Key Clinical MessageRetroperitoneal perforation of duodenal diverticula around the papilla of Vater is relatively rare. In this report, we describe retroperitoneal abscess, which was successfully treated by endoscopic drainage. Thus, endoscopic approach for retroperitoneal perforation caused by diverticulum is one of the treatment options in addition to surgery.

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A57-year-oldmanwasreferredtoourhospitalafteranabdominalmasswasidentifiedbyultrasound scanningduringahealthcheckup.Upperandlowergastrointestinalendoscopyexaminationswereboth unremarkable. Contrast-enhanced computed tomography (CT) showed an irregular, 5-cm mass in the mesentericregionoftherightlowerabdomenthatwasdenselystainedfromtheearlycontrastphase,togetherwithfaintlycontrasted,thickenedperitoneumattheliversurface,nearthebilateraliliacarteries, andaroundtherectum.PositronemissiontomographyCT(PET-CT)showedabnormalfluorodeoxyglucose(FDG)uptakeatthesesites.Peritonealdisseminationofanunknownprimarycancerorperitoneal mesotheliomawassuspected,anddiagnosticlaparoscopyandtumorbiopsywereconductedtoreachadefinitive diagnosis. Detailed inspection of the entire peritoneal cavity showed numerous white peritoneal nodules,bothsolitaryandinclusters,rangingfromtherangingfromaround1mmto10mm.Themass intherightlowerabdomenwaspalereddishwhite,firmrubbery,andcontinuouswiththegreateromentum.Thismasswasresectedanddiagnosedasepithelialmalignantmesotheliomaonhistopathologicalexamination.ThepatientwasdischargedwithoutcomplicationsonpostoperativeDay2andreferredtoan oncologist.ThepathologicaldiagnosiswasconfirmedonpostoperativeDay13,andthepatientwasstarted ontherapywithpemetrexedsodiumhydrateandplatinumonpostoperativeDay23.