INTRODUCTIONDuodenum is the second most frequent location for a diverticulum in the digestive tract. Complications are rare and perforation was only reported in less than 200 cases.PRESENTATION OF CASEA 79-year-old female was admitted to Emergency Department with abdominal pain and vomiting for the last 24 h. A CT scan was performed and moderated extra-luminal air was identified. During surgery a fourth portion perforated duodenal diverticulum was diagnosed and duodenal resection was performed.DISCUSSIONFirst reported in 1710, the incidence of duodenal diverticula can be as high as 22%. Nevertheless complications are extremely rare and include haemorrhage, inflammation, compression of surrounding organs, neoplastic progression, cholestasis and perforation.As perforations are often retroperitoneal, symptoms are nonspecific and rarely include peritoneal irritation, making clinical diagnose a challenge.CT scan will usually present extra-luminal retroperitoneal air and mesenteric fat stranding, providing clues for the diagnosis.Although non-operative treatment has been reported in selected patients, standard treatment is surgery and alternatives are diverse including diverticulectomy or duodenopancreatectomy.CONCLUSIONPerforated diverticula of the fourth portion of the duodenum are extremely rare and current evidence still supports surgery as the primary treatment modality.
Meckel's diverticulum is the commonest congenital abnormality of the gastrointestinal tract. Most cases are asymptomatic and only incidentally found. Its perforation by a foreign body is an extremely rare event. A 53-year-old female presented to Emergency Department with abdominal pain on the right iliac fossa and vomiting. CT scan was performed and showed an intestinal perforation by a foreign body. Diagnostic laparoscopy identified a perforation of a Meckel's diverticulum by a fish bone and a laparoscopic stapled diverticulectomy was performed. Meckel's diverticulum complications are more common in childhood, usually as bleeding. In adults, intestinal obstruction and inflammation are the usual manifestations. Although most swallowed foreign bodies are harmless, in a small number of cases perforation may occur. Preoperative diagnosis of complicated Meckel´s diverticulum is challenging and can often mimic other more common conditions. Laparoscopy is a valuable tool for the diagnosis and treatment of complicated Meckel’s diverticulum.
Abdominal pain in a pregnant woman with a history of laparoscopic Roux-en-Y gastric bypass (LRYGB) in the emergency department is challenging. Intussusception is a rare cause of small bowel obstruction after LRYGB and can lead to intestinal necrosis, perforation, sepsis and death. The authors report a case of a 34-week pregnant patient, previously submitted to LRYGB, presenting to the emergency department with abdominal pain and vomiting. A computed tomography scan suggested the presence of ileoileal intussusception. So, an emergent laparotomy was performed with invagination reduction. The postoperative period was uneventful, as well as pregnancy and caesarian performed 4 weeks after surgery. At the 45-month follow-up, there was no recurrence of intussusception.
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