Endoscopic rendez-vous after damage control surgery in treatment of retroperitoneal abscess from perforated duodenal diverticulum: a techinal note and literature review

Abstract

IntroductionThe duodenum is the second seat of onset of diverticula after the colon. Duodenal diverticulosis is usually asymptomatic, but duodenal perforation with abscess may occur.Case presentationWoman, 83 years old, emergency hospitalised for generalized abdominal pain. On the abdominal tomography in the third portion of the duodenum a herniation and a concomitant full-thickness breach of the visceral wall was detected. The patient underwent emergency surgery. A surgical toilette of abscess was performed passing through the perforated diverticula and the Petzer’s tube drainage was placed in the duodenal lumen; the duodenostomic Petzer was endoscopically removed 4 months after the surgery.DiscussionA review of medical literature was performed and our treatment has never been described.ConclusionFor the treatment of perforated duodenal diverticula a sequential two-stage non resective approach is safe and feasible in selected cases.

Indications and benefits of intraoperative esophagogastroduodenoscopy.

“…Further IOG indications may include assistance in Heller myotomy for achalasia [ 78 – 80 ], volvulus of the stomach [ 81 ], duodenal diverticula [ 82 ], intraoperative foreign body extraction [ 83 ] and rare causes of bleeding [ 84 , 85 ]. Pediatric indications are targeted in a more distinct way to inherited pathologies [ 1 , 86 ].…”

An innovative method of surgical excision of duodenal diverticulum in a 17-year-old girl

“…It was also noted that some DD caused secondary acute pancreatitis with the typical clinical presentation of the disease [4][5][6]. Complications of duodenal diverticula are rare, but they can be severe [2][3][4][5]. Around 5% of patients with DD have to be treated surgically due to the complications presented above.…”

“…Duodenal diverticula (DD) are the out-pouchings of the duodenal wall and can be found at any point of it; nevertheless, 90% of the diverticula occur in the second part of the duodenum. DD represent the second most common diverticula affecting the alimentary tract [1,2]. They appear in up to 23% of the population; however, recent studies have shown that approximately 90% of them are asymptomatic.…”

Laparoscopic resection of perforated duodenal diverticulum – A case report and literature review

“…On the other hand, we reviewed nine studies [2] , [3] , [4] , [5] , [25] , [26] , [27] , [28] , [29] published (the largest study is Chad et al) [4] combined with the one at our institution for a total of 83 perforated duodenal diverticulum patients from 1989 to 2016.…”

“…Treatment method and result data in the most original series of perforated duodenal diverticulum were analyzed [2] , [3] , [4] , [5] , [20] , [21] , [25] , [26] , [27] , [28] , [29] ( Table 2 ).…”