Patient A, a 58-year-old woman, arrived in acute distress, febrile and tender in the right upper abdomen. A computed tomographic (CT) scan showed periduodenal inflammation and edema surrounding the second portion of the duodenum, associated with air/fluid collections posterior to its first and second portion. Edema was noted in the right retroperitoneum, extending from the posterior duodenal fluid collection (, overleaf). A perforated duodenal diverticulum was diagnosed, and a surgical repair was scheduled.
FIG. 1. Abdominal CT (without contrast medium) of patient A, showing periduodenal inflammation, thickening of the duodenal wall and the presence of retroperitoneal collections of air and fluid.
After entering her peritoneal cavity we mobilized the hepatic flexure, exposing the second portion of the duodenum. The duodenum was kocherized, and the second and third portions mobilized over to the midline. We found the decompressed diverticulum plastered to the posterior wall of the duodenum and the head of the pancreas. Her diverticulum was dissected back to its origin, and reduced. The remaining 7-mm defect in the duodenal wall was closed in a transverse fashion with interrupted 3.0 Vicryl sutures. To complete the repair, we mobilized a tongue of greater omentum off the right colon and patched it over the repair.