Abstract
BackgroundPerforation of a duodenal diverticulum is a rare complication that may become fatal with a delay in appropriate treatment. However, the optimal treatment for perforated duodenal diverticulum remains controversial, ranging from conservative therapy to surgery including pancreatoduodenectomy.Case presentationThe patient was a 60-year-old woman with no particular medical history who visited our hospital with chief complaints of continuous fever and right dorsal pain. Upon arrival, she had tenderness in the right upper quadrant of the abdomen. Laboratory data showed the elevation of inflammatory markers. Computed tomography revealed free air with abscess formation around the duodenum, which was diagnosed as duodenal perforation with abdominal abscess. We decided on emergent surgery, and we identified the perforation site on the dorsal side of the second portion of the duodenum intraoperatively. However, the inflammation around the perforation site was severe, and it was difficult to perform primary closure or dissection of the perforated diverticulum. Therefore, we finished surgery by placing four indwelling intra-abdominal tubes. Since postoperative day (POD) 1, the elevation of inflammation markers appeared to be uncontrollable, owing to the leakage of bile and pancreatic juice. We decided to perform endoscopic retrograde cholangiopancreatography on POD 2, and inserted endoscopic nasobiliary drainage and nasopancreatic drainage tubes. The patient showed a good postoperative course and was discharged on POD 57.ConclusionsEndoscopic nasobiliary and nasopancreatic drainage in combination with surgical drainage may be an effective treatment for perforated duodenal diverticulum.
Highlights
Perforation of a duodenal diverticulum is a rare complication that may become fatal with a delay in appropriate treatment
Endoscopic nasobiliary and nasopancreatic drainage in combination with surgical drainage may be an effective treatment for perforated duodenal diverticulum
The most appropriate treatment for perforated duodenal diverticulum remains disputable, which ranges from conservative therapy to surgery, including pancreatoduodenectomy
Summary
Duodenal diverticulum is a relatively common disease and usually asymptomatic unless complications occur [1]. The most appropriate treatment for perforated duodenal diverticulum remains disputable, which ranges from conservative therapy to surgery, including pancreatoduodenectomy In addition to these treatments, we consider that endoscopic treatment may play a large role to control the leakage of bile and pancreatic juice [8, 9]. Case presentation The patient was a 60-year-old female who came to the hospital with chief complaints of fever and right dorsal pain She had no particular past medical history. Because the laboratory findings revealed the elevation of inflammation markers, she was referred to our hospital for further examination and treatment. Her vital signs showed a body temperature of 37.2 °C and heart rate of 119 beats/min. In order to manage the leakage of pancreatic juice and
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
