A Case of Retroperitoneal Abscess from Posterior Perforation of Duodenal Ulcer

Ichio Suzuka, Takashi Tsukazaki, Hiroshi Sugata

Department of Surgery, National Sanatorium Tsuyama Hospital

A l5-year-old boy who had been treated medically for multiple gastroduodenal ulcers and pyloric stenosis for 2 years was hospitalized because of vomiting and pain in the right lateral abdominal region. His parents and grandfather had also suffered from duodenal ulcers. He was diagnosed with acute appendicitis, and appendectomy was performed. Thereafter, he developed a high fever and pyloric obstruction. A second laparotomy was performed, and retroperitoneal abscess due to posterior perforation of the duodenal ulcer was found. Because of remarkable fibrotic change of the bulbus, distal gastrectomy without resection of the perforated duodenal ulcer, gastro-jejunostomy (Billroth II), and abscess drainage were performd. Blood coagulation factor XIII-concentrate (Fibrogammin^®) was administered in expectation of closing of the perforation. This case is rare, as only 17 similar cases (2 Japanese and 15 non-Japanese cases), including our case, have been reported in the literature during the past 30 years. In 7 cases (41.7%), a past history of peptic ulcer was recognized preoperatively, 3 cases (17.6%) were correctly diagnosed preoperatively, and approximately half the cases died from this event. Unlike other retroperitoneal abscesses, those from perforation of a duodenal ulcer have an influx of digestive fluid into the retroperitoneum, so that misdiagnosis or delayed therapy of this even can be fatal.

Key words
duodenal ulcer, perforation, retroperitoneal abscess

Reprint requests
Ichio Suzuka Department of Surgery, Kagawa Pref. Central Hospital
5-4-16 Ban-cho, Takamatsu City, 760 JAPAN

Accepted
March 2, 1994

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