Retroperitoneal Perforation of a Duodenal Diverticulum with Colonic Necrosis - Report of a Case

Abstract

Primary duodenal diverticula are usually asymptomatic. About 115 perforations have been reported, but none with right colon necrosis. We report a 45-year-old woman, with a five days history of high fever along with epigastric and periumbilical pain. Physical examination revealed right upper and lower quadrant tenderness with peritoneal signs. White blood cell count was 11 500/mm (3) while biochemical and hepatic biology tests were normal. Abdominal radiographs showed no pathologic findings. Ultrasound disclosed fluid in the lower pelvis. Computerized tomography revealed fluid collection in the right hepatorenal space. Intraoperative findings included purulent fluid in the lower pelvis, segmental necrotic changes of the right colon, and a perforated diverticulum on the antimesenteric border of the third part of the duodenum. Surgery consisted of right hemicolectomy and ileo-transverse anastomosis, diverticulectomy, and decompressive lateral duodenostomy at the second duodenal portion. The patient had an uneventful postoperative course. A contrast study from the duodenostomy tube on the 6 (th) postoperative day showed no leakage or obstruction. Duodenostomy tube was removed on the 14 (th) postoperative day. Histology confirmed the diagnosis of a primary duodenal diverticulum.

Recurrent ascending cholangitis with acute pancreatitis and pancreatic atrophy caused by a juxtapapillary duodenal diverticulum

“…Inflammatory complications in buried narrow-ostium diverticula including diverticulitis and peridiverticulitis, spontaneous localized retroperitoneal [ 18 ] or intraperitoneal perforation, free intraperitoneal perforation with generalized peritonitis, [ 19 ] traumatic (accidental or iatrogenic) perforation, [ 20 – 22 ] or duodenocolic or duodeno-jejunal fistulae [ 5 ]…”

Diagnosis and Management of the Symptomatic Duodenal Diverticulum: a Case Series and a Short Review of the Literature

“…Fifty percent of all conventional radiological examinations show no abnormalities. 10 An abdominal CT scan is the most sensitive examination if there is suspicion that a DD perforation may have occurred. Findings consist of a thickened bowel wall, mesenteric fat stranding, and an extraluminal, retroperitoneal collection of air or fluid.…”

“…8 Up until 2005, 115 cases of perforated DD have been published. [9][10][11] In 57% of all cases, the possible cause of duodenal perforation was peptic digestive processes as a result of the retention of food in the diverticula. 12 Other causes, such as ulcerations, enterocoliths, blunt abdominal trauma, or iatrogenic perforation during an ERCP, have also been described.…”

A Rare Cause Of Acute Abdomen: Perforation Of Duodenal Diverticulum Containing Ectopic Pancreatic Tissue

“…Almost half of the conventional radiological examinations show no abnormalities (17). If there is a clinical suspicion of a perforated duodenal diverticula, contrast enhanced CT is the most sensitive examination (18).…”