Perforation of a duodenal diverticula

Area of Science:

• Gastroenterology
• Surgical Gastroenterology
• Abdominal Imaging

Background:

• Duodenal diverticula are common, with diagnosis rates increasing due to advanced imaging.
• Periampullary diverticula (PAD) are classified endoscopically (Types 1, 2, 3) based on major papilla location.
• Complications include ulceration, bleeding, obstruction, and rare but high-mortality perforations.

Purpose of the Study:

• To describe a case of spontaneous duodenal diverticulum perforation presenting as acute pancreatitis.
• To highlight the diagnostic challenges and the effectiveness of conservative management for this rare complication.

Main Methods:

• Case report of a 61-year-old male with severe abdominal pain and elevated inflammatory markers.
• Initial diagnosis of acute pancreatitis, later revised after repeat CT scan revealed duodenal diverticulum perforation.
• Management involved conservative measures: absolute diet, parenteral nutrition, and antibiotics (ciprofloxacin, metronidazole).

Main Results:

• The patient presented with symptoms initially mimicking acute pancreatitis but showed poor response to treatment.
• Repeat CT confirmed spontaneous perforation of a duodenal diverticulum.
• Conservative management led to clinical improvement, tolerance of diet reintroduction, and resolution of inflammatory markers.

Conclusions:

• Spontaneous duodenal diverticulum perforation, though rare, requires careful diagnosis and consideration.
• Conservative management can be a successful approach for contained duodenal perforations.
• Early recognition and appropriate non-operative treatment are crucial for favorable outcomes.