for treating such complications. Typically managed through surgery or percutaneous drainage with an 84% success rate, this report introduces endoscopy as a viable and less invasive option. Early intervention and adoption of such innovative techniques could potentially enhance recovery outcomes, emphasizing the importance of considering endoscopic treatment in similar clinical scenarios.
