Laparoscopic Diverticulectomy for a Perforated Duodenal Diverticulum: A Case Report

Division of Gastrointestinal Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Journal of Laparoendoscopic & Advanced Surgical Techniques (Impact Factor: 1.34). 11/2010; 20(9):757-60. DOI: 10.1089/lap.2010.0346
Source: PubMed


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.

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    • "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 [11]. 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. "
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    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.
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    ABSTRACT: To perform a literature review of perforated duodenal diverticulum with attention to changes in management. We searched PubMed for relevant studies published from January 1, 1989, through August 1, 2011. In addition, we identified and reviewed 4 cases at our institution. Search phrases were perforated duodenal diverticulum and duodenal diverticulitis. Patient demographics, clinical characteristics, radiologic findings, treatment, and outcomes were obtained. We reviewed 39 studies producing 57 cases, which were combined with the 4 at our institution for a total of 61 patients. The addition of 2 previous series revealed a total of 162 patients in the world literature. Perforations were most commonly located in the second or third portion of the duodenum (60 of 61 cases [98%]), and the most frequent cause was diverticulitis (42 of 61 [69%]). There has been a dramatic improvement in the preoperative diagnosis of perforated diverticula. Only 13 of 101 reported cases (13%) were correctly diagnosed before 1989, and 29 of 61 (48%) in the present series were identified with radiologic examinations. Most patients in the current series (47 of 61) underwent operative treatment for their perforation, although 14 underwent successful nonoperative management. Complications were reported in 17 of 47 patients in the surgical group (36%), whereas only 1 complication was seen in patients undergoing nonoperative management. Mortality in the surgical group was 6% (3 of 47), and no deaths were reported in the nonoperative group. Perforation of a duodenal diverticulum is rare, with only 162 cases reported in the world literature. Nonoperative management has emerged as a safe, practical alternative to surgery in selected patents.
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    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.
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