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Duodenal Diverticulitis: To Operate or Not To Operate?

Duodenal diverticulum (DD) is a common incidental finding, which rarely causes complications. Perforation is one of the most feared and the least common complications. Surgery is the mainstay for complicated duodenal diverticulum, but with the advancement of medical treatment and intensive care, nonoperative management has been reported. We present a rare case of perforated DD that failed medical management and subsequently underwent surgical intervention. A 77-year-old, healthy female presented…

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Case Reports

. 2019 Nov 26;11(11):e6236.

doi: 10.7759/cureus.6236.

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Case Reports

Jaafar Sahned et al. Cureus. .

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Abstract

Duodenal diverticulum (DD) is a common incidental finding, which rarely causes complications. Perforation is one of the most feared and the least common complications. Surgery is the mainstay for complicated duodenal diverticulum, but with the advancement of medical treatment and intensive care, nonoperative management has been reported. We present a rare case of perforated DD that failed medical management and subsequently underwent surgical intervention. A 77-year-old, healthy female presented with right-sided abdominal pain with low-grade fever and leukocytosis. Computed tomography (CT) of the abdomen showed retroperitoneal fluid collection around the second part of the duodenum, which was not amenable to percutaneous drainage. Contrast studies showed no evidence of perforation or leak of the stomach or duodenum. The diagnosis was made via an upper endoscopy that showed a large periampullary duodenal diverticulum with purulent drainage and normal-looking ampulla. After failed conservative management with broad-spectrum antibiotics and worsening symptoms, she underwent excision and primary repair of the diverticulum with a jejunal serosal patch and exploration of the common bile duct (CBD). She had an uncomplicated postoperative course and was discharged home on postoperative day four. Although rare, the duodenal diverticular perforation can be a life-threatening complication. Combined subjective, clinical, and radiological assessment of the patient is crucial in deciding whether to operate or not.

Keywords: duodenal diverticulitis; duodenal diverticulum; duodenum.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1

Figure 1. CT abdomen (coronal section) demonstrates a complex collection with a contained contrast leak related to the perforated duodenal diverticulum
Figure 2

Figure 2. CT abdomen (sagittal section) demonstrates a complex collection with a contained contrast leak related to the perforated duodenal diverticulum

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References

    1. Perforated duodenal diverticulum: surgical treatment and literature review. Costa Simões V, Santos B, Magalhães S, Faria G, Sousa Silva D, Davidea J. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4147632/ Int J Surg Case Rep. 2014;5:547–550. – PMC PubMed
    1. Conservative treatment of duodenal diverticulitis perforation: a case report and literature review. Kim KH, Park SH. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6121776/ Open Access Emerg Med. 2018;30:101–104. – PMC PubMed
    1. Perforated duodenal diverticulum treated conservatively: another two successful cases. Degheili JA, Abdallah MH, Haydar AA, Moukalled A, Hallal AH. Case Rep Surg. 2017;2017:4045970. – PMC PubMed
    1. Perforated duodenal diverticulum. Duarte B, Nagy KK, Cintron J. Br J Surg. 1992;79:877–881. – PubMed
    1. Duodenoscopic diagnosis of perforated periampullary diverticulitis. Yarze JC. https://www.ncbi.nlm.nih.gov/pubmed/11922587. Am J Gastroenterol. 2002;97:769. – PubMed

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