A Case of Diverticular Perforation of Duodenum at the Third Portion, Diagnosed by Retroperitoneal Emphysema and Abscess

Hirohisa Miwa, Takao Matsuura, Hiroshi Kitahara, Sigenori Aoki, Nobuaki Shinozaki*, Kazunao Watanabe*, Noriyuki Saeki*, Kouichi Maekawa*, Takao Suzuki*

Department of General Surgery, Chigasaki Tokusyuukai Medical Center
*Department of General Surgery, Shonan Kamakura Medical Center

We report the first Japanese case of the diverticular perforation of duodenum at the third portion, diagnosed by retroperitoneal emphysema and abscess. A 39-year-old woman was admitted to our hospital under suspicion of small bowel obstruction. Supportive therapies were fairly effective. On the third hospital day, she had a body temperature of 38°C, WBC count of 15,5000/mm³, and CRP of 27.3 mg/dl. Abdominal plain X-ray and enhanced CT revealed pneumoretroperitoneum, and gastrointestinal perforation was suspected. On laparotomy, retroperitoneal emphysema and edema were seen. The right colon was mobilized anteriorly. A small diverticulum in the third portion of the duodenum was perforated and surrounded by yellowish-white abscess. The diverticulum was inverted into the duodenal lumen and a z-stitch was placed. γ-Streptococci was cultured. The postoperative course was excellent. In Japan, 15 cases of diverticular perforation of the duodenum have been reported, all located in the second portion of the duodenum. This is the first report of diverticular perforation of the duodenum at the third portion in this country.

Key words
perforation of duodenal diverticulum, pneumoretroperitoneum, retroperitoneal emphysema

Reprint requests
Hiroshisa Miwa Department of General Surgery, Chigasaki Tokusyuukai Medical Center
14-1 Saiwai-cho, Chigasaki-shi, 253 JAPAN

Accepted
July 7, 1993

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