Total duodenal necrosis with retroperitoneal perforation in an adolescent with jejunal intussusceptions

Emergency pancreaticoduodenectomy for pancreatitis-associated necrotic perforation of the distal stomach and full-length duodenum: A case report

BACKGROUND

Non-ulcerative necrosis of the stomach and duodenum is rare because of the abundant blood supply in the gastrointestinal tract. Duodenal necrosis is a rare complication of severe acute pancreatitis. Emergency pancreaticoduodenectomy (EPD) is a rare procedure, with extensive duodenal necrosis being one of its indications.

CASE SUMMARY

We here report the case of a 57-year-old man who survived EPD for pancreatitis, which resulted in the necrosis of the distal stomach, full-length duodenum, and part of the jejunum.

CONCLUSION

Despite significant surgical risks, an EPD could be a life-saving procedure in severe cases of pancreatitis.

Near Complete Biliopancreatic Segment Necrosis: A Rare and Unknown Entity Observed After Roux-en-Y Gastric Bypass-A Case Report

BACKGROUND

Roux-en-Y gastric bypass is one of the common bariatric surgery procedures performed worldwide. Necrosis of the biliopancreatic or Roux limbs in the late period after RYGB is a rarely observed condition, the most common causes of which are postoperative adhesion, inflammatory entities, volvulus, intussusception, and internal herniations. The goal of surgical treatment is the removal of the necrotic segment and the reconstruction of biliopancreatic or gastric drainage.

CASE PRESENTATION

Here, we present a rare case in which a patient developed complete necrosis of the third and fourth segments of the duodenum and proximal jejunal limb in the postoperative seventh month after undergoing Roux-en-Y gastric bypass surgery.

DISCUSSION

Necrosis occurring after RYGB surgery often affects the Roux limb, though necrosis of the biliopancreatic limb is extremely rare. The goal of surgery is to remove the necrotic segment and reconstruct the drainage. An area of ischemia is often observed in the jejunum, while a large ischemic area was noted in the present case that encompassed the third and fourth parts of the duodenum.

CONCLUSION

Although in general necrosis of the Roux limb occurs due to volvulus, intussusception, or internal herniation following RYGB surgery, it must be taken into account that necrosis of the jejunal, duodenal, or complete biliopancreatic segment may occur in cases in which the underlying etiology cannot be exactly revealed.