We report a case of a perforated duodenal diverticulum that was diagnosed by computed tomography and treated by laparoscopic diverticulectomy. A 61-year-old woman visited the emergency room complaining of severe, sudden abdominal pain with nausea and vomiting. Computed tomography showed a round space containing air bubbles and food material in the posterior aspect of the second duodenal portion. The patient underwent an emergency laparoscopic exploration. Entering the posterior side of the duodenum, dirty reactive fluid was drained and an ∼4-cm perforated diverticulum was revealed at the posterolateral aspect of the second duodenal portion. After completing the peridiverticular dissection, a diverticulectomy was performed using ultrasonic shears, and the opening of the diverticulum was closed in two layers using intracorporeal hand-sewn sutures. She was discharged on postoperative day 10 without complications. To our knowledge, this is the first report of laparoscopic resection of a perforated duodenal diverticulum.
"In literature, several types of treatments are described, both surgical or conservative, according to the patient’s condition and the localization of the duodenal diverticulum: segmental duodenectomies, pylorus-preserving pancreaticoduodenectomy (p-p Whipple), diverticulectomies . At the moment, the conventional treatment is diverticulectomy with duodenal closure and drainage positioning, especially when they are located in the retroperitoneal space [21-23]. The revision of the medical literature does not reveal any surgical treatment equal to ours for complicated diverticula in the third duodenal portion. "
[Show abstract][Hide abstract] ABSTRACT: The duodenum is the second seat of onset of diverticula after the colon. Duodenal diverticulosis is usually asymptomatic, but duodenal perforation with abscess may occur.
Woman, 83 years old, emergency hospitalised for generalized abdominal pain. On the abdominal tomography in the third portion of the duodenum a herniation and a concomitant full-thickness breach of the visceral wall was detected. The patient underwent emergency surgery. A surgical toilette of abscess was performed passing through the perforated diverticula and the Petzer's tube drainage was placed in the duodenal lumen; the duodenostomic Petzer was endoscopically removed 4 months after the surgery.
A review of medical literature was performed and our treatment has never been described.
For the treatment of perforated duodenal diverticula a sequential two-stage non resective approach is safe and feasible in selected cases.
World Journal of Emergency Surgery 07/2013; 8(26). DOI:10.1186/1749-7922-8-26 · 1.47 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Hemorrhagic duodenal diverticula are rare and are treated by endoscopy or open diverticulectomy, especially when there is a massive hemorrhage. We report what we believe to be the first instance of urgent laparoscopic diverticulectomy of a large, inflamed duodenal diverticulum with massive hemorrhage. An elderly patient had a screening colonoscopy and additional upper gastrointestinal endoscopy because of vague upper gastrointestinal symptoms; however, both were reported to be normal. She subsequently developed massive hematemesis. Clinical examination revealed a tender right upper quadrant mass and imaging confirmed a large duodenal diverticulum with surrounding inflammatory changes. Urgent laparoscopic diverticulectomy was performed with an uneventful recovery and follow-up. Laparoscopic diverticulectomy should be considered in managing hemorrhagic duodenal diverticula.
[Show abstract][Hide abstract] ABSTRACT: Duodenal diverticula (DD) are frequently encountered and are usually asymptomatic, with an incidence at autopsy of 22%. Perforation of DD is a rare complication (around 160 cases reported) with potentially dramatic consequences. However, little evidence regarding its treatment is available in the literature. The aim of this study was to review our experience of perforated DD, with a focus on surgical management. Between January 2001 and June 2011, all perforated DD were retrospectively reviewed at a single centre. Seven cases (5 women and 2 men; median age: 72.4 years old, rang: 48-91 years) were found. The median American Society of Anesthesiologists' score in this population was 3 (range: 3-4). The perforation was located in the second portion of duodenum (D2) in six patients and in the third portion (D3) in one patient. Six of these patients were treated surgically: five patients underwent DD resection with direct closure and one was treated by surgical drainage and laparostomy. One patient was treated conservatively. One patient died and one patient presented a leak that was successfully treated conservatively. The median hospital stay was 21.1 d (range: 15-30 d). Perforated DD is an uncommon presentation of a common pathology. Diverticular excision with direct closure seems to offer the best chance of survival and was associated with a low morbidity, even in fragile patients.
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