PMC5699878_01
Drawing of the anatomical and technical situation after transstomal EndoVAC  implementation. (A - transstomal EndoVAC  sponge at the duodenal perforation; B - transstomal EndoVAC ; C - jejunofix catheter; D - double-barreled jejunal stoma; E - surgical drain; F - t-duct drain of the common bile duct).
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Simultaneously, cholecystectomy with t-duct drainage of the common bile duct in order to deviate bile flow was performed (Fig. 1).
A: Transstomal EndoVAC  installation (black arrows). The tip of the sponge is placed beside the leak, where a small mesenteric abscess occurred (red arrows). B: 21 day later the mesenteric abscess decreased about 50% (red arrows). C: CT-scan 2 weeks after termination of EndoVAC  therapy the mesenteric fluid collection nearly disappeared (red arrows). D: After six weeks during the transluminal contrast agent application no leak was found. 1. Pyloric antrum, 2. Pyloric canal, 3. Duodenal bulb, 4. Duodenum pars II; Black arrows: biliary drainage; red arrows: previous leakage position. E: Endoluminal view of the duodenal perforation. Behind the duodenal wall, a surgical drain is visible (black arrow). F: Endoluminal view of the closed duodenal perforation. Black arrows marking the border between normal duodenal mucosa a scar tissue. A small piece of transparent suture is visible (red arrows).
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The tip of the sponge was placed beside the leak where a small mesenteric abscess occurred (Fig. 2A). Twenty-one days later, the mesenteric abscess decreased about 50% (Fig. 2B). In addition, a CT-scan two weeks after termination of EndoVAC  therapy showed that the mesenteric fluid collection nearly disappeared (Fig. 2C).