A case of perforated duodenal ulcer with retroperitoneal abscess

Abstract

A 52-year-old man who had alcoholic liver cirrhosis and diabetes mellitus was seen for abdominal pain in April, 2007. Chest X-ray film showed free air under the left diaphragm. Perforation of digestive tract was suspected and an emergency laparotomy was done. Perforation of a bulbar ulcer was found and closure of the hole with omentopexy was done. In spite of continuous postoperative antibiotic treatment, infection signs and symptoms continued. Abdominal computed tomography on postoperative days 8 showed an abscess formation around the pancreas and the left kidney and in the retroperitoneal space along the left iliopsoas muscle. Percutaneous drainage of the retroperitoneal abscess was done through a catheter put in the left anterior pararenal extraperitoneal space. The drainage from the catheter was good, but infection marker did not improved. Then an open drainage and drain tube placement around the kidney over the left iliopsoas muscle for the retroperitoneal abscess was done through left retroperitoneal approach on 16 days after surgery. The second drainage therapy worked well and he was discharged on postoperative days 32.