Perforated duodenal diverticulum successfully diagnosed preoperatively with abdominal CT scan associated with upper gastrointestinal series
Department of Surgery, Fujita Health University, Nagoya, Aichi, Japan Journal of Gastroenterology
(Impact Factor: 4.52).
02/2004; 39(4):379-83. DOI: 10.1007/s00535-003-1306-5
Although duodenal diverticulum is not uncommon, precise preoperative diagnosis is occasionally difficult. We report a patient with perforated duodenal diverticulum successfully diagnosed preoperatively by an upper gastrointestinal series followed by abdominal computed tomography (CT) scanning. An 81-year-old Japanese woman visited a local hospital because of right-sided abdominal pain. Physical examination revealed diffuse muscle guarding localized in the entire right-side of the abdomen indicative of peritonitis. While plain abdominal X-ray film revealed no free air, abdominal ultrasound and abdominal CT scanning revealed fluid collection and gas in the anterior perirenal space. An emergency upper gastrointestinal series, using water-soluble contrast media, demonstrated multiple diverticula in the descending portion and the horizontal portion of the duodenum. Leakage of the contrast material was found by the upper gastrointestinal series followed by the abdominal CT scanning, suggesting that the peritonitis was caused by the perforated duodenal diverticulum, and an emergency laparotomy was performed. The diverticulum in the descending portion of the duodenum was mobilized from the retroperitoneum and complete resection and peritoneal drainage were performed. The resected specimen showed that the diverticulum was 42 x 23 mm in size, and two separate sites of perforation were identified. The present case suggests that upper gastrointestinal series followed by CT scan is useful for the preoperative diagnosis of perforated duodenal diverticulum.
Available from: Claudio Renzi
- "They are usually asymptomatic; on the other hand they can determine abdominal postprandial pain, dyspeptic disorders or colic-like pains ; diverticulitis, bleeding, perforation may rarely occur [4,5]. The first case report of duodenal diverticulosis, describing a diverticulum containing 22 gallstones, was performed in 1710 by Chomel . Surgery is necessary only if symptoms are persistent or if complications arise : the diagnosis of perforated diverticula of the third duodenal portion is late and the management is still matter of debate [8-12]. "
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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.
Available from: Nihat Yavuz
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ABSTRACT: Background and Design.- Duodenal diverticular disease is an uncommon clinical entity; however, with progressive aging of the population, duodenal diverticulosis is encountered more often. Duodenal diverticula, discovered incidentally in patients during upper gastrointestinal examinations, are usually asymptomatic, but can be the source of significant morbidity. When duodenal divertucula are located near the major duodenal papilla, they are called juxtapapillary (periampullary) duodenal diverticula. The aim of this study was to investigate the frequency, clinical characteristics, findings and possible varieties of treatment of duodenal diverticula in patients with duodenal diverticula. We retrospectively reviewed the cases of duodenal diverticulum undergone surgical treatment between 1983 and 2003. Clinical findings and pathological results were learned from records of cases. Results.- 25 patients with duodenal diverticula were treated at our clinic from 1983 to 2003. Their age was comprised between 43 and 80 years. Mean age of them was 58.1 years. Fifteen of cases were women (60%) while ten were men (40%). The second part of duodenum was involved in 15 cases (60%). The third part of duodenum was involved in 6 cases (24%) and the fourth in 4 cases (16%) Multiple diverticula were found only 2 cases. 9 patients had bilio-pancreatic symptoms including in recurrent episodes of cholangitis, progressive jaundice and abdominal pain. In patients with diverticula of third and fourth part, abdominal pain and vomiting were the main symptoms. Conclusions.- Diverticulectomy is an effective surgical procedure. Juxtapapillary duodenal diverticula are important causative factors in the formation of biliary stones. Ersan Y, Yavuz N, Çiçek Y, Ergüney S, Kuşaslan R, Belli A. Clinical analysis and review of related literature in cases of duodenal diverticulosis. Cerrahpaşa J Med 2005; 36: 120-127.
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ABSTRACT: La enfermedad diverticular del duodeno es una entidad clínica poco frecuente. La perforación es la complicación menos habitual. La secuencia diagnóstica y terapéutica no está definida debido a que su forma de presentación y sus síntomas son muy inespecíficos. La demora diagnóstica comporta tasas de mortalidad operatoria elevadas (30%). El diagnóstico precoz es fundamental para reducir la morbimortalidad. Se presenta el caso de un paciente con un divertículo duodenal perforado. Este caso indica que la tomografía computarizada es de gran utilidad en el diagnóstico preoperatorio. El tratamiento consistió en la exclusión duodenal y el drenaje del retroperitoneo.
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