A common feature of external duodenal fistulae is the devastating effect of the duodenal content rich in bile and pancreatic juice on nearby tissues with therapy-resistant local and systemic complications. This study analyzes the results of different management options with emphasis on successful fistula closure rates. A retrospective single academic center study of adult patients treated for complex duodenal fistulas over a 17-year period with descriptive and univariate analyses was performed. Fifty patients were identified. First line treatment was surgical in 38 (76%) cases and consisted of resuture or resection with anastomosis combined with duodenal decompression and periduodenal drainage in 36 cases, rectus muscle patch, and surgical decompression with T-tube in one each. Fistula closure rate was 29/38 (76%). In 12 cases, the initial management was nonoperative with or without percutaneous drainage. The fistula was closed without surgery in 5/6 patients (1 patient died with persistent fistula). Among the remaining 6 patients eventually operated, fistula closure was achieved in 4 cases. There was no difference in successful fistula closure rates among initially operatively versus nonoperatively managed patients (29/38 vs. 9/12, p = 1.000). However, when considering eventually failed nonoperative management in 7/12 patients, there was a significant difference in the fistula closure rate (29/38 vs. 5/12, p = 0.036). The overall in-hospital mortality rate was 20/50 (40%). Surgical closure combined with duodenal decompression in complex duodenal leaks offers the best chance of successful outcome. In selected cases, nonoperative management can be tried, accepting that some patients may require surgery later.

中文翻译：

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复杂十二指肠瘘：手术噩梦

十二指肠外瘘的一个共同特征是富含胆汁和胰液的十二指肠内容物对附近组织造成破坏性影响，并产生难以治疗的局部和全身并发症。本研究分析了不同治疗方案的结果，重点关注瘘管成功闭合率。对 17 年来接受复杂十二指肠瘘治疗的成年患者进行了一项回顾性单一学术中心研究，并进行了描述性和单变量分析。已确定 50 名患者。一线治疗为手术38例（76%），其中36例为重新缝合或切除吻合联合十二指肠减压及十二指肠周围引流，直肌补片和T形管手术减压各1例。瘘管闭合率为 29/38 (76%)。在12个案例中，最初的治疗是非手术治疗，有或没有经皮引流。5/6 的患者无需手术即可闭合瘘管（1 名患者因持续性瘘管死亡）。其余6例患者最终手术，4例实现瘘管闭合。最初手术治疗的患者与非手术治疗的患者之间，瘘管成功闭合率没有差异（29/38 vs. 9/12，p = 1.000）。然而，当考虑到 7/12 例患者的非手术治疗最终失败时，瘘管闭合率存在显着差异（29/38 vs. 5/12，p = 0.036）。总体院内死亡率为 20/50 (40%)。对于复杂的十二指肠漏，手术闭合结合十二指肠减压提供了获得成功的最佳机会。在某些情况下，可以尝试非手术治疗，