Four Cases of Perforated Duodenal Diverticulum

Daisuke Kitayama, Fumihiko Shimamura and Masaru Miyazaki*

Department of Surgery, Chiba Emergency Medical Center
Department of General Surgery, Graduate School of Medicine, Chiba University*

We experienced four cases of perforated duodenal diverticulum between January 1999 and December 2005. We reviewed 38 cases of perforated duodenal diverticulum reported in Japanese medical literature, including our own cases reported here, and then assessed the pathophysiology and treatment policies for perforation, which is a rare complication of duodenal diverticulum. The mean age of the patients with perforated duodenal diverticulum was 68.6 years, and the patients comprised 9 men and 29 women. Most of the chief complaints were abdominal pain, but the location was variable. Many cases were not associated with leukocytosis or muscular defense. The preoperative established diagnosis was low, 26.3%, and this condition was often difficult to diagnose. CT findings were the most useful results, enabling a definite diagnosis in 96.6% of the cases; retroperitoneal emphysema was also a characteristic feature. Surgery was the most common treatment. Most of the patients successfully underwent appropriate decompression and drainage in addition to a diverticulectomy. Nevertheless, the variable findings often make a definite diagnosis difficult, possibly leading to a deterioration in the patient's condition.

Key words
perforated duodenal diverticulum, retroperitoneal emphysema, pneumoretroperitoneum

Reprint requests
Daisuke Kitayama Department of Surgery, Chiba Emergency Medical Center
3-32-1 Isobe, Mihama-ku, Chiba, 261-0012 JAPAN

Accepted
June 28, 2006

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