A Patient with Retroperitoneal Abscess Following ESD-Related Duodenal Perforation

Abstract

In a 61-year-old male, duodenal perforation occurred following endoscopic submucosal dissection (ESD) for early duodenal cancer. On the same day, an emergency laparotomy was performed. For repair, a T-tube measuring 13 mm in diameter was inserted into the 3-cm perforation site at the descending limb of the duodenum. Seven days after surgery, an intraperitoneal hemorrhage was seen due to leakage at the repair site. Hemostasis under laparotomy and duodenojejunostomy was performed. Subsequently, multiple abscesses involving the dorsal side of the right kidney to chest wall/mediastinum developed. At the same site, emphysema related to air infusion on endoscopic treatment was also observed. An oblique incision was established in the right ventral region 19 days after the initial surgery, and open-drainage of the retroperitoneal cavity was conducted. The patient was admitted to the ICU. Under mechanical ventilation, manual lavage was performed for 32 days. Subsequently, the abscess cavity gradually reduced, and the patient was discharged 195 days after the initial surgery. Advances in endoscopic techniques have increased the number of patients for whom endoscopic treatment is indicated. With this tendency, the incidence of complications, which had been low, has also increased. In this study, we report on a patient in whom post-ESD duodenal perforation resulted in retroperitoneal abscess, and review the literature.