Papalambros E, Felekouras E, Sigala F, Kiriakopoulos A, Giannopoulos A, Aessopos A, Bastounis E, Mirilas P, Hepp W
1st Surgical Department, University of Athens, "LAIKO" Hospital, Athens, Greece.
Zentralbl Chir. 2005 Jun;130(3):270-3. doi: 10.1055/s-2005-836529.
Primary duodenal diverticula are usually asymptomatic. About 115 perforations have been reported, but none with right colon necrosis. We report a 45-year-old woman, with a five days history of high fever along with epigastric and periumbilical pain. Physical examination revealed right upper and lower quadrant tenderness with peritoneal signs. White blood cell count was 11 500/mm (3) while biochemical and hepatic biology tests were normal. Abdominal radiographs showed no pathologic findings. Ultrasound disclosed fluid in the lower pelvis. Computerized tomography revealed fluid collection in the right hepatorenal space. Intraoperative findings included purulent fluid in the lower pelvis, segmental necrotic changes of the right colon, and a perforated diverticulum on the antimesenteric border of the third part of the duodenum. Surgery consisted of right hemicolectomy and ileo-transverse anastomosis, diverticulectomy, and decompressive lateral duodenostomy at the second duodenal portion. The patient had an uneventful postoperative course. A contrast study from the duodenostomy tube on the 6 (th) postoperative day showed no leakage or obstruction. Duodenostomy tube was removed on the 14 (th) postoperative day. Histology confirmed the diagnosis of a primary duodenal diverticulum.
原发性十二指肠憩室通常无症状。据报道约有115例穿孔，但无一例伴有右结肠坏死。我们报告一例45岁女性，有5天高热病史，伴有上腹部和脐周疼痛。体格检查发现右上腹和右下腹压痛并伴有腹膜刺激征。白细胞计数为11500/mm³，而生化和肝脏生物学检查正常。腹部X线片未见病理改变。超声显示盆腔下部有积液。计算机断层扫描显示肝肾隐窝有积液。术中发现盆腔下部有脓性液体，右结肠节段性坏死改变，十二指肠第三部系膜缘有一个穿孔性憩室。手术包括右半结肠切除术和回肠-横结肠吻合术、憩室切除术以及十二指肠第二部减压性侧方十二指肠造口术。患者术后恢复顺利。术后第6天经十二指肠造口管进行的造影检查显示无渗漏或梗阻。术后第14天拔除十二指肠造口管。组织学检查确诊为原发性十二指肠憩室。
