Penetration at the Horizontal Portion of the Duodenum with Intramesenteric Abscess Formation Caused by Duodenal Foreign Bodies—A Case Report—

Abstract

A 43-year-old woman who was a resident of a facility for mentally retarded persons presented with anorexia/vomiting. As computerized tomography (CT) revealed foreign bodies in the stomach, she was admitted to the emergency department in our hospital. Upper gastrointestinal endoscopy revealed foreign bodies in the gastric and duodenal lumina, but they were too large to be removed. The duodenal lumen was finally emptied of the foreign bodies, and thereafter her clinical course had been observed. Subsequently, she underwent emergency surgery, because penetration and abscess formation in the mesenterium of the small intestine were suspected on CT. The foreign bodies in the stomach were removed via minilaparotomy at first. The gastric wall was then closed and the intraperitoneal cavity was examined by single-incisional laparoscopy, but there were no obvious detectable abnormalities. Intraoperative colonoscopic observation of the alimentary tract performed up to the ileum did not reveal any obvious abnormalities or presence of foreign bodies. Through an incision in the jejunum, retrograde observation of the duodenal and gastric lumina was made by intraoperative endoscopy. The site of penetration was located in the horizontal portion of the duodenum. After kocherization and derotation of the mesenterium of the small intestine, the duodenal descending to horizontal portion was examined. An inflammatory lesion was noted at the site of insertion of the mesenterium to the duodenal horizontal portion, and the site of perforation was confirmed upon ablation of the insertion. The perforation was closed by placing sutures, covered with an omental patch and decompressive duodenostomy. The postoperative course was uneventful, and the patient was discharged home in an improved condition.