Endoscopic Management of a Chronic Anastomotic Leak after a Billroth II Procedure.

We report the case of a 56-year-old woman with a pertinent past medical history of chronic pancreatitis and peptic ulcer disease, who initially presented with a perforated posterior duodenal ulcer following a Billroth II procedure, which was complicated by a duodenal stump abscess and purulent free fluid in the pelvis. The patient subsequently underwent a computed tomography (CT) scan of the abdomen, which revealed extraluminal contrast extravasation within the left upper quadrant, raising concern of an anastomotic leak ([Fig. 1]). The patient subsequently underwent upper gastrointestinal endoscopy with argon plasma coagulation (APC) and full-thickness endoscopic suturing, with placement of a nasojejunal tube (NJT) in the efferent jejunal limb ([Fig. 2]; [Video 1]). An upper gastrointestinal series was performed the next day, which showed no evidence of residual leakage ([Fig. 3]). The patient was discharged with instructions to remain nil by mouth, and an NJT for tube feeding, along with oral antibiotics. Subsequently, she was started on an oral diet and tolerated this without any complications. At follow-up, 3 months after the procedure, the patient was tolerating solid food well.