A Case of Perforated Duodenal Diverticulum and Retroperitoneal Abscess Performed Pyloric Exclusion

Abstract

Perforation of a duodenal diverticulum is a relatively uncommon entity and we often have great difficulties in selecting therapeutic methods owing to its anatomical specificity. This time we were able to obtain a favorable outcome in such a patient by adding pyloric exclusion. This paper deals with the case with a review of the literature.
A 77-year-old woman was referred to our emergency clinic because of abdominal pain. Blood analysis revealed increased inflammatory reaction. An abdominal CT scan showed abscess formation around the duodenum. Retroperitoneal abscess due to duodenal perforation was diagnosed, and sub-emergency surgery was performed on the 2^nd hospital day.
Intraoperatively we saw that the abscess had extended from the pancreas head to the posterior aspect of the duodenum ; the perforated site was demonstrated at the anal side of the ampulla of Vater ; and the surrounding tissue became necrotic for which omentoplasty was performed. The patient was considered to be at high risk of developing anastomotic leakage and we decided to add pyloric exclusion to decompress the duodenum. We closed the pylorus from the inner lumen and gastrojejunostomy was added. A T-tube was placed into the common bile duct. Although anastomotic leakage occurred at the filling site in the duodenum, she was able to have meals and was discharged from the hospital on the 11^th postoperative day.