Endoscopic Closure of Duodenal Perforation using Intracavitary Endoscopic Negative Pressure Therapy

Abstract

Regardless of the cause of a duodenal perforation, operative treatment remains a fundamental therapeutic choice. The endoscopic closure of leaks is helpful only for fresh defects without an accompanying infection and is limited by the size of the defect. However, the operative treatment of duodenal perforations in the population of older and multimorbid patients is associated with a high morbidity, as well as mortality. Here, we describe a successful case of an endoscopic closure of a duodenal perforation in the bulbus using intracavitary endoscopic negative pressure therapy in a 68-year-old patient initially operated because of an acute cholecystitis with focal gallbladder perforation involving the duodenal wall. Over the course of time a secondary perforation of the duodenum was diagnosed, and a reoperation with a suturing of the duodenum did not lead to complete closure of the defect. Three weeks of intracavitary endoscopic negative pressure therapy led to the successful closure of the duodenal defect. This type of therapy can be an excellent alternative to surgery, for treating duodenal perforations in selected patients.