Case Report
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World J Gastrointest Surg. Mar 27, 2013; 5(3): 47-50
Published online Mar 27, 2013. doi: 10.4240/wjgs.v5.i3.47
Perforated duodenal diverticulum, a rare complication of a common pathology: A seven-patient case series
Andrea Rossetti, Nicolas Christian Buchs, Pascal Bucher, Stephane Dominguez, Philippe Morel
Andrea Rossetti, Nicolas Christian Buchs, Pascal Bucher, Stephane Dominguez, Philippe Morel, Division of Visceral Surgery and Transplantation, Department of Surgery, University Hospital of Geneva, 1205 Geneva, Switzerland
Andrea Rossetti, Clinic for Visceral and Vascular Surgery, Rosarchestrasse 95, 9007 St. Gallen, Switzerland
Author contributions: Rossetti A, Bucher P and Dominguez S studied and designed conception and acquired and analysed of date; Morel P and Buchs NC contributed to revise critical of manuscript.
Correspondence to: Dr. Andrea Rossetti, MD, Clinic for Visceral and Vascular Surgery, Kantonsspital St. Gallen, Rosarchestrasse 95, 9007 St. Gallen, Switzerland.
Telephone: +41-21-3142418 Fax: +41-21-3142411
Received: July 24, 2012
Revised: December 12, 2012
Accepted: January 23, 2013
Published online: March 27, 2013

Duodenal diverticula (DD) are frequently encountered and are usually asymptomatic, with an incidence at autopsy of 22%. Perforation of DD is a rare complication (around 160 cases reported) with potentially dramatic consequences. However, little evidence regarding its treatment is available in the literature. The aim of this study was to review our experience of perforated DD, with a focus on surgical management. Between January 2001 and June 2011, all perforated DD were retrospectively reviewed at a single centre. Seven cases (5 women and 2 men; median age: 72.4 years old, rang: 48-91 years) were found. The median American Society of Anesthesiologists’ score in this population was 3 (range: 3-4). The perforation was located in the second portion of duodenum (D2) in six patients and in the third portion (D3) in one patient. Six of these patients were treated surgically: five patients underwent DD resection with direct closure and one was treated by surgical drainage and laparostomy. One patient was treated conservatively. One patient died and one patient presented a leak that was successfully treated conservatively. The median hospital stay was 21.1 d (range: 15-30 d). Perforated DD is an uncommon presentation of a common pathology. Diverticular excision with direct closure seems to offer the best chance of survival and was associated with a low morbidity, even in fragile patients.

Keywords: Duodenal perforation, Duodenum, Duodenal diverticulum, Surgical management