Management of Perforated Duodenal Diverticulum: Report of Two Cases

Sanghyun Song

doi:10.4166/kjg.2015.66.3.159

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Song: Management of Perforated Duodenal Diverticulum: Report of Two Cases

Case Report

Korean J Gastroenterol 2015;66(3):159-163.

Published online: 4 October 2015

DOI: https://doi.org/10.4166/kjg.2015.66.3.159

Management of Perforated Duodenal Diverticulum: Report of Two Cases

Sanghyun Song

Department of Surgery, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea

Correspondence to: Sanghyun Song, Department of Surgery, Dankook University College of Medicine, 119 Dandae-ro, Dongnam-gu, Cheonan 31116, Korea. Tel: +82-41-550-3087, Fax: +82-41-550-6034, E-mail: youngmoon77@gmail.com

Received 22 January 2015 Revised 24 March 2015 Accepted 30 March 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Duodenal diverticula are common, but perforated duodenal diverticulum is rare. Because of the disease rarity, there is no standard management protocol for perforated duodenal diverticulum. To properly manage this rare complication, a clear pre-operative diagnosis and clinical disease severity assessment are important. An abdominopelvic CT is an unquestionably crucial diagnostic tool. Perforation is considered a surgical emergency, although conservative treatment based on fasting and broad-spec-trum antibiotics may be offered in some selected cases. Herein, we report two cases of perforated duodenal diverticulum, one case managed with surgical treatment and one with conservative treatment.

Keywords: Duodenum, Diverticulum, Intestinal perforation

References

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Fig. 1.

Abdomino-pelvic CT image in a 53-year-old male in the present case. Axial CT image of perforated duodenal diverticulum with a foreign material demonstrated by a complex collection with fluid and gas surrounding the second portion of the duodenum (arrowheads).

Fig. 2.

An isolated perforated duodenal diverticulum on an antero-medial side of duodenal 2nd portion. Black arrowheads show the perforation site, and white arrowheads show the stalk of diverticulum.

Fig. 3.

Abdomino-pelvic CT image in a 73-year-old male in the present case. Suspected duodenal perforation denoted by retroperitoneal air (arrowheads).

Fig. 4.

Following CT after 18 days in a 73-year-old male in the present case. The axial image shows a near complete disappearance of fluid collection (arrowheads).

Fig. 5.

Follow-up esophagogastroduodenoscopy of the present case (arrowheads).

Table 1.

Reported Cases of Perforated Duodenal Diverticulum, 2012–2014

Source	Sex/age	Method of diagnosis	Treatment	Complication	Hospital day
Present study	M/53	CT	Diverticulectomy	None	12
	M/73	CT	Conservative	None	22
de Perrot et al.⁴ (2012)	F/92	CT	Diverticulectomy	None
	F/86	CT	Diverticulectomy	None
	F/48	CT	Diverticulectomy	None
	F/75	CT	Conservative	None
	F/77	CT	Diverticulectomy	None
	M/69	CT	Diverticulectomy	Death
	F/71	CT	Conservative	None
Rossetti et al.⁵ (2013)	−/91	OR	Diverticulectomy	None	26
	−/68	OR	Drain and laparotomy	Death	1
	−/83	CT	Diverticulectomy	None	18
	−/78	OR	Diverticulectomy	Leak	30
	−/76	CT	Conservative	None	16
	−/65	OR	Diverticulectomy	None	15
	−/48	CT	Diverticulectomy	None	22
Favre-Rizzo et al.¹¹ (2013)	F/82	CT	Diverticulectomy	None	14
Barillaro et al.¹⁴ (2013)	F/83	CT	Surgical drainage	None	30
Costa Simões et al.¹⁵ (2014)	F/79	CT	Duodenojejunostomy	None	12
Haboubi et al.¹⁶ (2014)	F/78	OR	Diverticulectomy	None	22

M, male; F, female; OR, operating room.

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