Management of postgastrectomy duodenal leak

* Patients who present with diffuse peritonitis, intra-abdominal hemorrhage, major wound dehiscence, uncontrolled sepsis, clinical deterioration, or multiorgan failure/shock should undergo immediate surgical exploration.
¶ For empirical choices of antibiotics, refer to UpToDate topic on antimicrobial approach to intra-abdominal infections in adults.
Δ The following procedures augment the primary duodenal leak closure or control. With the exception of paraduodenal drain, they are performed selectively at the discretion of the surgeon; one or more paraduodenal drains is always placed. Refer to UpToDate topic for details of each procedure.