Peptic Perforation of the 4th Duodenal Segment. Case Report

Abstract

Introduction: Even if the prevalence of peptic ulcer disease has decreased in the last years, duodenal perforation remains a life threatening complication. The duodenum is the second most common site of gastrointestinal perforations after the colon and perforation of the 4th portion is very rare. Case Presentation: A 67-yers-old man was admitted to the emergency department of the Annecy Hospital with intense abdominal pain, vomiting and no transit for the last 24 hours. The laboratory count showed an inflammatory syndrome. A CT scan revealed free air and fluid near the Treitz’s angle. An exploratory laparotomy was performed that revealed a perforation of the forth portion of the duodenum. A duodenal resection with duodeno-jejunal anastomosis was performed. Discussions: Peptic ulcer disease is a common disease and the perforation is one of its most life threatening complications. The localization of the DP on the forth segment of the duodenum is very unusual. The most frequent localization of DP is the first duodenal segment. Abdominal CT scan is the most sensitive radiological exam if there is suspicion of a DP. A Zollinger-Ellison syndrome must be taken into count. Peritonitis is an indication for immediate laparoscopy or laparotomy, taking into account the patient’s condition. Despite the successful medication therapy and the progress in treatment of duodenal ulcer, perforation remains a serious complication, requiring an emergency surgical treatment. Conclusion: Duodenal perforation of the fourth portion is an extremely rare complication of the peptic ulcer disease and the surgery is the primary modality of treatment.