ТРУДНОСТИ ДИАГНОСТИКИ ОСЛОЖНЕНИЙ ДИВЕРТИКУЛЯРНОЙ БОЛЕЗНИ ДВЕНАДЦАТИПЕРСТНОЙ КИШКИ

Abstract

Abstract. Introduction. Duodenal diverticulum is a hernia‒like protrusion of the duodenal wall. In terms of prevalence, this disease ranks second among all diverticula of the gastrointestinal tract after colonic diverticula. Aim. To substantiate the difficulty of diagnosing duodenal diverticulum perforation, based on a clinical case. Materials and Methods. A clinical case dated December 2021 of successful diagnostics and treatment of duodenal diverticulum perforation in female patient A. aged 68 is presented, based on the practice of the surgeons of the Surgery Unit in the Clinic of Hospital Surgery of Samara State Medical University. A set of laboratory investigations was performed, such as clinical blood analysis, biochemical blood analysis, coagulation profile, clinical urine analysis, and blood tests for HIV, viral hepatitis, and syphilis. Instrumental diagnostic methods were used, such as ultrasound (Aloka SSD 1700 (Japan)), CT (Revolution EVO (Russia)) of abdominal organs, review radiography, and Napalkov test. Results and Discussion. Laboratory and instrumental diagnostics, such as ultrasound and survey radiography, and primary laparotomy turned out to be insufficient for correct diagnosis and reasonable treatment. Napalkov test was performed, which revealed the contrast agent flow into retroperitoneum. The patient underwent relaparotomy, during which the duodenal diverticulum perforation by a foreign body (a fragment of a laurel leaf) was found. Conclusions. The case presented is an example of timely diagnosis of duodenal diverticulum perforation. The surgeons’ experience allowed them to suspect perforation in a short time, which helped avoid serious complications and contributed to the patient’s recovery. With timely diagnosis of such a rare and grave complication as duodenal diverticulum perforation, its clinical cure is justified.