Abstract
In a 52-year-old man presenting with the chief complaint of right abdominal pain, abdominal computed tomography showed pneumoretroperitoneum and slight fluid retention in the region from the back of the caudal pancreatic head to that around the right kidney. Upper gastrointestinal tract endoscopy showed redness, adhesive pus, and purulent fluid discharge from a diverticular wall around the papilla of Vater. Duodenography showed contrast medium leakage from the diverticulum into the retroperitoneal space. Based on these findings, the patient was diagnosed as having a retroperitoneal abscess caused by duodenal diverticular perforation. Since the white blood cell count was elevated to 20340/mm3, surgery was also considered. However, we selected conservative therapy with duodenal drainage and antibiotic administration, considering the risk for complications such as biliary injuries and stenosis and the small size of the abscess cavity. The symptoms gradually improved, and duodenography performed on hospital day 10 showed no leakage of contrast from the diverticulum. The patient resumed eating on day 14 and was discharged from the hospital on day 18. His clinical course has since been uneventful, and there has been no evidence of recurrence for over five years. We report this case of duodenal diverticular perforation that was managed conservatively, along with a review of the literature.
