Duodenal perforation masquerading as an intra-abdominal abscess: successful management with pedicled falciformopexy

Duodenal perforation typically presents as an acute abdomen. In contrast, presentation as an intra-abdominal abscess is rare and may delay diagnosis. We report a 25-year-old male who presented with 8 days of upper abdominal pain and 4 days of progressive abdominal distension. Despite marked abdominal distension, he had no signs of peritonitis. Laboratory investigations showed marked leukocytosis. Chest radiography showed no classical subdiaphragmatic free air, whereas computed tomography confirmed pneumoperitoneum. Emergency exploratory laparotomy revealed an intra-abdominal abscess with dense omental adhesions encasing the bowel. A 1 × 1 cm perforation on the anterior wall of the first part of the duodenum was identified. As the omentum was unsuitable for conventional patch repair, the perforation was successfully repaired using a pedicled falciform ligament flap. This case highlights an uncommon presentation of duodenal perforation and demonstrates the falciform ligament flap as an effective alternative when omental patch repair is not feasible.