Umbu Landry, Harrison Hailey, Thomas David, Contreras Megan, Darku Kwesi
Department of Surgery, Trumbull Regional Medical Center, Warren, OH 44483, USA.
American University of Antigua, College of Medicine, New York, NY 10005, USA.
J Surg Case Rep. 2023 Jun 22;2023(6):rjad368. doi: 10.1093/jscr/rjad368. eCollection 2023 Jun.
The development of a retroperitoneal abscess in the setting of duodenal perforation is a rare occurrence. There are various causes of duodenal perforation such as trauma, iatrogenic injury and, most commonly, peptic ulcer disease [1]. Urgent surgical intervention is required when a patient presents with a perforated duodenal ulcer and signs of peritonitis. Generally, closure is performed with an omental pedicle or Graham patch [2]. In cases of large perforations, surgical resection, gastric partition with diverting gastrojejunostomy or T-drain placement may be required [2]. In this case, we present a patient with duodenal ulcer perforation complicated by retroperitoneal abscess formation. Treatment involved interventional radiological (IR) drainage of the abscess, followed by laparotomy for persistence of fluid. The surgery comprised of a right-side hemicolectomy, Braun jejunojejunostomy, pyloric exclusion, intraoperative retroperitoneal abscess drainage and Graham patch repair of retroperitoneal duodenal perforation.
十二指肠穿孔并发腹膜后脓肿的情况较为罕见。十二指肠穿孔有多种原因，如外伤、医源性损伤，最常见的是消化性溃疡病[1]。当患者出现十二指肠溃疡穿孔并伴有腹膜炎体征时，需要紧急进行手术干预。一般来说，采用网膜蒂或格雷厄姆补片进行闭合[2]。对于大穿孔病例，可能需要进行手术切除、行转流性胃空肠吻合术的胃分隔术或放置T形引流管[2]。在此，我们报告一例十二指肠溃疡穿孔并发腹膜后脓肿形成的患者。治疗包括介入放射学（IR）引导下的脓肿引流，随后因积液持续存在而行剖腹手术。手术包括右侧半结肠切除术、布劳恩空肠空肠吻合术、幽门旷置术、术中腹膜后脓肿引流以及腹膜后十二指肠穿孔的格雷厄姆补片修补术。
