Duodenal diverticulitis: a crossroad between conservative therapy and surgery: a case report.

Abstract

Background: In total, 90% of patients with duodenal diverticulum are asymptomatic; 5% of patients present with symptoms due to its complications, as compression of neighboring organs, cholestasis (in cases of periampullary diverticulum), hemorrhage, inflammation (diverticulitis), or perforation. Duodenal diverticulitis represent a diagnostic challenge because of nonspecific symptoms and indeterminate computed tomography images, leading to diagnostic delay with possible complications such as perforation.

Case presentation: A 68-year-old Caucasian Italian female patient presented with large retroperitoneal fluid collection (5.5 × 5.6 × 4.8 cm) with air-fluid level around the second part of the duodenum, initially interpreted as localized duodenal perforation. An effective conservative management was performed with good outcomes.

Conclusion: With the exception of cases of peritonitis or frank sepsis, the treatment of duodenal diverticulitis, with or without retroperitoneal perforation, is based on the patient's clinical manifestation, and in selected patients, conservative treatment may be a valid alternative to surgery, avoiding over-treatment and potential serious complications of a very difficult surgery.