A Case of Diverticular Perforation of the Transverse Duodenum That Was Managed Conservatively

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  • Uchida Fumitake
    Department of Digestive Surgery, Ureshino Medical Center, National Hospital Organization
  • Moriyama Masaaki
    Department of Digestive Surgery, Ureshino Medical Center, National Hospital Organization
  • Oyama Shosaburo
    Department of Digestive Surgery, Ureshino Medical Center, National Hospital Organization
  • Shibuya Ayako
    Department of Digestive Surgery, Ureshino Medical Center, National Hospital Organization
  • Wada Hideo
    Department of Digestive Surgery, Ureshino Medical Center, National Hospital Organization
  • To Kazuo
    Department of Digestive Surgery, Ureshino Medical Center, National Hospital Organization

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Other Title
  • 保存的に治療しえた十二指腸水平部憩室穿孔の1例

Abstract

<p>A 64-year-old male visited a clinic due to left lower quadrant abdominal pain for 2 days. He was referred to our hospital for retroperitoneal emphysema observed on abdominal CT. Blood tests showed severe inflammation. Contrast-enhanced CT of the abdomen showed increased density of the adipose tissue and pneumoperitoneum around the celiac and superior mesenteric arteries. Peritonitis was localized, and conservative treatment was initiated. A nasal decompression tube was inserted under fluoroscopic guidance, and the tip was guided to the end of the descending duodenum. The tube was placed for intermittent continuous suction and the patient was treated with total parenteral nutrition, proton pump inhibitors, pancreatic enzyme inhibitors, and antibiotics. Inflammation gradually improved and the patient started oral intake on treatment day 17. On treatment day 29, upper gastrointestinal endoscopy was performed, and a diverticulum with granulation tissue was observed in the transverse duodenum. Diverticular perforation of the transverse duodenum is rare, and there are very few reports of cases with conservative treatment. Our case shows that conservative management of this condition is feasible with careful observation.</p>

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