A Case of Perforated Duodenal Diverticulum

Tomohiro Takeda, Satoshi Tanaka, Shinya Yamamoto, Takashi Maeba

First Department of Surgery, Kagawa Medical School

A 77-year-old women was admitted with right quadrant pain. Four days after the onset, an operation was performed under a diagnosis of acute cholecystitis. Laparatomy disclosed a perforation of the duodenal at the middle aspect of the descending portion and abscess formation posteiror to the head of pancreas, accompanied by biliary phregmon of the adjacent stractures. Becouse of severe inflammatory change of the duodenal wall surrounding the perforation, primary closure was not attempted, but distal gastrectomy was performede in the Billroth II fashion; a drainage tube was placed in the abcess, and an additionlly T-tube was placed in the common bile duct for billiary drainage. The postoperative course was umcomplicated and the patient was cured and discharged. Retrospective inspection of the gastroduodenal roentgenogram, examined by a physician two months prior to the present illnes, revealed a diverticulum at the descending portion of duodenum, and this made us cofident that its perforation had caused the disease. A preoperative X-ray study show a low density area behind the head of the pancreas and gas accumlation in the retroperitonial space, observed on CT scan and film respectively. These findings were highly indicative of duodenal perforation.

Key words
perforatea duodenal diverticulum

Reprint requests
Tomohiro Takeda First Department of Surgery, Kagawa Medical School
1750-1 Miki-cho, Kita-gun, Kagawa, 761-07 JAPAN

Accepted
January 10, 1990

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