Abstract
BackgroundThe duodenum is a common site for diverticulum formation. Most of the duodenal diverticula are asymptomatic, incidental findings. Perforation is a rare but potentially lethal complication of duodenal diverticular disease. Surgery remains the mainstay of treatment for perforated duodenal diverticula. In recent years, a few cases were successfully managed either conservatively or with endoscopy.Case presentationWe present two cases of female patients treated in our department for duodenal diverticulum perforation. The first case was treated surgically with a diverticulectomy. The second case was managed conservatively with bowel rest and intravenous antibiotics. Both patients had an uncomplicated postoperative course and were discharged home.ConclusionsBoth surgical and conservative treatments are viable options for a perforated duodenal diverticulum in selected patients. Patients with a contained duodenal diverticular perforation can be managed conservatively at the outset. Possibly, the introduction of a classification system for duodenal diverticulum perforation may help clinicians in making essential therapeutic decisions.
Highlights
The duodenum is a common site for diverticulum formation
The prevalence of duodenal diverticula is believed to be as high as 22% of the population as found in cadaveric studies, increasing with age [2], but the majority of them remain uncomplicated and are only discovered incidentally during endoscopic or imaging studies of the upper GI
Perforation of a Duodenal Diverticula (DD), the rarest, is the gravest complication, as it bears a high mortality rate, varying from 3 to 30% in the literature [4, 5]. It is often overlooked in the differential diagnosis. It is misdiagnosed in a lot of cases, and its symptoms are attributed to other causes of acute abdomen
Summary
Both surgical and conservative treatments are viable options for a perforated duodenal diverticulum in selected patients. Patients with a contained duodenal diverticular perforation can be managed conservatively at the outset. The introduction of a classification system for duodenal diverticulum perforation may help clinicians in making essential therapeutic decisions
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