The challenging diagnosis and treatment of duodenal diverticulum perforation: a report of two cases

Moysidis, Moysis; Paramythiotis, Daniel; Karakatsanis, Anestis; Amanatidou, Evropi; Psoma, Elisavet; Mavropoulou, Xanthippi; Michalopoulos, Antonios

doi:10.1186/s12876-019-1154-2

Cited by 25 publications

(21 citation statements)

References 11 publications

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“…Based on our search on PubMed (2013-present), there have been 29 reports of non-traumatic, noniatrogenic DDP (Table 1) [11,[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32]. Including our case, the location of DDP was at D2 in 20 cases (67%) and D3 in six cases (20%).…”

Section: Discussionmentioning

confidence: 83%

Perforated Duodenal Diverticulum With Postoperative Diverticulum Bleeding Successfully Treated Using Transcatheter Arterial Embolization

Tomida

Nakagawa

Matsumura

et al. 2021

Cureus

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A diverticulum is a relatively common finding that is generally discovered incidentally; it is most commonly observed in the colon, followed by the duodenum. However, duodenal diverticulum perforation (DDP) is a rare complication. Due to its rarity, its diagnosis is often challenging and the appropriate treatment remains unclear, possibly contributing to its high mortality rate. Traditionally, surgical repair is the primary mode of treatment. However, with the recent advancements in medical technology, conservative management such as bowel rest and endoscopic drainage help successfully manage DDP. Duodenal diverticulum bleeding (DDB) is a rare cause of upper gastrointestinal bleeding. While endoscopic, angiographical, and surgical treatments have been performed to achieve hemostasis, there is no consensus regarding the optimal treatment for DDB. We describe a case of a perforated duodenal diverticulum (DD) with postoperative diverticulum bleeding. Our patient, an elderly female, complained of abdominal pain. Computed tomography images revealed free air in the retroperitoneum, and gastrointestinal perforation was suspected. During the emergency surgery, a perforated DD was detected in the third portion of the duodenum. Due to severe inflammation, diverticulectomy was not performed as it was deemed risky. Instead, we directly sutured the orifice using an omental patch. Duodenal leakage was observed from postoperative day (POD) 3 with bleeding from the remnant DD occurred on PODs 6 and 13. An attempt at endoscopic hemostasis failed, but transcatheter arterial embolization (TAE) was successfully performed. The postoperative course was complicated, and the patient died on POD 54. To the best of our knowledge, this is the first report on DD perforation with postoperative DDB. The remnant DD may be damaged by the digestive juices and result in bleeding. Precautionary measures for duodenal leakage should be undertaken when the DD is unresectable. Additionally, TAE is effective for postoperative DDB.

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Section: Discussionmentioning

confidence: 83%

Perforated Duodenal Diverticulum With Postoperative Diverticulum Bleeding Successfully Treated Using Transcatheter Arterial Embolization

Tomida

Nakagawa

Matsumura

et al. 2021

Cureus

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“…4 ). Duodenal diverticulum is commonly an incidental diagnosis demonstrated during ERCP, and its presence in the duodenum is similarly associated with bleeding, infection, biliary obstruction and perforation [ 8 , 9 ]. The adjacent diverticulum may interfere with the normal emptying mechanism of the ductal systems, predisposing patients to biliary obstruction and stent migration.…”

Section: Discussionmentioning

confidence: 99%

Duodenal diverticulum at the site of the major papilla may be a risk factor for biliary stent migration

Morosin

Robles

Still

2021

Journal of Surgical Case Reports

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Stent migration is a well-documented complication following biliary stent insertion. The majority of cases demonstrate passage through the bowel without incident; however, migration may also result in complications, including bowel obstruction or perforation requiring urgent intervention. Risk factors for stent migration comprise of disease pathology as well as stent characteristics including dimension, material and number. Although duodenal diverticulae has been noted as a risk factor for duodenal perforation or obstruction post stent migration, it has yet to be implicated as a contributor to migration itself. Here, we present an unusual case of ileal obstruction secondary to biliary stent impaction, in which the presence of a duodenal diverticulum may be considered a viable risk factor for stent migration.

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“…Some patients may complain of back pain, especially if the perforation is retroperitoneal. Other symptoms will be fever, nausea, and vomiting [15]. CT is effective for the diagnosis showing extraluminal gas and extraluminal fluid, and it is the most useful modality in the diagnosis of a perforated duodenal diverticulum [15].…”

Section: Discussionmentioning

confidence: 99%

“…Eeckhout et al reported the endoscopic approach to the abdominal abscess due to a perforated duodenal diverticulum [8]. To date, there are only few reports of endoscopic treatment selected for perforated duodenal diverticula [15].…”

Section: Discussionmentioning

confidence: 99%

Perforated duodenal diverticulum successfully treated with a combination of surgical drainage and endoscopic nasobiliary and nasopancreatic drainage: a case report

et al. 2020

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Background: Perforation of a duodenal diverticulum is a rare complication that may become fatal with a delay in appropriate treatment. However, the optimal treatment for perforated duodenal diverticulum remains controversial, ranging from conservative therapy to surgery including pancreatoduodenectomy. Case presentation: The patient was a 60-year-old woman with no particular medical history who visited our hospital with chief complaints of continuous fever and right dorsal pain. Upon arrival, she had tenderness in the right upper quadrant of the abdomen. Laboratory data showed the elevation of inflammatory markers. Computed tomography revealed free air with abscess formation around the duodenum, which was diagnosed as duodenal perforation with abdominal abscess. We decided on emergent surgery, and we identified the perforation site on the dorsal side of the second portion of the duodenum intraoperatively. However, the inflammation around the perforation site was severe, and it was difficult to perform primary closure or dissection of the perforated diverticulum. Therefore, we finished surgery by placing four indwelling intra-abdominal tubes. Since postoperative day (POD) 1, the elevation of inflammation markers appeared to be uncontrollable, owing to the leakage of bile and pancreatic juice. We decided to perform endoscopic retrograde cholangiopancreatography on POD 2, and inserted endoscopic nasobiliary drainage and nasopancreatic drainage tubes. The patient showed a good postoperative course and was discharged on POD 57. Conclusions: Endoscopic nasobiliary and nasopancreatic drainage in combination with surgical drainage may be an effective treatment for perforated duodenal diverticulum.

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The challenging diagnosis and treatment of duodenal diverticulum perforation: a report of two cases

Cited by 25 publications

References 11 publications

Perforated Duodenal Diverticulum With Postoperative Diverticulum Bleeding Successfully Treated Using Transcatheter Arterial Embolization

Perforated Duodenal Diverticulum With Postoperative Diverticulum Bleeding Successfully Treated Using Transcatheter Arterial Embolization

Duodenal diverticulum at the site of the major papilla may be a risk factor for biliary stent migration

Perforated duodenal diverticulum successfully treated with a combination of surgical drainage and endoscopic nasobiliary and nasopancreatic drainage: a case report

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