TY - JOUR T1 - Enterolith-induced duodenal stump perforation: rare remote complication of surgery for PUD JF - Trauma Surgery & Acute Care Open JO - Trauma Surg Acute Care Open DO - 10.1136/tsaco-2019-000360 VL - 4 IS - 1 SP - e000360 AU - Amanda Chelednik AU - Mary Street AU - JoEdd Biggs AU - Stephen Barnes Y1 - 2019/08/01 UR - http://tsaco.bmj.com/content/4/1/e000360.abstract N2 - Duodenal stump blowout is a feared complication of Billroth II reconstruction after gastrectomy. Most commonly presenting in the early postoperative period, there is significant variation in the surgical management of the difficult duodenal stump due to complexity. Here, we report a highly unusual case of a delayed duodenal stump perforation secondary to a golf-ball sized enterolith without evidence of a cholecystoenteric fistula or afferent loop obstruction in a patient with a remote history of distal gastrectomy with Billroth II reconstruction. An 84-year-old man status post vagotomy and antrectomy with Billroth II reconstruction for peptic ulcer disease (PUD) 40 years ago presented with the acute onset of abdominal pain of 6 hours duration. The patient had focal peritonitis in the right upper quadrant (RUQ), hypoxia requiring 3 L of oxygen by nasal cannula and tachycardia with heart rate of 100 beats per minute. Laboratory findings were significant for a leukocytosis of 14 820/µL and metabolic acidosis. A CT scan demonstrated free air around the duodenal stump … ER -