Abstract
A 62-year-old woman had upper abdominal pain for two days. Abdominal CT showed pneumoperitoneum and fluid collection around the duodenum. Esophagogastroduodenoscopy revealed discharges out of juxtapapillary duodenal diverticulum. Then she underwent emergency operation under the diagnosis of perforated duodenal diverticulitis. We dissected the duodenum to find the perforation site, but were unable to detect it. The perforation site was thought to be hard to close surgically, and we decided to finish the operation by leaving drains there. After the operation inflammation had turned down, however, small amount of discharge had kept on coming out of the drain. Fistulogram showed a shadow defect in the diverticulum suggesting an enterolith, and esophagogastroduodenoscopy revealed an enterolith in the duodenal diverticulum. Endoscopic lithotomy was attempted in vain, then the patient underwent reoperation. The enterolith was removed, and plication of the duodenal diverticulum was performed. The enterolith was a true enterolith. There are 89 domestic case reports of perforated duodenal diverticulum, and 28 of those had enteroliths. Because most of true enteroliths are X-ray lucent and could be missed like our case, we must confirm existence of enteroliths in duodenal diverticulum.
