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Duodenal Diverticulitis: To Operate or Not To Operate?
Jaafar Sahned1, Suysen Hung Fong1, Dereen Mohammed Saeed2
1Surgery, Brandon Regional Hospital, Brandon, USA.
Cureus
|January 1, 2020
Summary
Perforated duodenal diverticulum (DD) is rare but serious. This case highlights a patient whose condition worsened despite antibiotics, necessitating surgical repair for perforated DD.
Area of Science:
- Gastroenterology
- Surgical Gastroenterology
- Abdominal Imaging
Background:
- Duodenal diverticulum (DD) is frequently found incidentally, with complications being rare.
- Perforation of a duodenal diverticulum is an uncommon but severe complication.
- While surgery is standard for complicated DD, nonoperative management is increasingly reported.
Observation:
- A 77-year-old female presented with abdominal pain, fever, and leukocytosis.
- CT revealed retroperitoneal fluid; contrast studies were inconclusive for perforation.
- Upper endoscopy diagnosed a large periampullary DD with purulent drainage.
Findings:
- The patient's condition deteriorated despite conservative management with antibiotics.
- Surgical intervention, including diverticulum excision and repair with a jejunal serosal patch, was performed.
- The patient experienced an uncomplicated postoperative recovery.
Implications:
- Perforated duodenal diverticulum, though rare, can be life-threatening.
- A comprehensive assessment integrating clinical, subjective, and radiological data is vital for treatment decisions.
- This case underscores the importance of surgical intervention when nonoperative management fails for perforated DD.
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