Perforated duodenal diverticulum successfully diagnosed preoperatively with abdominal CT scan associated with upper gastrointestinal series

ArticleinJournal of Gastroenterology 39(4):379-83 · February 2004with24 Reads
DOI: 10.1007/s00535-003-1306-5 · Source: PubMed
Abstract
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.
    • "They are usually asymptomatic; on the other hand they can determine abdominal postprandial pain, dyspeptic disorders or colic-like pains [2] ; 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 [6]. Surgery is necessary only if symptoms are persistent or if complications arise [7] : the diagnosis of perforated diverticula of the third duodenal portion is late and the management is still matter of debate89101112. "
    [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.
    Full-text · Article · Jul 2013
    • "Larger case series regarding cannulation difficulties of the common bile duct during ERCP due to the presence of juxtapapillary diverticula can be found in the gastroenterology literature [6,7,14,15]. Sparse case reports on various complications of duodenal diverticula have also been published and in our study we tried to provide the clinical information and illustrate the imaging findings in patients with acute abdomen that could possibly or definitely be attributed to duodenal diverticulosis161718. Not surprisingly in our patients the clinical suspicion of duodenal diverticula as an underlying cause of abdominal pathology was very low. "
    [Show abstract] [Hide abstract] ABSTRACT: The purpose of this study was to evaluate and demonstrate the clinical and imaging features of symptomatic duodenal diverticula presenting as or mimicking acute abdomen. The imaging studies of 10 patients, all presenting with acute abdomen and diagnosed with duodenal diverticula as the possible underlying cause, over a time period of 20 months were retrospectively analyzed. Eleven duodenal diverticula were depicted in 8 Multidetector Computed Tomography (MDCT) exams, 2 MRI-MRCP exams and in one intraoperative cholangiography. Acute abdominal symptomatology resulting from duodenal diverticula was as follows: one patient presented with perforation-diverticulitis, two patients with pancreatitis, one patient with acute acalculous cholecystitis, four patients with biliary dilation and two patients with acute postprandial discomfort-pain. The mean maximal diameter of the diverticula examined was 2.67 cm (range 0.96-4.98 cm). Further image analysis of the MDCT exams revealed that both the axial and the coronal plane demonstrated the presence of the diverticula but the depiction of the diverticular neck was demonstrated in five cases in the axial plane and in all cases in the coronal plane. Although duodenal diverticula constitute a rare cause of acute abdomen, careful analysis of imaging studies can aid to the identification of this uncommon factor of abdominal symptomatology.
    Full-text · Article · Jan 2011
    • "Furthermore, a omentoplasty can be patched over the closure site [6]. During the procedure special care should be taken to avoid injury to the pancreatic duct and parenchyma as well as to the extrahepatic bile ducts, because most diverticula arise in the periampullary region [3, 21]. Injury to these structures can be avoided by placing a tube into Vater's papilla before dissecting the diverticulum [6]. "
    Article · Jan 2011 · Annals of Gastroenterology
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