Shiraishi Toshio, Wada Hideo, Hashimoto Shintaro, Katayama Hiroki, Taba Mitsuru, To Kazuo
Department of Surgery, Sasebo Chuo Hospital, 15 yamato, Sasebo, Nagasaki 857-1195, Japan; Department of Surgery, Ureshino medical Center, 4279-3 Ureshino, Saga 843-0393, Japan.
Department of Surgery, Ureshino medical Center, 4279-3 Ureshino, Saga 843-0393, Japan.
Int J Surg Case Rep. 2021 Oct;87:106388. doi: 10.1016/j.ijscr.2021.106388. Epub 2021 Sep 6.
A duodenal diverticulum is a pseudodiverticulum that lacks a proper muscular layer. Cases of traumatic penetration or perforation of a duodenal diverticulum are relatively rare.
A 67-year-old woman was injured when her roommate kicked her in the upper abdomen, and was transferred to our hospital 6 h after the injury with upper abdominal pain and lethargy. Computed tomography revealed a duodenal diverticulum and retroperitoneal emphysematous changes and exudates. Peritonitis due to duodenal penetration was suspected and emergency laparotomy was performed. Intraoperative findings revealed two traumatic penetrations of the duodenal diverticulum. We resected the diverticulum with an automatic suture device and covered the resection site with omentum. Twenty-one days postoperatively, she was transferred to her original hospital with no complications following an uneventful postoperative course.
Most causes of penetration or perforation of the duodenal diverticulum are diverticulitis, and few reports have described penetration or perforation of duodenal diverticulum due to trauma. Our case was extremely rare that caused by a kick to the upper abdomen and resulted in two penetrations of a duodenal diverticulum although factors contributing to the multiple penetrations were considered.
Penetration or perforation of a duodenal diverticulum occasionally results in a rapid deterioration to a severe state. Comprehensive judgement of the general condition and laboratory findings and selection of an appropriate treatment policy is important.
十二指肠憩室是一种缺乏完整肌层的假性憩室。十二指肠憩室发生创伤性穿透或穿孔的病例相对少见。
一名67岁女性被室友踢中上腹部后受伤，受伤6小时后因上腹部疼痛和嗜睡被转至我院。计算机断层扫描显示十二指肠憩室、腹膜后气肿改变及渗出液。怀疑因十二指肠穿孔导致腹膜炎，遂行急诊剖腹手术。术中发现十二指肠憩室有两处创伤性穿孔。我们用自动缝合装置切除了憩室，并用网膜覆盖了切除部位。术后21天，她在术后恢复顺利、无并发症的情况下转回原医院。
十二指肠憩室穿透或穿孔的大多数原因是憩室炎，很少有报告描述因创伤导致十二指肠憩室的穿透或穿孔。我们的病例极为罕见，是由上腹部被踢引起，导致十二指肠憩室两处穿孔，尽管考虑了导致多处穿孔的因素。
十二指肠憩室的穿透或穿孔偶尔会迅速恶化为严重状态。对一般状况和实验室检查结果进行综合判断并选择合适的治疗策略很重要。
