A case of retroperitoneal abscess caused by a perforated duodenal diverticulum with an enterolith

Abstract

A 58-year-old woman was seen at the hospital because of epigastric pain and vomiting. An abdominal CT scan revealed free air which looked like abscess in the inner part of the second portion of the duodenum and the posterior aspect of the spleen, and an increased density which seemed an inflammatory change from the pancreas head to the posterolateral aspect of the second portion of the duodenum and further to the right anterior paranephric cavity. The most likely diagnosis was retroperitoneal abscess associated with perforation of the second portion of the duodenum, and an emergency operation was done. Laparotomy through upper abdominal midline incision followed by repositioning of the duodenum demonstrated an edematous retroperitoneal cavity from the anterior aspect of the inferior vena cava to the right lower pole of the kidney. Furthermore, a necrotized diverticulum was present in the inner part of the second portion of the duodenum, and a 2.5-cm sized enterolith was seen in the inner part of the diverticulum. Duodenal perforation caused by the diverticular enterolith was diagnosed. After dissection of the diverticulum followed by transection of it with a stapling device, abdominal drainage was performed. The postoperative course was uneventful, and the patient was discharged from the hospital on the 27th postoperative day.
Although perforation of a duodenal diverticulum is a very rare entity, it often reveals characteristic CT findings. We must keep a possible association of the disease in mind in making appropriate therapeutic decisions.