Perforated duodenal diverticulum case report

被引:9
作者
Glener, Julia [1 ]
Poris, Stephenie [2 ]
Foles, Brandon [2 ]
Harmon, Rhonda [2 ]
机构
[1] Univ Cent Florida, Coll Med, 6850 Lake Nona Blvd, Orlando, FL 32827 USA
[2] Florida Hosp, 601 E Rollins St, Orlando, FL 32803 USA
关键词
Duodenal diverticulum; Perforation; Case report;
D O I
10.1016/j.ijscr.2016.10.049
中图分类号
R61 [外科手术学];
学科分类号
摘要
INTRODUCTION: The duodenum is the second most common location of intestinal diverticula following the colon (Juler et al., 1969) [1]. Only 1-5% of patients with duodenal diverticula become symptomatic (Oukachbi, 2013) [2]. The least common but most serious complication of duodenal diverticula is perforation, which has a mortality rate of 20% (Oukachbi, 2013; Yin et al., 2001; Song, 2015; Schnueriger et al., 2008) [2-5]. PRESENTATION OF CASE: A 65 year old female presented with sudden onset periumbilical and epigastric pain. Her abdomino-pelvic CT without contrast revealed a duodenal perforation of the anterior wall of the duodenum. After attempting a laparoscopic approach, the operation was converted to an open procedure to enhance visualization. A wide Cattell-Braasch maneuver was performed, mobilizing the duodenum, which revealed an inflamed diverticulum. Following a pyloric exclusion, a gastrojejunostomy and a Braun enteroenterostomy were completed in addition to a jejunostomy tube on the efferent limb. DISCUSSION: Clinical presentation of duodenal diverticula is vague and often varies. Although difficult to elucidate on imaging, the most sensitive exam to detect a duodenal diverticulum perforation is an abdominal CT scan, which can reveal thickened bowel wall, mesenteric fat stranding, and an extraluminal, retroperitoneal collection of air or fluid (Song, 2015) [4]. Due to the rareness of perforated duodenal diverticulum, surgical treatment guidelines are lacking. CONCLUSION: Ultimately, it is necessary to have a high index of suspicion to detect a duodenal diverticulum perforation. The perforation usually necessitates operative treatment that consists of a diverticulectomy and two-layer closer of the duodenum, Kocher maneuver, and drainage of the retroperitoneum. (C) 2016 The Authors. Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.
引用
收藏
页码:100 / 102
页数:3
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