Abstract
A 68-year-old male with a past medical history of systemic lupus erythematosus was seen due to epigastric and back pain. On physical examination, only epigastric tenderness was found. Abdominal CT showed a thickened fourth portion of the duodenal wall, a dirty fat sign, and free air in the anterior of the left renal vein. An emergency operation was performed under the diagnosis of perforation of a duodenal neoplasm. A laparotomy in corporating the Kocher maneuver, displacement of the distal pancreas, and cutting of the ligament of Treitz did not reveal the mass or the perforation. Intraoperative endoscopy was done, and a perforated duodenal diverticulum due to a fishbone was found. The diverticulum was excised. The patient was discharged on the 19th post op day. We report a rare case of a perforated fourth portion of the duodenal diverticulum, caused by a fishbone which was diagnosed on intraoperative endoscopy.
