Perforated duodenal diverticulum: Surgical treatment and literature review

Abstract

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.

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.…”

Ileus Caused by Large Diverticulum of Postbulbar Duodenum: Case Report

“…Duodenal diverticula are the most common acquired diverticula of the small bowel, and Meckel's divericulum is the most common true congenital diverticulum of the small bowel. Duodenal diverticula represent the second most common site for diverticulum formation after the colon [1] [6]- [8]. They occur twice as often in women as in men and are rare in patients younger than age 40.…”

“…The overwhelming majority of duodenal diverticula are asymptomatic and are usually noted incidentally by an upper gastrointestinal series [5] [9]. Complications are rare and perforation was only reported in less than 200 cases [6]. Diagnosis may also be obtained by upper gastrointestinal endoscopy.…”

“…These symptoms may vary regarding the site and duration of obstruction. Nausea and vomiting are more common with a higher obstruction and may be the only symptoms in patients with high intestinal obstruction [1] [6].…”

“…Usually most common complication described was perforation when segmental duodenectomy was performed. Other complications mentioned were gastrointestinal bleeding, intractable pain, biliary or pancreatic obstruction and gastrointestinal obstruction [1] [6]. In most papers, authors concluded that operative treatment of duodenal diverticula is safe but should be reserved for those with emergent presentations [2] [6] [8] [10].…”