A systematic review of the perforated duodenal diverticula: lessons learned from the last decade

Abstract

Background The perforated duodenal diverticulum remains a rare clinical entity, the optimal management of which has not been well established. Historically, primary surgery has been the preferred treatment modality. This was called into question during the last decade, with the successful application of non-operative therapy in selected patients. The aim of this systematic review is to identify cases of perforated duodenal diverticula published over the past decade and to assess any subsequent evolution in treatment. Methods A systematic review of English and non-English articles reporting on perforated duodenal diverticula using MEDLINE (2008–2020) was performed. Only cases of perforated duodenal diverticula in adults (> 18 years) that reported on diagnosis and treatment were included. Results Some 328 studies were identified, of which 31 articles met the inclusion criteria. These studies included a total of 47 patients with perforated duodenal diverticula. This series suggests a trend towards conservative management with 34% (16/47) of patients managed non-operatively. In 31% (5/16) patients initially managed conservatively, a step-up approach to surgical intervention was required. Conclusion Conservative treatment of perforated duodenal diverticula appears to be an acceptable and safe treatment strategy in stable patients without signs of peritonitis under careful observation. For patients who fail to respond to conservative treatment, a step-up approach to percutaneous drainage or surgery can be applied. If surgery is required, competence in techniques ranging from simple diverticulectomy to Roux-en-Y gastric diversion or even Whipple’s procedure may be required depending on tissue friability and diverticular collar size.

An Uncommon Case of Intraluminal Duodenal Diverticulum Complicated by Recurrent Gastrointestinal Bleeding and Small Bowel Obstruction

“…A fearful complication of the untraversable duodenal diverticulum is bowel perforation. Duodenal perforation reported as often as 78% are seen within the second portion of the duodenum, within 2 cm from the ampulla of Vater [19,20]. Although, it is exceedingly rare with a total sum of 11 cases described in the literature as of 2012 [20].…”

“…Duodenal perforation reported as often as 78% are seen within the second portion of the duodenum, within 2 cm from the ampulla of Vater [19,20]. Although, it is exceedingly rare with a total sum of 11 cases described in the literature as of 2012 [20]. The most common causes of perforation are diverticulitis 62%, followed by enterolithiasis (~10%) and ulceration [20].…”

“…Although, it is exceedingly rare with a total sum of 11 cases described in the literature as of 2012 [20]. The most common causes of perforation are diverticulitis 62%, followed by enterolithiasis (~10%) and ulceration [20]. Treatment is based on the patient's clinical condition and hemodynamical stability whether pursuing conservative versus surgical interventions.…”

“…Treatment is based on the patient's clinical condition and hemodynamical stability whether pursuing conservative versus surgical interventions. Conservative treatment of perforated duodenal diverticula is an acceptable and safe strategy in stable patients without signs of peritonitis [20]. A step-up approach to percutaneous drainage or surgery can be applied if conservative management fails [19,20].…”

“…Conservative treatment of perforated duodenal diverticula is an acceptable and safe strategy in stable patients without signs of peritonitis [20]. A step-up approach to percutaneous drainage or surgery can be applied if conservative management fails [19,20].…”