Perforated Duodenal Diverticulitis: A Report of Three Cases

Miller, George; Mueller, Catherine; Yim, Duke; Macari, Michael; Liang, Howard; Marcus, Stuart G.; Shamamian, Peter

doi:10.1159/000087974

Cited by 45 publications

(36 citation statements)

References 20 publications

(21 reference statements)

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“…However, when a patient presents with mild abdominal symptoms without evidence of impending sepsis, nonoperative management, including bowel rest, intravenous hydration or total parenteral nutrition, and broad-spectrum antibiotics may be sufficient. 9 We performed enteroscopy directly in our case, because the symptoms were aggravated and focal inflammation of the duodenum was noted on the abdominal CT. However, as the endoscopic procedure may cause a catastrophic perforation through a very weak bowel wall due to inflammation, it was performed very carefully with gentle maneuvers and minimal air insufflation.…”

Section: Discussionmentioning

confidence: 98%

“…3 This is most commonly caused by ulcerations, hemorrhage, obstruction of the duodenum or the common bile duct, pancreatitis, fistula formation, malignant degeneration, diverticulitis, or a perforation of the retroperitoneum. 9 Duodenal diverticulitis is very rare because of the large size of the duodenum and the fluent intraluminal flow of relatively sterile, liquid duodenal contents. 1 Duodenal diverticulitis can be caused by stasis of contents, particularly when the diverticular neck is small, which limits efflux of the intraluminal contents from the diverticulum.…”

Section: Discussionmentioning

confidence: 99%

“…Stasis causes a perforation of the diverticulum in nearly 60% of patients. 6,9 Other reported predisposing factors include the presence of foreign bodies, gallstones or enterolithiasis, ulcerations within the diverticulum, blunt trauma, or ingestion of carbonated beverages. 9 A perforation rarely arises from a complication of duodenal diverticulitis.…”

Section: Discussionmentioning

confidence: 99%

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Duodenal Diverticulitis Due to Impacted Foreign Body: Enteroscopic Diagnosis and Treatment

Kang

Cho

et al. 2011

Intest Res

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Duodenal diverticulitis is a rare complication of the duodenal diverticulum. Its rarity is due to the relatively large diameter of the duodenum, which makes the intraluminal flow of sterile liquid duodenal contents fluent. Additionally, nonspecific signs and symptoms of duodenal diverticulitis make it very difficult to diagnose properly. We describe a patient presenting with abdominal pain, nausea, and leukocytosis, with diverticulitis of the third portion of the duodenum caused by the impaction of a foreign body, who was diagnosed and treated with enteroscopy.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Duodenal Diverticulitis Due to Impacted Foreign Body: Enteroscopic Diagnosis and Treatment

Kang

Cho

et al. 2011

Intest Res

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“…Miller et al recommended diversion of gastric and biliary flow away from the duodenum [13]. This can be accomplished by stapling or suturing, closing the distal pyloric channel, decompression of the biliary tree with an externally draining common bile duct T-tube, and the creation of an externalized tube duodenostomy.…”

Section: Discussionmentioning

confidence: 99%

Naujas perforavusio dvylikapirštės žarnos divertikulo gydymas atliekant Roux-en-Y duodenojejunostomiją

Šileikis¹,

Šileikytė²

2017

LietChirur

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Duodenum diverticulum is the most common site for diverticular disease of small intestine. Symptomatic duodenal diverticulum are 1% to 5%, which present with pain, bleeding, inflammation, cholestasis, cholangitis, obstruction, perforation, pancreatitis, or malignant transformation. The most difficult complication is perforation -0.03%. Once duodenal diverticulitis perforation has been diagnosed, traditional management has been simple diverticulectomy and two layer closure of the duodenum with drainage of the retroperitoneum. However, nowadays there is increase in case reports of successful conservative and different surgical treatment. We present our experience by treating duodenal diverticulitis with simple diversion by Roux-en-Y duodenojejunostomy according to Shigeru Fujisaki after unsuccessful conservative treatment. Key words: duodenum diverticulitis, perforation, treatment Dvylikapirštės žarnos divertikulai yra dažniausia divertikuliozės vieta plonojoje žarnoje. Nuo 1 % iki 5 % tokių divertikulų yra simptominiai ir pasireiškia skausmu, kraujavimu, uždegimu, cholestaze, cholangitu, obstrukcija, perforacija, pankreatitu ar piktybine transformacija. Pati sudėtingiausia komplikacija yra perforacija, kuri sudaro 0,03 %. Diagnozavus dvylikapirštės žarnos divertikulo perforaciją, tradicinis gydymas buvo paprasta divertikulektomija ir dvylikapirštės žarnos užsiuvimas dviem sluoksniais su retroperitoninio tarpo drenavimu. Pastaruoju metu aprašoma vis daugiau sėkmingų konservatyvaus ir kitokio chirurginio gydymo atvejų. Mes aprašome savo patirtį, susijusią su dvylikapirštės žarnos divertikulito gydymu atliekant Roux-en-Y duodenojejunostomiją Shigeru Fujisaki metodu po nesėkmingo konservatyvaus gydymo. Reikšminiai žodžiai: dvylikapirštės žarnos divertikultas, perforacija, gydymas 194

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“…Helical computed tomography (CT) has emerged as a useful diagnostic tool and most centers now use CT routinely to confirm the diagnosis. Yet surgical exploration in unstable and septic patients is still considered mandatory, especially if the diagnosis is not clear [13,14] . The appropriate surgical management remains under debate.…”

Section: Introductionmentioning

confidence: 99%

Perforated duodenal diverticulum, a rare complication of a common pathology: A seven-patient case series

Rossetti

Buchs²,

Bucher³

et al. 2013

WJGS

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Duodenal diverticula (DD) are frequently encountered and are usually asymptomatic, with an incidence at autopsy of 22%. Perforation of DD is a rare complication (around 160 cases reported) with potentially dramatic consequences. However, little evidence regarding its treatment is available in the literature. The aim of this study was to review our experience of perforated DD, with a focus on surgical management. Between January 2001 and June 2011, all perforated DD were retrospectively reviewed at a single centre. Seven cases (5 women and 2 men; median age: 72.4 years old, rang: 48-91 years) were found. The median American Society of Anesthesiologists' score in this population was 3 (range: 3-4). The perforation was located in the second portion of duodenum (D2) in six patients and in the third portion (D3) in one patient. Six of these patients were treated surgically: five patients underwent DD resection with direct closure and one was treated by surgical drainage and laparostomy. One patient was treated conservatively. One patient died and one patient presented a leak that was successfully treated conservatively. The median hospital stay was 21.1 d (range: 15-30 d). Perforated DD is an uncommon presentation of a common pathology. Diverticular excision with direct closure seems to offer the best chance of survival and was associated with a low morbidity, even in fragile patients.

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Perforated Duodenal Diverticulitis: A Report of Three Cases

Cited by 45 publications

References 20 publications

Duodenal Diverticulitis Due to Impacted Foreign Body: Enteroscopic Diagnosis and Treatment

Duodenal Diverticulitis Due to Impacted Foreign Body: Enteroscopic Diagnosis and Treatment

Naujas perforavusio dvylikapirštės žarnos divertikulo gydymas atliekant Roux-en-Y duodenojejunostomiją

Perforated duodenal diverticulum, a rare complication of a common pathology: A seven-patient case series

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