A CASE OF PERFORATED DUODENAL DIVERTICULUM

Abstract

We have experienced a case of perforated duodenal diverticulum. An 85-year female was admitted to the hospital because of a right lower-quadrant abdominal pain. She was operated on under a suspicion of acute appendicitis. Upon laparotomy the appendix was normal, and so we searched in her abdominal cavity. A perforated duodenal diverticulum was found on the lateral posterior side of 2nd portion of the duodenum. Diverticulectomy was performed. Cholangiography during the operation was done in order to identify the location of the duodenal papilla. The patient recovered completely and was discharged on the 30th postoperative day. Histopathologically the diverticulum was constructed of thin duodenal wall lacking in the proper muscle layer, and the perforated hole comprising of necrotic portion was identified. The diagnosis of peritonitis due to perforated diverticulum was made. The duodenum is not an uncommon site for diverticulum among gastrointestinal organs, but perforated diverticulum of he duodenum is so rare that only 20 cases can be seen in the Japanese literature so far. In this paper we present an analysis of these cases for the diagnosis and treatment of the disease, and emphasize the importance of intraoperative cholangiography.