A Case of Effective CT-guided Drainage for Retroperitoneal Perforation of a Duodenal Diverticulum

Abstract

A 63-year-old woman presented to us with epigastric pain and was diagnosed in the emergency department as having retroperitoneal perforation of a duodenal diverticulum by contrast-enhanced computed tomography (CT). Due to the emphysema being confined to the retroperitoneum and the absence of peritoneal irritation, the patient was started on conservative management, including fasting, fluid replacement, antibiotic and proton pump inhibitor administration, and nasogastric drainage. On the 4th day, follow-up CT revealed abscess formation, and CT-guided drainage was performed using a pig-tail catheter. On the 7th day, the patient was begun on enteral nutrition, and her condition improved without complications, so that she was discharged from the hospital on the 16th day. On the 33rd day, although the abscess had resolved, elevated drain-fluid amylase levels suggested a possible pancreatic leak. The patient was readmitted and the existing drain was replaced with a straight tube. On the day after the replacement, the tube was accidentally removed by the patient; however, the patient was discharged uneventfully on the 41st day. On the 67th day, follow-up CT confirmed the absence of recurrence, and the patient remained asymptomatic without any further complications. Percutaneous drainage is rarely used to treat perforated duodenal diverticulum. However, when the abscess cavity is large, CT-guided drainage via the transabdominal route should be considered as a minimally invasive treatment option.