Occult Perforation at the Ligament of Treitz in a Patient with Cirrhosis: A Case Report and Literature Review

Abstract

Abstract Background: Small intestine perforations in adults occur usually as a result of obstruction and ischemia, hernia strangulation, or trauma. When patients are found to have small intestine perforations, the location of the defect is commonly described as the distance from the ligament of Treitz, which is the suspensory ligament of the duodenum that landmarks the duodenojejunal junction. Few cases exist in which perforations occur right at the ligament of Treitz. Here, we report a rare case of an occult small intestine perforation at the ligament of Treitz in a patient with cirrhosis. Case Presentation: A 75-year-old Caucasian male with Child-Pugh class B alcoholic cirrhosis presented to the emergency department with acute abdominal pain caused by a recurrent umbilical hernia. On physical examination, he had a moderate amount of ascites and a tender mass to the right of the umbilicus. The patient was taken to the operating room (OR) for open reduction and umbilical repair. A fat-containing hernia wi...