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Ohno S, Shinoda T, Kawahara T, Nonomura Y, Tachikawa R, Tawada K, Ikawa A, Sano B. A perforation of a duodenal diverticulum in a 97-year-old patient after total gastrectomy and Roux-en-Y reconstruction: a case report. Clin J Gastroenterol 2024:10.1007/s12328-024-01965-4. [PMID: 38589720 DOI: 10.1007/s12328-024-01965-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 03/19/2024] [Indexed: 04/10/2024]
Abstract
Most duodenal diverticula (DD) are asymptomatic and rarely develop perforations. Perforation is the most serious complication of DD and often requires emergency surgery. A 97-year-old woman who had undergone total gastrectomy and Roux-en-Y reconstruction 30 years ago was referred to our department with chief complaints of abdominal pain and fever during her hospitalization after femoral neck fracture surgery in the orthopedic department. Contrast-enhanced computed tomography showed free air and residue in the abdominal cavity and right retroperitoneum, and an emergency laparotomy was performed. The abdominal cavity was mildly contaminated, and a 6-cm DD with a 1-cm perforation in the wall of the diverticulum on the contralateral side of the mesentery of the duodenum was found. Diverticulectomy and duodenal closure were performed and a drainage tube was placed. The patient experienced no complications and was transferred to the orthopedic department on postoperative day 10. Reports of perforation of DD after gastrectomy are very rare. Particular attention should be paid to perforation of DD after Billroth-II and Roux-en-Y reconstructions as they involve the formation of a duodenal stump that differs from the normal anatomy and may be highly invasive surgical procedures, depending on the degree of inflammation and fistula formation.
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Affiliation(s)
- Shinya Ohno
- Department of Surgery, Takayama Red Cross Hospital, 3-11 Tenmanmachi, Takayama, Gifu, 506-0025, Japan.
| | - Tomohito Shinoda
- Department of Surgery, Takayama Red Cross Hospital, 3-11 Tenmanmachi, Takayama, Gifu, 506-0025, Japan
| | - Tatsuki Kawahara
- Department of Surgery, Takayama Red Cross Hospital, 3-11 Tenmanmachi, Takayama, Gifu, 506-0025, Japan
| | - Yusuke Nonomura
- Department of Surgery, Takayama Red Cross Hospital, 3-11 Tenmanmachi, Takayama, Gifu, 506-0025, Japan
| | - Reo Tachikawa
- Department of Surgery, Takayama Red Cross Hospital, 3-11 Tenmanmachi, Takayama, Gifu, 506-0025, Japan
| | - Kakeru Tawada
- Department of Surgery, Takayama Red Cross Hospital, 3-11 Tenmanmachi, Takayama, Gifu, 506-0025, Japan
| | - Aiko Ikawa
- Department of Surgery, Takayama Red Cross Hospital, 3-11 Tenmanmachi, Takayama, Gifu, 506-0025, Japan
| | - Bun Sano
- Department of Surgery, Takayama Red Cross Hospital, 3-11 Tenmanmachi, Takayama, Gifu, 506-0025, Japan
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2
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Chait JS, Galli LD, Clark CJ. Indications for Operative Management of Complicated Duodenal Diverticula: A Review. Am Surg 2023; 89:3043-3046. [PMID: 36533836 DOI: 10.1177/00031348221146957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
The duodenum is the second most common location for a diverticulum to form after the colon. These duodenal diverticula (DD) are often found incidentally and rarely require intervention. In recent years, surgical management has been restricted to patients with significant complicated sequelae, such as perforation, abscess, or fistula formation. We present the rare case of a perforated broad-based diverticulum in the third portion of the duodenum necessitating surgical correction. The patient presented with persistent symptoms following failure of conservative management and underwent surgical resection. Due to difficulty visualizing the extent of the diverticulum, a novel intraoperative technique of bowel insufflation via nasogastric tube was used allowing for elucidation of the diverticular borders and complete resection. Although DD are common, there exists no consensus on when operative intervention is indicated. Given that significant morbidity and mortality can be associated with symptomatic DD, a systematic way to guide management decisions is needed. After conducting a review of the literature, we propose that the modified Hinchey classification can be used not only to categorize duodenal diverticulitis but to guide treatment choice in cases with unclear risk benefit profiles.
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Affiliation(s)
- Joshua S Chait
- Department of General Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Lucas D Galli
- Department of General Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Clancy J Clark
- Department of General Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
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3
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Ahmed MJ, Vinod VC, Younis MU, Shafique M, Ikram F. A Case of Perforated Duodenal Diverticular Stone. Cureus 2023; 15:e38468. [PMID: 37273375 PMCID: PMC10238359 DOI: 10.7759/cureus.38468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2023] [Indexed: 06/06/2023] Open
Abstract
Nontraumatic surgical emergencies constitute a major bulk of general surgical practice. Most of the cases seen fall under routine, but now and then, a surgeon or emergency physician is faced with an unusual diagnosis or a rarer presentation of a usual diagnosis. Sharing among peers their experiences with these outliers of practice helps spread knowledge and increases the experience pool. We share our experience of a 66-year-old female who presented to our emergency with upper abdominal pain of one-day duration.
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Affiliation(s)
- Monis J Ahmed
- General Surgery, Mediclinic City Hospital, Dubai, ARE
| | | | | | | | - Faisel Ikram
- General Surgery, Mediclinic City Hospital, Dubai, ARE
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4
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McKinley WI, Symalla T, Benjamin A. Management of the perforated duodenal diverticulum. Trauma Surg Acute Care Open 2023; 8:e001087. [PMID: 36793394 PMCID: PMC9923343 DOI: 10.1136/tsaco-2023-001087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Affiliation(s)
| | - Trever Symalla
- Surgical Operations Squadron, David Grant Medical Center, Travis AFB, California, USA
| | - Andrew Benjamin
- Biological Sciences Division, University of Chicago, Chicago, Illinois, USA
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5
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Zhong B, Li Z, Lin Z, Shen Y, Zhang J, Jin W. Spontaneous perforation of a primary duodenal diverticulum stepped treatment model: A 10-patient case report. Front Surg 2022; 9:936492. [PMID: 36117841 PMCID: PMC9470883 DOI: 10.3389/fsurg.2022.936492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 07/28/2022] [Indexed: 11/15/2022] Open
Abstract
After colonic diverticula, a duodenal diverticulum (DD) is the second most common type of gastrointestinal diverticulum. DD is mainly caused by poor congenital development, resulting in a limited outward protrusion of the duodenal wall in a sac (primary diverticula). Perforation is one of the infrequent but most severe complications of DD, most commonly in the second segment of the duodenum (D2, 58%), followed by the third segment (D3, 30%). In the current case reports on the treatment of DD perforation, preoperative diagnosis is rare, with most patients being diagnosed and treated by laparotomy; the surgical approach is complex and varied, with artificial choices; and there is a high rate of complications and mortality (6%–34%) after surgical treatment. This study aimed to review our experience treating spontaneous perforation of the primary duodenal diverticulum, focusing on the surgical treatment model. A retrospective review of all spontaneous perforations of primary DD was conducted at one center between January 2010 and January 2022. We identified 10 patients with spontaneous perforation of primary DD (6 women and 4 men; median age: 51.5 years; range: 24–87 years). The patients had a median American Society of Anesthesiologists (ASA) score of 2. All patients underwent surgical treatment, of which six had percutaneous retroperitoneal drainage, two had diverticulectomy, one had distal gastrectomy + gastrojejunostomy + diverticuloplasty, and one had diverticulum repair. No patients died. The median length of stay was 12 days (range: 3–21 days). There were no long-term complications during the follow-up period (median follow-up of 12 months). A stepwise treatment model for spontaneous perforation of primary DD appears to have more advantages, and transabdominal exploratory surgery should probably not be the preferred treatment modality.
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Affiliation(s)
- Bin Zhong
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Zhonghu Li
- Department of General Surgery, Central Theater Command General Hospital of the Chinese People’s Liberation Army, Wuhan, China
| | - Zhenyu Lin
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Yanbing Shen
- Department of General Surgery, Central Theater Command General Hospital of the Chinese People’s Liberation Army, Wuhan, China
| | - Jianxin Zhang
- Department of General Surgery, Central Theater Command General Hospital of the Chinese People’s Liberation Army, Wuhan, China
- Correspondence: Wei-Dong Jin Jian-Xin Zhang
| | - Weidong Jin
- Department of General Surgery, Central Theater Command General Hospital of the Chinese People’s Liberation Army, Wuhan, China
- Correspondence: Wei-Dong Jin Jian-Xin Zhang
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Wichmann D, Jansen KT, Onken F, Stüker D, Zerabruck E, Werner CR, Yurttas C, Thiel K, Königsrainer A, Quante M. Endoscopic negative pressure therapy as stand-alone treatment for perforated duodenal diverticulum: presentation of two cases. BMC Gastroenterol 2021; 21:436. [PMID: 34802417 PMCID: PMC8607673 DOI: 10.1186/s12876-021-02018-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 11/08/2021] [Indexed: 12/24/2022] Open
Abstract
Background Endoscopic negative pressure therapy is a novel and successful treatment method for a variety of gastrointestinal leaks. This therapy mode has been frequently described for rectal and esophageal leakages. Duodenal diverticular perforations are rare but life-threatening events. The early diagnosis of duodenal diverticular perforation is often complicated by inconclusive symptoms. This is the first report about endoscopic negative pressure therapy in patients with perforated duodenal diverticula. Case presentation We present two cases of duodenal diverticula perforations treated with endoscopic negative pressure therapy as stand-alone treatment. Start of symptoms varied from one to three days before hospital admission. Early sectional imaging led to the diagnosis of duodenal diverticular perforation. Both patients were treated with endoluminal endoscopic negative pressure therapy with simultaneous feeding option. Three respective changes of the suction device were performed. Both patients were treated with antibiotics and antimycotics during their hospital stay and be discharged from hospital after 20 days. Conclusions This is the first description of successful stand-alone treatment by endoscopic negative pressure therapy in two patients with perforated duodenal diverticulum. We thus strongly recommend to attempt interventional therapy with endoluminal endoscopic negative pressure therapy in patients with duodenal diverticular perforations upfront to surgery. Supplementary Information The online version contains supplementary material available at 10.1186/s12876-021-02018-7.
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Affiliation(s)
- Dörte Wichmann
- Department of General, Visceral and Transplantation Surgery, University Hospital of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany.
| | - Kai Tobias Jansen
- Department of General, Visceral and Transplantation Surgery, University Hospital of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Flurina Onken
- Department of General, Visceral and Transplantation Surgery, University Hospital of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Dietmar Stüker
- Department of General, Visceral and Transplantation Surgery, University Hospital of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Emanuel Zerabruck
- Interdisciplinary Endoscopic Unit, University Hospital of Tübingen, Hoppe-Seyler-Str. 6, 72076, Tübingen, Germany
| | - Christoph R Werner
- Department of Internal Medicine I, Gastroenterology, Hepatology, Gastrointestinal Oncology, Infectiology and Geriatrics, University Hospital of Tübingen, Otfried-Müller-Str. 10, 72076, Tübingen, Germany
| | - Can Yurttas
- Department of General, Visceral and Transplantation Surgery, University Hospital of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Karolin Thiel
- Department of General, Visceral and Transplantation Surgery, University Hospital of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Alfred Königsrainer
- Department of General, Visceral and Transplantation Surgery, University Hospital of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Markus Quante
- Department of General, Visceral and Transplantation Surgery, University Hospital of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
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Tomida H, Nakagawa K, Matsumura H, Shinichiro I, Matsushita A, Koike S. Perforated Duodenal Diverticulum With Postoperative Diverticulum Bleeding Successfully Treated Using Transcatheter Arterial Embolization. Cureus 2021; 13:e18219. [PMID: 34722030 PMCID: PMC8544636 DOI: 10.7759/cureus.18219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2021] [Indexed: 11/16/2022] Open
Abstract
A diverticulum is a relatively common finding that is generally discovered incidentally; it is most commonly observed in the colon, followed by the duodenum. However, duodenal diverticulum perforation (DDP) is a rare complication. Due to its rarity, its diagnosis is often challenging and the appropriate treatment remains unclear, possibly contributing to its high mortality rate. Traditionally, surgical repair is the primary mode of treatment. However, with the recent advancements in medical technology, conservative management such as bowel rest and endoscopic drainage help successfully manage DDP. Duodenal diverticulum bleeding (DDB) is a rare cause of upper gastrointestinal bleeding. While endoscopic, angiographical, and surgical treatments have been performed to achieve hemostasis, there is no consensus regarding the optimal treatment for DDB. We describe a case of a perforated duodenal diverticulum (DD) with postoperative diverticulum bleeding. Our patient, an elderly female, complained of abdominal pain. Computed tomography images revealed free air in the retroperitoneum, and gastrointestinal perforation was suspected. During the emergency surgery, a perforated DD was detected in the third portion of the duodenum. Due to severe inflammation, diverticulectomy was not performed as it was deemed risky. Instead, we directly sutured the orifice using an omental patch. Duodenal leakage was observed from postoperative day (POD) 3 with bleeding from the remnant DD occurred on PODs 6 and 13. An attempt at endoscopic hemostasis failed, but transcatheter arterial embolization (TAE) was successfully performed. The postoperative course was complicated, and the patient died on POD 54. To the best of our knowledge, this is the first report on DD perforation with postoperative DDB. The remnant DD may be damaged by the digestive juices and result in bleeding. Precautionary measures for duodenal leakage should be undertaken when the DD is unresectable. Additionally, TAE is effective for postoperative DDB.
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Affiliation(s)
- Hidenori Tomida
- Surgery, Shinshu University School of Medicine, Matsumoto, JPN
| | - Kan Nakagawa
- Surgery, National Hospital Organization Matsumoto Medical Center, Matsumoto, JPN
| | - Hideyasu Matsumura
- Surgery, National Hospital Organization Matsumoto Medical Center, Matsumoto, JPN
| | - Imai Shinichiro
- Surgery, National Hospital Organization Matsumoto Medical Center, Matsumoto, JPN
| | - Akimasa Matsushita
- Surgery, National Hospital Organization Matsumoto Medical Center, Matsumoto, JPN
| | - Shoichiro Koike
- Surgery, National Hospital Organization Matsumoto Medical Center, Matsumoto, JPN
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9
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A systematic review of the perforated duodenal diverticula: lessons learned from the last decade. Langenbecks Arch Surg 2021; 407:25-35. [PMID: 34164722 PMCID: PMC8847262 DOI: 10.1007/s00423-021-02238-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 06/09/2021] [Indexed: 11/23/2022]
Abstract
Background The perforated duodenal diverticulum remains a rare clinical entity, the optimal management of which has not been well established. Historically, primary surgery has been the preferred treatment modality. This was called into question during the last decade, with the successful application of non-operative therapy in selected patients. The aim of this systematic review is to identify cases of perforated duodenal diverticula published over the past decade and to assess any subsequent evolution in treatment. Methods A systematic review of English and non-English articles reporting on perforated duodenal diverticula using MEDLINE (2008–2020) was performed. Only cases of perforated duodenal diverticula in adults (> 18 years) that reported on diagnosis and treatment were included. Results Some 328 studies were identified, of which 31 articles met the inclusion criteria. These studies included a total of 47 patients with perforated duodenal diverticula. This series suggests a trend towards conservative management with 34% (16/47) of patients managed non-operatively. In 31% (5/16) patients initially managed conservatively, a step-up approach to surgical intervention was required. Conclusion Conservative treatment of perforated duodenal diverticula appears to be an acceptable and safe treatment strategy in stable patients without signs of peritonitis under careful observation. For patients who fail to respond to conservative treatment, a step-up approach to percutaneous drainage or surgery can be applied. If surgery is required, competence in techniques ranging from simple diverticulectomy to Roux-en-Y gastric diversion or even Whipple’s procedure may be required depending on tissue friability and diverticular collar size.
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10
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Laparoscopic duodenal segmental resection and duodenojejunostomy for symptomatic duodenal diverticula in three cases treated at a community hospital. THE JOURNAL OF MINIMALLY INVASIVE SURGERY 2021; 24:51-55. [PMID: 35601280 PMCID: PMC8965992 DOI: 10.7602/jmis.2021.24.1.51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 08/04/2020] [Accepted: 10/14/2020] [Indexed: 11/08/2022]
Abstract
The duodenum is the second most common site of diverticula following the colon, but is associated with fewer complications than colonic diverticula. Diverticulitis, cholangitis, pancreatitis, perforation, hemorrhage, and blind loop syndrome may occur as complications of duodenal diverticula. Although nonoperative treatment is an option for patients in good condition without signs of sepsis, surgery is generally required for definitive treatment of complications. There are several surgical procedures for symptomatic duodenal diverticula. We performed laparoscopic duodenal segmental resection and duodenojejunostomy without open conversion in three cases. We believe that this procedure is ideal for cases of symptomatic duodenal diverticula when performed by an experienced surgeon with the goal of definitive treatment.
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Takatori Y, Kato M, Nakayama A, Yahagi N. A Case of Duodenal Tumor Adjacent to the Diverticulum That Was Resected by the Technique of Partial Submucosal Injection Combined with Underwater Endoscopic Mucosal Resection. Dig Dis 2021; 39:70-74. [PMID: 32526738 PMCID: PMC7949217 DOI: 10.1159/000509323] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 06/03/2020] [Indexed: 02/02/2023]
Abstract
A 66-year-old male was referred to our hospital for treatment of duodenal tumor. The most difficult part was that the lesion was adjacent to duodenal diverticulum. Endoscopic mucosal resection (EMR) was difficult because submucosal injection spread broadly and quickly and makes it difficult to visualize the diverticulum edge of the lesion. Simple underwater EMR (UEMR) had risk for perforation at the diverticulum part because duodenal diverticulum is spurious diverticulum that defects the proper muscle layer. Therefore, to make sufficient distance between diverticulum and the lesion, we performed partial submucosal injection into only the diverticulum side of the lesion combined with simple UEMR. The lesion was resected en bloc without any adverse events. Histopathological diagnosis was tubular adenoma with moderate atypia and surgical margin negative. Partial submucosal injection combined with simple UEMR might be useful for duodenal tumor that has any technical difficulties as in this case.
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Affiliation(s)
| | - Motohiko Kato
- *Motohiko Kato, Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582 (Japan),
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12
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Kansoun A, El-Helou E, Amiry AR, Bahmad M, Mohtar IA, Houcheimi F, Maanieh N, Hazim M, Rahal K, Atwi H, Ambriss W. Surgical approach for duodenal diverticulum perforation: A case report. Int J Surg Case Rep 2020; 76:217-220. [PMID: 33049647 PMCID: PMC7559533 DOI: 10.1016/j.ijscr.2020.09.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 09/25/2020] [Indexed: 10/31/2022] Open
Abstract
INTRODUCTION Duodenal Diverticula is not uncommon and it is mostly found in the 2nd part of the duodenum. Despite the fact that it is mostly found incidentally, it can complicate however it rarely complicates by perforation. Treatment is indicated only in complicated cases and it is divided into conservative and surgical arms. PRESENTATION OF CASE It is a case of 78 years old Lebanese female that was diagnosed intra-operatively with a perforated duodenal diverticulum after presenting with post prandial abdominal pain, distention and pneumoperitoneum on imaging. Our case was consistent with previous reports where the diverticulum occurred in the second part of the duodenum. We opted for primary resection of the diverticulum and over-sewing. Moreover, patient had an uneventful post-operative course and progressed gradually to be discharged on day 10. CONCLUSION Our case aims to draw attention to a rare complication of duodenal diverticula and to widen the differential diagnosis of pneumoperitoneum thus concluding about the better treatment option. Previous reports show that proper management is still a controversial topic; however surgical approach is indicated in case of systemic signs.
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Affiliation(s)
- Alaa Kansoun
- Lebanese University, Faculty of Medical Sciences, Department of General Surgery, Beirut, Lebanon.
| | - Etienne El-Helou
- Lebanese University, Faculty of Medical Sciences, Department of General Surgery, Beirut, Lebanon.
| | - Abdel Rahman Amiry
- Department of General Surgery, Hammoud Hospital University Medical Center, Saida, Lebanon.
| | - Marwan Bahmad
- Department of General Surgery, Hammoud Hospital University Medical Center, Saida, Lebanon; Department of Gastroenterology, Hammoud Hospital University Medical Center, Saida, Lebanon.
| | - Iyad Al Mohtar
- Department of General Surgery, Hammoud Hospital University Medical Center, Saida, Lebanon.
| | - Faisal Houcheimi
- Department of General Surgery, Hammoud Hospital University Medical Center, Saida, Lebanon.
| | - Nisreen Maanieh
- Department of General Surgery, Hammoud Hospital University Medical Center, Saida, Lebanon.
| | - Mouhamad Hazim
- Department of General Surgery, Hammoud Hospital University Medical Center, Saida, Lebanon.
| | - Khaled Rahal
- Department of General Surgery, Hammoud Hospital University Medical Center, Saida, Lebanon.
| | - Hasan Atwi
- Department of Gastroenterology, Hammoud Hospital University Medical Center, Saida, Lebanon.
| | - Walid Ambriss
- Beirut Arab University, Faculty of Medical Sciences, Department of General Surgery, Beirut, Lebanon.
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13
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Palumbo V, Sofia M, Mattone E, Bonaccorso R, Guastella T, La Greca G, Russello D, Latteri S. Traumatic perforated diverticulum of the fourth duodenal portion: First case report and literature review. Ann Med Surg (Lond) 2020; 57:114-117. [PMID: 32742650 PMCID: PMC7385273 DOI: 10.1016/j.amsu.2020.07.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/11/2020] [Accepted: 07/12/2020] [Indexed: 12/26/2022] Open
Abstract
Introduction Duodenal rupture following blunt abdominal trauma is rare, and traumatic rupture of duodenal diverticula is exceptional. However, duodenum is the second most frequent location of intestinal diverticula following colon. Duodenal diverticula are common but only in few cases they are symptomatic due to the onset of complications such as inflammation, hemorrhage, or perforation. Perforation, although rare, especially post-trauma, is the most serious life threatening complication. Case presentation We report the case of a patient who, 24 hours after a blunt trauma secondary to a car accident, complained symptoms related to the perforation of a diverticulum of the fourth portion of the duodenum. A computed tomography was performed and extraluminal fluid-air collection was identified. During emergent laparotomy, a fourth portion perforated duodenal diverticulum was diagnosed, and resected. The recovery was uneventful. Discussion Diagnosis of perforated duodenal diverticulum represents a challenge in diagnosis and few guidelines exist about the management of this rare occurrence, especially in a traumatic setting. The present case is the first report of traumatic perforated diverticulum of the fourth duodenal portion. Conclusion Surgery still remain the most common approach in the treatment of this pathology, including diverticulectomy and primary repair. Duodenal diverticula are a frequent, but they are usually asymptomatic until they develop complications, as perforation. Traumatic perforation of duodenum is very infrequent and the traumatic rupture of duodenal diverticula is extremely rare. Perforation, usually involves the second part of the duodenum. The present case is the first report of traumatic perforated diverticulum of the fourth duodenal portion. Surgery remain the most common approach in the treatment of complicated duodenal diverticula.
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Affiliation(s)
- Valentina Palumbo
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, Via S. Sofia 84, 95123, Catania, Italy
| | - Maria Sofia
- General Surgery, Cannizzaro Hospital, via Messina 829, 95126, Catania, Italy
| | - Edoardo Mattone
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, Via S. Sofia 84, 95123, Catania, Italy
| | - Rosario Bonaccorso
- General Surgery, Cannizzaro Hospital, via Messina 829, 95126, Catania, Italy
| | - Tommaso Guastella
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, Via S. Sofia 84, 95123, Catania, Italy
| | - Gaetano La Greca
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, Via S. Sofia 84, 95123, Catania, Italy
| | - Domenico Russello
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, Via S. Sofia 84, 95123, Catania, Italy
| | - Saverio Latteri
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, Via S. Sofia 84, 95123, Catania, Italy
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Maki H, Yuasa Y, Matsuo Y, Mori O, Tomibayashi A. Repair of a perforated duodenal diverticulum using intraduodenal suture in 94 year old woman: A case report. Int J Surg Case Rep 2020; 71:163-167. [PMID: 32454453 PMCID: PMC7248578 DOI: 10.1016/j.ijscr.2020.04.083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 04/30/2020] [Accepted: 04/30/2020] [Indexed: 12/02/2022] Open
Abstract
Duodenal diverticula are common; however, perforation is rare. No standard protocol exists for the management of perforated duodenal diverticula. Especially in emergent cases, a rapid and simple technique seems more feasible. We treated a woman with perforation using partial manual sutures inside the duodenum. This promises to be a feasible technique for managing such cases.
Introduction In case of gastrointestinal diverticula, the duodenal type is quite frequent; duodenum is the second most common site for diverticula following the colon (Glener et al., 2016). However, duodenal diverticular perforation is rare, so the appropriate surgical treatment for this condition is yet unclear (Simoes et al., 2014). This literature has been written in line with the SCARE criteria (Agha et al., 2018). Presentation of case A 94-year-old woman emergently presented to our department with diffuse abdominal tenderness and guarding, indicating pan-peritonitis. Computed tomography revealed pneumoretroperitoneum; Therefore, gastrointestinal perforation was suspected. Emergency surgery was performed; we detected the perforated diverticulum located at the posterior wall of the duodenum with accompanying inflammation. Considering the location, postoperative leakage, and the patient's advanced age, we placed trans-section on duodenal wall against the lesion and resected the diverticulum, The lumen was then manually sutured from within. The anterior wall was closed using linear staplers. The patient recovered uneventfully and was discharged 24 days after surgery. Discusssions As perforated duodenal diverticulum is rare, the ideal management is unclear. Several studies mention various surgical procedures. However, actual treatment varies based on the patient's situation and surgeon's assessment. Almost all cases that require surgery present emergently; therefore, simpler and more effective treatment methods are required (Simoes et al., 2014; Philip et al., 2019; Fujisaki et al., 2014). Conclusion We used a unique surgical technique; intraduodenal suture for perforated diverticulum. This technique can be a feasible alternative for managing this condition.
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Affiliation(s)
- Hidenori Maki
- Department of Surgery, Tokushima Red Cross Hospital, Tokushima, Japan.
| | - Yasuhiro Yuasa
- Department of Surgery, Tokushima Red Cross Hospital, Tokushima, Japan
| | - Yuta Matsuo
- Department of Surgery, Tokushima Red Cross Hospital, Tokushima, Japan
| | - Osamu Mori
- Department of Surgery, Tokushima Red Cross Hospital, Tokushima, Japan
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15
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Sahned J, Hung Fong S, Mohammed Saeed D, Misra S, Park IS. Duodenal Diverticulitis: To Operate or Not To Operate? Cureus 2019; 11:e6236. [PMID: 31890435 PMCID: PMC6935341 DOI: 10.7759/cureus.6236] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 11/25/2019] [Indexed: 11/24/2022] Open
Abstract
Duodenal diverticulum (DD) is a common incidental finding, which rarely causes complications. Perforation is one of the most feared and the least common complications. Surgery is the mainstay for complicated duodenal diverticulum, but with the advancement of medical treatment and intensive care, nonoperative management has been reported. We present a rare case of perforated DD that failed medical management and subsequently underwent surgical intervention. A 77-year-old, healthy female presented with right-sided abdominal pain with low-grade fever and leukocytosis. Computed tomography (CT) of the abdomen showed retroperitoneal fluid collection around the second part of the duodenum, which was not amenable to percutaneous drainage. Contrast studies showed no evidence of perforation or leak of the stomach or duodenum. The diagnosis was made via an upper endoscopy that showed a large periampullary duodenal diverticulum with purulent drainage and normal-looking ampulla. After failed conservative management with broad-spectrum antibiotics and worsening symptoms, she underwent excision and primary repair of the diverticulum with a jejunal serosal patch and exploration of the common bile duct (CBD). She had an uncomplicated postoperative course and was discharged home on postoperative day four. Although rare, the duodenal diverticular perforation can be a life-threatening complication. Combined subjective, clinical, and radiological assessment of the patient is crucial in deciding whether to operate or not.
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Affiliation(s)
| | | | | | | | - In Soon Park
- Surgery, Brandon Regional Hospital, Brandon, USA
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16
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A Rare Presentation of Small Bowel Diverticulosis Causing Chronic Obstruction and Malnutrition: A Case Study with Review of Literature. Case Rep Surg 2019; 2019:2548631. [PMID: 30755807 PMCID: PMC6348891 DOI: 10.1155/2019/2548631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 12/04/2018] [Accepted: 12/26/2018] [Indexed: 02/07/2023] Open
Abstract
Small bowel diverticulosis is an uncommon entity. Clinical presentation of small intestinal diverticulosis is variable. A high mortality is associated with complications such as chronic malnutrition, haemorrhage, intestinal obstruction, and perforation. We report a case of a 63-year-old female with multiple small bowel diverticuli spanning from the first part of the duodenum to the proximal ileum presenting with chronic malnutrition and subacute intestinal obstruction. Although exploratory laparotomy was performed, we opted for a totally conservative treatment in order to avoid complications such as short gut syndrome and anastomotic leakage.
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17
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Kim KH, Park SH. Conservative treatment of duodenal diverticulitis perforation: a case report and literature review. Open Access Emerg Med 2018; 10:101-104. [PMID: 30214324 PMCID: PMC6121776 DOI: 10.2147/oaem.s168487] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Perforation is the rarest complication of the duodenal diverticulum (DD), but it is the most serious complication. Mortality rate was reported up to 30%, which may be related to diagnostic delay because the symptoms of the perforated DD are vague and nonspecific. Therefore, accurate diagnosis is important to improve the clinical outcome. Surgical treatment was considered as the standard therapeutic option. However, surgical intervention may increase morbidity and mortality due to surgical complications. Therefore, nonoperative management can be considered in some patients with perforated diverticulum who have stable vital signs without generalized peritonitis, or in elderly patients with comorbidities. Several case reports of nonoperative management of perforated DD have been reported. Herein, we describe a patient with perforated DD diagnosed based on a computed tomography scan, who was successfully treated with conservative treatment.
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Affiliation(s)
- Ki Hoon Kim
- Department of Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea,
| | - Sang Hyun Park
- Department of Urology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
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18
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Duodenal Diverticular Perforation after Small Bowel Obstruction: A Case Report. Case Rep Surg 2018; 2018:6197828. [PMID: 30159194 PMCID: PMC6109567 DOI: 10.1155/2018/6197828] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 06/13/2018] [Indexed: 12/12/2022] Open
Abstract
Introduction Duodenal diverticulum is a rare disease that can be easily missed. The incidence of duodenal diverticulum diagnosed by upper GI study is approximately 5%. Autopsy results show that 22% of the population have duodenum diverticulum. Most patients with duodenal diverticulum are asymptomatic. However, complications like inflammation, perforation with retroperitoneal abscess, sepsis, pancreatitis, bile duct obstruction, and bleeding can occur. Approximately 162 cases of perforated duodenal diverticulum have been reported in the literature. Case Presentation We present a rare case of an 82-year-old female with perforation of a duodenal diverticulum caused by small bowel obstruction; in addition to this, there was a synchronous colonic tumor. Conclusion Diagnosis and management of this rare disorder are controversial. Nonoperative management is advocated in some cases. Some of the cases require early aggressive surgical intervention. The mortality rate remains approximately 45% in all these patients.
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Kagolanu DC, Subhani M, Novick D, Rizvon K. Jejunal diverticulitis in a healthy 91-year-old man. BMJ Case Rep 2018; 2018:bcr-2018-225116. [PMID: 29848538 DOI: 10.1136/bcr-2018-225116] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
A 91-year-old African American man was admitted with sudden onset diffuse abdominal pain which radiated to the right flank. CT of the abdomen with contrast showed diverticula in the jejunum with adjacent inflammation and microperforation that was contained. Conservative therapy similar to colonic diverticulitis was effective. Although rare, our case highlights the importance of having an early and high suspicion for jejunal diverticulitis when patients present with non-specific abdominal symptoms in order to avoid perforation.
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Affiliation(s)
| | - Miral Subhani
- Department of Internal Medicine, Nassau University Medical Center, East Meadow, New York, USA
| | - Daniel Novick
- Department of Radiology, Nassau University Medical Center, East Meadow, New York, USA
| | - Kaleem Rizvon
- Department of Gastroenterology, Nassau University Medical Center, East Meadow, New York, USA
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20
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Hong J, Park SB. A case of retroperitoneal abscess: A rare complication of Meckel's diverticulum. Int J Surg Case Rep 2017; 41:150-153. [PMID: 29078157 PMCID: PMC5742015 DOI: 10.1016/j.ijscr.2017.10.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 10/07/2017] [Accepted: 10/07/2017] [Indexed: 10/29/2022] Open
Abstract
INTRODUCTION The frequent complications of Meckel's diverticulum are hemorrhage, intestinal obstruction, and inflammation, and perforation. The presentation as a retroperitoneal abscess as complications of Meckel's diverticulum is a very rare clinical entity. PRESENTATION OF CASE We report a rare case of perforated Meckel's diverticulum with retroperitoneal abscess. A 31-year-old presented with a half-hour history of severe epigastric pain and diffuse periumbilical pain. Abdominal computed tomography (CT) revealed pneumoperitoneum and retroperitoneal abscesses which air, with diffuse infiltration of the small bowel mesentery and a tubular structure that originated in the ileum at the umbilicus level. Preoperative diagnosis was perforation of Meckel's diverticulum or small bowel perforation. We performed an approximate 10-cm segmental resection of the ileum that contained the Meckel's diverticulum. DISCUSSION Retroperitoneal abscesses are rare complications of Meckel's diverticulum and are associated with its perforation. CONCLUSION The complications of Meckel's diverticulum should be kept in mind in the differential diagnosis of retroperitoneal abscesses.
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Affiliation(s)
- Jeana Hong
- Department of Pediatric, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
| | - Sung Bae Park
- Department of Surgery, Kangwon National University Hospital, Kangwon National University School of Medicine, 17-1 Hyoja 3Dong, Chuncheon -Si, Kangwong-Do, 200-947, Republic of Korea.
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21
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Branco C, Carneiro T, Luis D, Gomes A. Perforated duodenal diverticulum: a rare complication in a common condition. BMJ Case Rep 2017. [PMID: 28647710 DOI: 10.1136/bcr-2017-219881] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The authors present a rare case of perforated duodenal diverticulum diagnosed in an 80-year-old Caucasian woman with vomiting and abdominal pain localised to the epigastrium. CT scan showed thickening of the second portion of the duodenum with retroperitoneal fat stranding and perihepatic free fluid, with a presumptive diagnosis of a duodenal perforation. A laparotomy was performed which showed a perforated diverticulum in the second portion of the duodenum. A diverticulectomy with single-layer closure was performed, without complications. The postoperative course was uneventful.
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22
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Shirobe T, Kawakami H, Abe S, Yokochi T. Retroperitoneal perforation arising from duodenal diverticulum treated by endoscopic drainage: a case report. Clin Case Rep 2017; 5:654-657. [PMID: 28469870 PMCID: PMC5412815 DOI: 10.1002/ccr3.921] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Revised: 01/05/2017] [Accepted: 02/26/2017] [Indexed: 11/10/2022] Open
Abstract
Retroperitoneal perforation of duodenal diverticula around the papilla of Vater is relatively rare. In this report, we describe retroperitoneal abscess, which was successfully treated by endoscopic drainage. Thus, endoscopic approach for retroperitoneal perforation caused by diverticulum is one of the treatment options in addition to surgery.
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Affiliation(s)
- Takashi Shirobe
- Department of Surgery Narita-Tomisato Tokushukai Hospital Tomisato Chiba Japan
| | - Hideyuki Kawakami
- Department of Surgery Narita-Tomisato Tokushukai Hospital Tomisato Chiba Japan
| | - Sadanori Abe
- Department of Surgery Narita-Tomisato Tokushukai Hospital Tomisato Chiba Japan
| | - Tomoki Yokochi
- Department of Clinical Research Chiba Tokushukai Hospital Funabashi Chiba Japan
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23
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Small bowel diverticulitis: an imaging review of an uncommon entity. Emerg Radiol 2016; 24:195-205. [PMID: 27815648 DOI: 10.1007/s10140-016-1448-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 09/29/2016] [Indexed: 02/07/2023]
Abstract
In this review, we discuss the clinical and radiologic findings of small bowel diverticulosis, which is infrequently encountered during practice and far less common than colonic diverticulosis. Small bowel diverticulosis can present with a range of emergent symptomatic complications including diverticulitis, perforation, or hemorrhage. Here, we focus on the clinical features, pathogenesis, radiologic findings, and treatment of small bowel diverticulitis. Although not routinely considered in the differential diagnosis of an acute abdomen, prospective radiologic diagnosis of small bowel diverticulitis is important and can lead to conservative treatment thus preventing unnecessary exploratory laparotomy.
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24
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Glener J, Poris S, Foles B, Harmon R. Perforated duodenal diverticulum case report. Int J Surg Case Rep 2016; 29:100-102. [PMID: 27835805 PMCID: PMC5107681 DOI: 10.1016/j.ijscr.2016.10.049] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 10/05/2016] [Accepted: 10/21/2016] [Indexed: 11/17/2022] Open
Abstract
1–5% of patients with duodenal diverticula become symptomatic (Oukachbi, 2013) [2]. The least common but most serious complication is perforation. Duodenal diverticula perforation can be the result of the peptic digestion, ulceration, enterocoliths, blunt abdominal trauma, or iatrogenic perforation during an ERCP (Schnueriger et al., 2008; Duarte and Cintron, 1992) [5,6]. The most sensitive exam to detect a duodenal diverticulum perforation is an abdominal CT scan (Song, 2015) [4]. A duodenal diverticulum perforation usually necessitates operative treatment with a diverticulectomy and two-layer closer of the duodenum, Kocher maneuver, and drainage of the retroperitoneum.
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.
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Affiliation(s)
- Julie Glener
- University of Central Florida College of Medicine, 6850 Lake Nona Blvd, Orlando, FL 32827, USA.
| | - Stephenie Poris
- Florida Hospital, 601 E Rollins St., Orlando, FL 32803, USA.
| | - Brandon Foles
- Florida Hospital, 601 E Rollins St., Orlando, FL 32803, USA.
| | - Rhonda Harmon
- Florida Hospital, 601 E Rollins St., Orlando, FL 32803, USA.
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25
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Yeh TC. Laparoscopic resection of perforated duodenal diverticulum - A case report and literature review. Int J Surg Case Rep 2016; 28:204-210. [PMID: 27721199 PMCID: PMC5061311 DOI: 10.1016/j.ijscr.2016.10.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 09/29/2016] [Accepted: 10/02/2016] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Duodenum diverticulum is the most common site for diverticular disease of small intestine. Most of duodenal diverticulum are asymptomatic, but complicated or perforated duodenal diverticulum is rare. Nonoperative management is attractive in selected patients, because of higher surgical complications. We suggest the use of a minimally invasive operative method as an alternative approach for the management of complicated duodenal diverticulum, especially when conservative treatment has failed. CASE PRESENTATION A 67-year-old female was admitted to Emergency Department with sudden onset of severe right upper abdominal pain and fever (38.2°C) lasted 8h. Abdominal computed tomographic imaging was performed and a perforated duodenal diverticulum with right-sided anterior pararenal space free air and fluid retention was identified. After assessment and resuscitation, proper treatment modality was selected taking in consideration type, location and complication of duodenal diverticulum. A emergency laparoscopic duodenal diverticulectomy with intraabdominal drainage was performed. Postoperative period was uneventful and patient was discharged on the 10th postoperative day. English literatures discussing laparoscopic management for complicated duodenal diverticulum were carefully reviewed. CONCLUSIONS Laparoscopic approach showed less complication, shorted hospital stay and better outcome in comparison to conservative, or open surgery. Laparoscopic approach is safe and feasible in selected cases of complicated duodenal diverticulum (laterally located and protruding duodenal diverticulum). With advances in laparoscopic instruments and techniques, complicated duodenal diverticulums can be managed safely by laparoscopically.
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Affiliation(s)
- Ting-Chia Yeh
- Division of General Surgery, Department of Surgery, Yunlin Christian Hospital, Taiwan.
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Song S. Management of Perforated Duodenal Diverticulum: Report of Two Cases. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2016; 66:159-63. [PMID: 26387699 DOI: 10.4166/kjg.2015.66.3.159] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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 preoperative diagnosis and clinical disease severity assessment are important. An abdomino-pelvic CT is an unquestionably crucial diagnostic tool. Perforation is considered a surgical emergency, although conservative treatment based on fasting and broad-spectrum 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.
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Affiliation(s)
- Sanghyun Song
- Department of Surgery, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea
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