2013 Volume 33 Issue 1 Pages 127-129
A 65-year-old man with severe symptosis presented to the emergency room with a 1-month history of abdominal pain and a 3-day history of anorexia. On admission, he was in shock and showed upper abdominal tenderness, rebound tenderness and muscle guarding. Abdominal computed tomography (CT) revealed irregular regions of gas and fluid collection in the lesser sac. Emergency surgery was performed after the patient was diagnosed as having gastrointestinal perforation into the lesser sac causing septic shock. During surgery, an abscess was identified in the lesser sac extending from the first portion of the duodenum to the left colonic flexure. Quick exploration did not reveal any gastrointestinal perforation during the surgery. However, the surgery needed to be terminated because of hypotension and instability. Only a drainage of the lesser sac was performed. After surgery, gastroduodenoscopy revealed a duodenal ulcer in the posterior wall of the first portion of the duodenum. Furthermore, a connection between the lesser sac and the first portion of the duodenum was confirmed by contrast studies through the lesser sac drain, which led to the diagnosis of a lesser sac abscess resulting from a duodenal ulcer perforation.
