Conservative management of perforated duodenal diverticulum: A case report and review of the literature

Abstract

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.

Perforated Duodenal Diverticulum

“…Standard treatment for perforated diverticula is surgical intervention. Diverticulectomy with single or double layer closure is the most frequent reported alternative if inflammation permits [7]. As in our case diverticulectomy with double layer closure achieved good results.…”

“…It can even demonstrate the presence of a diverticulum in some cases. Typical radiological findings include thickened bowel wall, fat stranding and extra-luminal air or fluid [5,7]. In patients with no evidence of impending sepsis, non-operative treatment for perforated diverticula is safe and a practical alternative to surgery.…”

“…In patients with no evidence of impending sepsis, non-operative treatment for perforated diverticula is safe and a practical alternative to surgery. Treatment in such cases includes nasogastric suction, bowel rest, intravenous antibiotic therapy, parenteral nutrition, endoscopic cleaning of the infected pouch and combined endoscopic and percutaneous drainage of retroperitoneal abscess [7,8]. Close clinical observation is mandatory and surgical intervention is indicated if conservative management fails.…”

Retroperitoneal perforation arising from duodenal diverticulum treated by endoscopic drainage: a case report

“…In addition, these cases took longer time to achieve postoperative cure. Alternatively, there are several literatures describing that conservative therapy utilizing antimicrobial agents, antacids, nil per oral, and parenteral nutrition was effective to cure perforated duodenal diverticulum 5, 6, 10. It should be noted that there has been reports of death, and therefore, surgical treatment in a timely manner is crucial 5, 11, 12.…”

Giant Duodenum Diverticula: A Case Report

“…Komplikasyonlardan en s›k görülenleri pankreatit, perforasyon, divertikülit, safra yolu t›kan›kl›¤› ve kanamad›r. 7 Duodenumun anatomik yerleflimi nedeni ile komplikasyonlara tan› konabilmesi de güç olmaktad›r. Duodenum divertiküllerinin di¤er divertiküllere göre daha az semptom vermesi; komplikasyon geliflti¤inde yerleflim yeri aç›s›ndan daha geç tan›nabilmesi; üçüncü ve dördüncü k›s›mdaki duodenal divertiküllerin tan›s›nda endoskopinin yetersiz kalmas› nedeni ile GIS semptomlar› olan hastalar›n ay›r›c› tan›s›nda duodenumun divertiküler hastal›¤› göz önünde bulundurulmal›d›r.…”