Perforated duodenal diverticulum: clinical and imaging findings in eight patients

Duodenal diverticula are common and are usually asymptomatic. We have studied a substantial number of patients who had perforation of a duodenal diverticulum and found these challenging to diagnose with little guidance from prior publications. Retrospective study for the most recent 10-year period of all patients who had a discharge diagnosis of perforated duodenal diverticulum or duodenal diverticulitis and also had relevant imaging studies. Eight patients had CT evaluation and six had upper GI fluoroscopic evaluation. All presented with acute abdominal pain. Duodenal diverticular perforation was spontaneous in 6 patients, and caused by endoscopy or feeding tube placement in one patient each. The diagnosis was made correctly by imaging in only 2 patients, while retrospective review showed clear evidence of a diverticulum and extraluminal gas in all cases. Clinical management included surgery in five patients and nonoperative management in three. Average duration of hospital stay was 32 days and two patients died. Perforation of a duodenal diverticulum may cause severe illness or death and is difficult to diagnose. Careful attention to CT findings and appropriate use of upper GI studies may allow more confident diagnosis and management.