The Management of Duodenal Perforation: Change Over Time. A Case Series and Literature Review

Abstract

Duodenal perforation, which may occur with a variety of etiologies (i.e., peptic ulceration, trauma, iatrogenic, etc.) is a potentially life-threatening event. Contrast enhanced computed tomography (CECT) is the most useful imaging technique for identifying duodenal perforation, although some cases may require surgical exploration for diagnosis. The choice of treatment depends on the cause of perforation, the timing of presentation, its location, the extent of the injury and the clinical condition of the patient. Conservative management appears to be feasible and may be successful in stable patients with sealed perforations, but the majority of patients require immediate surgery for peritonitis and/or intra-abdominal sepsis. Recently, minimally invasive techniques have been introduced as a safe and effective alternative to conventional open surgery for selected patients. Here, we present our recent clinical experience and review the current literature on duodenal perforations along with the various different treatment strategies.