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

Abstract

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.

Conservative treatment of duodenal diverticulitis perforation: A case report and literature review

“…Therefore, a patient’s abdominal examination can be relatively normal initially or reveal only mild focal tenderness, as in the case of contained or retroperitoneal perforation. Retroperitoneal GI tract perforation often leads to back pain due to the anatomical location, and sometimes diverticular perforation presents with acute pain, followed by nausea and vomiting 11. Generally, compared to other complications of the diverticulum, diverticular perforation most often requires operation.…”

Perforated duodenal diverticulum: Surgical treatment and literature review

“…As most perforations are retroperitoneal, 10 symptoms are usually nonspecific including right upper abdominal pain associated with nauseas and vomiting, 6 and rarely include peritoneal irritation 3 . Blood samples are also unspecific and elevated pancreatic tests might be present due to the inflammation in the vicinity of the diverticulum 1 .…”

Retroperitoneal perforation arising from duodenal diverticulum treated by endoscopic drainage: a case report

“…Duodenal perforation may cause retroperitoneal abscess rather than panperitonitis. Several reports described that preoperational diagnosis was difficult when emergency surgery was chosen to treat with perforated duodenal diverticulum 2, 4, 5, 6. Helical CT, however, could be employed to detect retroperitoneal air surrounding the duodenum, which may suggest perforation of juxta‐papillary duodenal diverticulum 7.…”

“…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. Given these facts, nonsurgical drainage from retroperitoneal abscess could be one of the options to treat with perforated diverticulum.…”