Yanamaladoddi Vishnu R, Gonuguntla Akhilesh, Vasireddy Anila, Gopal Nikhil, Janumpalli Krishna Kalyan Reddy
General Surgery, Narayana Medical College & Hospital, Nellore, IND.
Department of General Surgery, Kasturba Medical College, Manipal, IND.
Cureus. 2023 Sep 1;15(9):e44522. doi: 10.7759/cureus.44522. eCollection 2023 Sep.
Duodenal perforation most commonly presents with life-threatening symptoms of acute abdomen. However, in rare cases, a perforation may have an indolent course due to subclinical progression, and the patient may present with complications at the first visit. We present a case of an anterior abdominal abscess as the initial presentation of a duodenal perforation in a 65-year-old female with no pre-morbidities. The patient presented with a painful mass in the right upper quadrant associated with fever. Physical examination revealed a tender, erythematous swelling in the right hypochondrium and lumbar regions with no signs of peritonitis. Contrast-enhanced CT (CECT) of the abdomen showed a subcapsular hepatic abscess with parietal extension, but no signs of hollow viscus perforation were visible. Empirical antibiotics were given, and incision and drainage (I&D) were performed to drain around 100 mL of pus. However, drain on postop day one demonstrated bile suggesting a hollow viscus perforation, which was confirmed by a Gastrografin study.
十二指肠穿孔最常表现为危及生命的急腹症症状。然而，在罕见情况下，由于亚临床进展，穿孔可能病程隐匿，患者在初次就诊时可能就出现并发症。我们报告一例65岁无基础疾病女性，以腹部前侧脓肿作为十二指肠穿孔的首发表现。患者表现为右上腹疼痛性肿块伴发热。体格检查发现右季肋区和腰部有压痛、红斑性肿胀，无腹膜炎体征。腹部增强CT（CECT）显示肝包膜下脓肿并向壁层延伸，但未见中空脏器穿孔迹象。给予经验性抗生素治疗，并进行切开引流（I&D），引流出约100 mL脓液。然而，术后第1天引流液显示为胆汁，提示中空脏器穿孔，经泛影葡胺造影检查得以证实。
