Surgically Treated Abscess Surrounding the Third Portion of the Duodenum: A Case Report

Abstract

An 86-year-old man came to our hospital with a chief complaint of abdominal pain. Contrast-enhanced computed tomography revealed extraluminal air and fluid extending into the dorsal retroperitoneum of the pancreas and duodenum and disruption of the wall of the third portion of the duodenum. A diagnosis of perforation of the third portion of the duodenum was made, and emergency surgery was performed. Kocher’s maneuver revealed a retroperitoneal abscess in the dorsal duodenum, which was determined to be the perforated area. We dissected the inferior duodenal angle and jejunum approximately 10 cm lateral to the ligament of Treitz and performed a side-to-side anastomosis between the second portion of the duodenum and the jejunum plus an additional gastrojejunal anastomosis and enterostomy. The patient’s overall clinical course was favorable despite delayed gastric emptying. The pathological diagnosis was duodenal diverticulitis and pneumatosis. In the surgical treatment of the third portion of the duodenum, a papilla-preserving duodenectomy can prove beneficial.