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Case Reports
. 2020 Jun 24:56:121-124.
doi: 10.1016/j.amsu.2020.06.027. eCollection 2020 Aug.

BISHOP-KOOP modification technique following proximal jejunal anastomosis: A case report

Vicky S Budipramana  1 , Putu Ayu Saraswati  1
Affiliations
Case Reports

BISHOP-KOOP modification technique following proximal jejunal anastomosis: A case report

Vicky S Budipramana et al. Ann Med Surg (Lond). .

Abstract

Introduction: Very-short proximal jejunal stump anastomosis leak has been a major problem in surgery and it causes high postoperative morbidity and mortality. However, using a Bishop-Koop Modification technique anastomosis with decompression and nutrition tube, we can completely cure the patient with this case.

Presentation of case: A 61-year-old man came to the emergency room with generalized peritonitis and sepsis, on emergency laparotomy we found a perforation from solid tumor located in the proximal jejunum, 20 cm distal to ligament of Treitz. Free purulent exudate and diffuse inflammatory reaction of the peritoneum were also found in the abdominal cavity. We resected the jejunum together with the mass and anastomosis using Bishop-Koop technique with the decompression and nutrition tube. The patient completely recovered and left the hospital after a total stay of 30 days.

Discussion: Surgery-associated-anastomotic leak has been a major complication in performing anastomosis on the very-proximal jejunum especially in septic condition. The decompression after anastomosis is important, because of the high excretion of Brunner gland, bile, pancreas, duodenum, and jejunum juice and also the paralytic bowel condition in septic condition can make fluid accumulation in jejunum. It was impossible to decompress the anastomosis by performing an external jejunostomy because the proximal stump was too close to the ligament of Treitz. Using Bishop-Koop anastomosis technique, we were able to decompress the anastomosis and to give early nutrition using tubes at the same time.

Conclusion: Bishop-Koop anastomosis modification with decompression and nutrition tube is a safe procedure for anastomosing on the very-proximal jejunum.

Keywords: Bishop-koop anastomosis; Case report; Decompression; Nutrition tube; Proximal jejunum.

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Conflict of interest statement

None.

Figures

Fig. 1
Fig. 1
Operative diagram showing (A) Perforated GIST on proximal jejunum. (B) Short stump of proximal jejunum and the blind end of the distal part of jejunum after resection. (C) End-to-side anastomosis followed by decompression and nutrition tube (arrow).
See this image and copyright information in PMC

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