Perforated Duodenal Diverticulitis: A Case Report of a Rare Surgical Entity Treated by Roux-en-Y Deriving Intestinal Patch

Abstract

Perforated diverticulitis is a rare but serious complication associated with a significant mortality rate. Although many cases of conservative treatment have been reported, surgery remains the mainstay for perforated duodenal diverticulitis.We report a rare case of a 55-year-old female who presented with epigastric pain without fever. Computed tomography revealed a 3 cm perforated duodenal diverticulum of the D2 part of the duodenum with a localized abscess. After the failure of conservative treatment, we performed a deriving intestinal patch completed by cholecystectomy and biliary decompression via a transcystic drain, as well as feeding jejunostomy. The patient was discharged on day 32. Removal of the transcystic drainage at eight weeks postoperatively was complicated by the appearance of an iatrogenic bilioperitoneum, which was effectively treated with percutaneous drainage. Surgery remains challenging; our experience suggests that perforation covering with a deriving jejunal patch offers an alternative to direct beach suturing when the latter is deemed precarious. Part of the treatment success lies in local drainage and duodenal exclusion that can be achieved by various surgical approaches.

Duodenal Diverticular Perforation Treated Conservatively: Reassessing Indications for Treatment

“…If the symptoms of DDP do not improve after 24 h, surgery may become necessary. Evangelos et al reported a recurrence of perforation on day 15 after the onset despite follow-up CT on day 4 of hospitalization showing no indications of a possible relapse ( 8 ). Kapp et al reported that surgery setup required 48 to 72 h ( 9 ).…”

Addressing recurrent hypoglycaemia through thoracic surgical intervention: understanding Doege-Potter syndrome, a rarity in syndromes

“…In addition to DPS, it is noteworthy to mention Pierre Marie-Bamberger syndrome (PMBS), which can accompany some patients with SFTs [ 28 ]. PMBS, also known as clubbing-osteogenic hypertrophy of the ends of the fingers, is characterised by the enlargement of the fingertips, clubbing of the fingers, and hypertrophic osteoarthropathy [ 28 , 29 ]. While not exclusive to SFTs, PMBS has been reported in association with SFTs, particularly those located in the pleura.…”

“…The exact mechanisms underlying the development of Pierre PMBS in the context of SFTs remain incompletely understood, but it is believed to be related to the release of various growth factors and cytokines by the tumour. Recognition of PMBS in patients with SFTs is important for comprehensive clinical assessment and management [ 29 , 30 ].…”