PMC4334954_01
Original anatomy. I - First duodenal portion. II - Second duodenal portion. III - Third duodenal portion. IV - Fourth duodenal portion. SMV - Superior mesenteric vein. SMA - Superior mesenteric artery. TREITZ - Ligament of Treitz.. The figure represented the diverticula of the first 70 cm of the jeunum and some linear cuts of the fourth duodenal portion which were the bleeding source.
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The abdomen was then temporarily closed without any attempt to immediate reconstruction to reduce surgery time as much as possible, minimize hypothermia and treat hypovolemia, acidosis, and coagulopathy. The macroscopic examination of the specimens did not show any sign of bleeding from the diverticula, but the fourth duodenal portion showed several profound linear cuts with fresh bleeding signs and clots. (Fig. 1) These peculiarities were confirmed by histopathological examination.
Schematic drawing of the nasojejunal tube for dreinage and feeding and of side-to-side jejunum-duodenal reconstruction.
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Two days later a side-to-side duodeno-jejunal anastomosis was performed, and a double lumen naso-jejunal tube was inserted through the anastomosis for decompression and feeding (Fig. 2).