Duodenal Diverticulum Perforation: A Rare Case Report and Review of the Literature

Öz

Aim: Duodenal diverticulum is the second most common diverticulum section in the gastrointestinal system, but perforation is rare. It is frequently diagnosed incidentally and has little clinical evidence. There are no certain treatment strategies for duodenal diverticulum perforation. Our aim is to identify perforated duodenal diverticulum cases published in the last 10 years through our case report and to evaluate different approaches to treatment. Case Report: A 58-year-old male was diagnosed central nervous system (CNS) tumor with a perforated duodenal diverticulum. Our case presented with abdominal pain and pneumoperitoneum on imaging. The patient was treated surgically with an omental patch, pyloric exclusion, retrocolic gastrojejunostomy, and tube duodenostomy. The patient died on the 10th postoperative day. Conclusion: Duodenal diverticulum perforation is a rare but fatal condition. CT is useful in diagnosis. If the patient is not in a septic condition, it can be followed conservatively. However, if the patient is in a septic condition, surgery may be required. Surgical options should be determined based on the perforation site and characteristics.

Anahtar Kelimeler

• Duodenum
• perforation
• duodenal diverticulum

Duodenal Divertikül Perforasyonu: Nadir Bir Olgu Sunumu ve Literatür İncelemesi

Öz

Amaç: Duodenal divertikül gastrointestinal sistemde en sık görülen ikinci divertikül kesitidir ancak perforasyon nadirdir. Sıklıkla tesadüfen teşhis edilir ve çok az klinik kanıtı vardır. Duodenal divertikül perforasyonu için kesin bir tedavi stratejisi yoktur. Amacımız olgu sunumumuz aracılığıyla son 10 yılda yayınlanan perfore duodenal divertikül vakalarını tespit etmek ve farklı tedavi yaklaşımlarını değerlendirmektir. Olgu Sunumu: Merkezi sinir sistemi (MSS) tümörü bulunan 58 yaşında bir erkek hastaya, perfore duodenal divertikülü tanısı konuldu. Hastanın karın ağrısı ve görüntülemede pnömoperitonyum mevcuttu. Hastaya omental yama, pilorun çıkarılması, retrokolik gastrojejunostomi ve tüp duodenostomi ile cerrahi olarak tedavi edildi. Hasta ameliyat sonrası 10. günde ex oldu. Sonuç: Duodenal divertikül perforasyonu nadir fakat ölümcül bir durumdur. BT tanıda faydalıdır. Hastanın septik durumu yoksa konservatif olarak takip edilebilir. Ancak hastanın septik bir durumu varsa ameliyat gerekebilir. Perforasyon yerine ve özelliklerine göre cerrahi seçenekler belirlenmelidir.

Anahtar Kelimeler

• Duodenum
• perforasyon
• duodenal divertikül

Kaynakça

1. 1. Thorson CM, Paz Ruiz PS, Roeder RA, Sleeman D, Casillas VJ. The perforated duodenal diverticulum. Arch Surg 2012;147(1):81-88.
2. 2. Ames JT, Federle MP, Pealer KM. Perforated duodenal diverticulum: clinical and imaging findings in eight patients. Abdom Imaging 2009;34(2):135-139.
3. 3. Ivatury RR, Nallathambi M, Gaudino J, Rohman M, Stahl WM. Penetrating duodenal injuries. Analysis of 100 consecutive cases. Ann Surg 1985;202(2):153-158.
4. 4. Haboubi D, Thapar A, Bhan C, Oshowo A. Perforated duodenal diverticulae: importance for the surgeon and gastroenterologist. BMJ Case Rep 2014;2014:bcr2014205859.
5. 5. Costa Simões V, Santos B, Magalhães S, Faria G, Sousa Silva D, Davide J. Perforated duodenal diverticulum: surgical treatment and literature review. Int J Surg Case Rep 2014;5:547- 550.
6. 6. Barillaro I, Grassi V, De Sol A, Renzi C, Cochetti G, Barillaro F, Corsi A, Cacurri A, Petrina A, Cagini L, Boselli C, Cirocchi R, Noya G. Endoscopic rendez-vous after damage control surgery in treatment of retroperitoneal abscess from perforated duodenal diverticulum: a techinal note and literature review. World J Emerg Surg 2013;8:26.
7. 7. Favre-Rizzo J, López-Tomassetti-Fernández E, Ceballos- Esparragón J, Hernández-Hernández JR. Duodenal diverticulum perforated by foreign body. Rev Esp Enferm Dig 2013;105(6):368-369.
8. 8. Rossetti A, Christian BN, Pascal B, Stephane D, Philippe M. Perforated duodenal diverticulum, a rare complication of a common pathology: A seven-patient case series. World J Gastrointest Surg 2013;27;5(3):47-50.

9. 9. Fujisaki S, Takashina M, Sakurai K, Tomita R, Takayama T. Simple diversion by duodenojejunostomy for a retroperitoneal perforation of the second portion of the duodenal diverticulum. Int Surg 2014;99(5):628-631.
10. 10. Sasaki F, Kanmura S, Nasu Y, Hashimoto S, Taguchi H, Numata M, Ido A. Double-balloon enteroscopy-assisted closure of perforated duodenal diverticulum using polyglycolic acid sheets. Endoscopy 2015;47 Suppl 1 UCTN:E204-5.
11. 11. Song S. Management of Perforated Duodenal Diverticulum: Report of Two Cases. Korean J Gastroenterol 2015;66(3):159- 163.
12. 12. Yang F, Di Y, Jin C, Zhong L, Fu DL. Education and imaging. Gastroenterology: Juxtapapillary diverticulum perforation after endoscopic retrograde cholangiopancreatography. J Gastroenterol Hepatol 2015;30(4):651.
13. 13. Majerus B, Mathonet P, Haxhe JP. Traumatic Rupture of a Duodenal Diverticulum: Case Report and Review of the Literature. Acta Chir Belg 2015;115(4):310-313.
14. 14. Glener J, Poris S, Foles B, Harmon R. Perforated duodenal diverticulum case report. Int J Surg Case Rep. 2016;29:100-102.
15. 15. Gulmez M, Yildiz MK, Odabasi HM, Abuoglu HH, Ilhan O, Kaytaz K. Perforated duodenal diverticulum: A case report. North Clin Istanb 2015;3(2):143-145.
16. 16. Koh YX, Chok AY, Wong AS. Perforated duodenal diverticulum as an unusual sequelae of intestinal obstruction. ANZ J Surg 2016;86(6):516-517.
17. 17. Branco C, Carneiro T, Luis D, Gomes A. Perforated duodenal diverticulum: a rare complication in a common condition. BMJ Case Rep 2017;2017:bcr2017219881.
18. 18. Degheili JA, Abdallah MH, Haydar AA, Moukalled A, Hallal AH. Perforated duodenal diverticulum treated conservatively: another two successful cases. Case Rep Surg 2017:4045970.
19. 19. Nepal P, Maemura K, Mataki Y, Kurahara H, Kawasaki Y, Hiwatashi K, Iino S, Sakoda M, Arigami T, Ishigami S, Shinchi H, Natsugoe S. Management of horizontal duodenal perforation: a report of three cases and review of literature. Surg Case Rep. 2017;3(1):119.
20. 20. Shirobe T, Kawakami H, Abe S, Yokochi T. Retroperitoneal perforation arising from duodenal diverticulum treated by endoscopic drainage: a case report. Clin Case Rep 2017;5(5):654- 657.
21. 21. Khan K, Saeed S, Maria H, Sbeih M, Iqbal F, Ramcharan A, Donaldson B. Duodenal diverticular perforation after small bowel obstruction: a case report. Case Rep Surg 2018:6197828.
22. 22. Philip J, Cocieru. Pancreatoduodenectomy in patient with perforated duodenal diverticulum and peritonitis: case report. Int J Surg Case Rep 2019;58:48-49.
23. 23. Sahned J, Hung Fong S, Mohammed Saeed D, Misra S, Park IS. Duodenal Diverticulitis: To Operate or Not To Operate? Cureus 2019;11(11):e6236.
24. 24. Yagi S, Ida S, Ohashi M, Kumagai K, Hiki N, Sano T, Nunobe S. Two cases of a perforated duodenal diverticulum after gastrectomy with Roux-en-Y reconstruction. Surg Case Rep 2019;5(1):169.
25. 25. Kabelitz N, Brinken B, Bumm R. Retroperitoneal perforation of a duodenal diverticulum containing a large enterolith after Roux-en-Y bypass and cholecystectomy. Surg Case Rep. 2020;2020(2):rjz383.
26. 26. Maki H, Yuasa Y, Matsuo Y, Mori O, Tomibayashi A. Repair of a perforated duodenal diverticulum using intraduodenal suture in 94 year old woman: A case report. Int J Surg Case Rep 2020;71:163-167.
27. 27. Moysidis M, Paramythiotis D, Karakatsanis A, Amanatidou E, Psoma E, Mavropoulou X, Michalopoulos A. The challenging diagnosis and treatment of duodenal diverticulum perforation: a report of two cases. BMC Gastroenterol 2020;20:5.
28. 28. Sugimoto H, Fujikawa A, Kishida A. A rare complication of the duodenal diverticulum. Frontline Gastroenterol 2020;11:81-82.
29. 29. Palumbo V, Sofia M, Mattone E, Bonaccorso R, Guastella T, La Greca G, Russello D, Latteri S. Traumatic perforated diverticulum of the fourth duodenal portion: First case report and literature review. Ann Med Surg (Lond) 2020;57:114-117.
30. 30. Shimada A, Fujita K, Kitago M, Ichisaka S, Ishikawa K, Kikunaga H, Kumai K, Miura H. Perforated duodenal diverticulum successfully treated with a combination of surgical drainage and endoscopic nasobiliary and nasopancreatic drainage: a case report. Surg Case Rep 2020;6(1):129.
31. 31. Kansoun A, El-Helou E, Amiry AR, Bahmad M, Mohtar IA, Houcheimi F, Maanieh N, Hazim M, Rahal K, Atwi H, Ambriss W. Surgical approach for duodenal diverticulum perforation: A case report. Int J Surg Case Rep 2020;76:217-220.
32. 32. Wichmann D, Jansen KT, Onken F, Stüker D, Zerabruck E, Werner CR, Yurttas C, Thiel K, Königsrainer A, Quante M. Endoscopic negative pressure therapy as stand-alone treatment for perforated duodenal diverticulum: presentation of two cases. BMC Gastroenterol 2021;21(1):436.
33. 33. Shiraishi T, Wada H, Hashimoto S, Katayama H, Taba M, To K. A case of two traumatic penetrations of a duodenal diverticulum caused by a kick to the upper abdomen. Int J Surg Case Rep 2021;87:106388.
34. 34. Tomida H, Nakagawa K, Matsumura H, Shinichiro I, Matsushita A, Koike S. Perforated Duodenal Diverticulum With Postoperative Diverticulum Bleeding Successfully Treated Using Transcatheter Arterial Embolization. Cureus 2021;13(9): e18219.
35. 35. Zhong B, Li Z, Lin Z, Shen Y, Zhang J, Jin W. Spontaneous perforation of a primary duodenal diverticulum stepped treatment model: A 10-patient case report. Front Surg 2022;9:936492.
36. 36. Coevoet D, Anné F, Schouten J, Holvoet T, Naessens B, Verlinden W. Spontaneous perforated duodenal diverticulum: a case series. Acta Gastroenterol Belg 2022;85(2):387-389.
37. 37. Chomel J. Report of a case of duodenal diverticulum containing gallstones. Hist Acad R Sci Paris 1710;1710:48-50.
38. 38. López Zárraga F, Saenz De Ormijana J, Diez Orive M, Añorbe E, Aisa P, Aguirre X, Arteche E, Catón Santaren B. Abdominal pain in a young woman (2009: 8b). Eur Radiol 2009;19(11):2783-2786.
39. 39. Duarte B, Nagy KK, Cintron J. Perforated duodenal diverticulum. Br J Surg 1992;79(9):877-881.