Perforated duodenal diverticulum: report of two cases.

Duodenal diverticula may be complicated by diverticulitis, perforation, hemorrhage, pancreatitis, or biliary obstruction. Two cases of perforated duodenal diverticulum are reported. Both patients were elderly females. Computed tomography of the abdomen showed retroperitoneal air around the duodenum in the first case, and an enterolith in a duodenal diverticulum and a retroperitoneal abscess in the second case. Laparotomy and diverticulectomy with two-layer closure of the duodenum was performed in the first case. The second patient was treated conservatively with antibiotics, percutaneous abscess drainage, and endoscopic lithotomy. Both recovered well. Computed tomography is useful in the diagnosis of a perforated duodenal diverticulum. Although surgical intervention is the standard treatment, conservative therapy is also an option. Duodenal enteroliths are rare but may cause perforation of a diverticulum or biliary obstruction. The duodenal blind loop created by a Billroth II gastrectomy provides a static environment for the formation of enteroliths in duodenal diverticula.