BMC Surgery最新文献

{"title":"Integration of mobile CT and basal anesthesia for pain-free preoperative localization of small pulmonary nodules: a retrospective cohort study.","authors":"Mengxu Yao, Yungang Sun, Qiang Zhang, Feng Shao","doi":"10.1186/s12893-025-03116-z","DOIUrl":"10.1186/s12893-025-03116-z","url":null,"abstract":"","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"431"},"PeriodicalIF":1.8,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12495603/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145226187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraoperative evaluation of median arcuate ligament syndrome using a transit-time flowmeter: a case report.","authors":"Daisuke Koike, Hiroyuki Kato, Masahiro Shimura, Kazuma Horiguchi, Hiroki Tani, Yoshiki Kunimura, Takahiko Higashiguchi, Toki Kawai, Hironobu Yasuoka, Takayuki Ochi, Takahiro Tashiro, Yukio Asano, Masahiro Ito, Yutaro Kato, Tsunekazu Hanai, Akihiko Horiguchi","doi":"10.1186/s12893-025-03177-0","DOIUrl":"10.1186/s12893-025-03177-0","url":null,"abstract":"<p><strong>Background: </strong>Median arcuate ligament syndrome (MALS) is a rare surgical condition caused by external compression of the celiac artery, resulting in compromised blood flow. Intraoperative evaluation is typically based on visual findings alone, and reliable, quantitative methods for assessing surgical success remains limited.</p><p><strong>Case: </strong>A 74-year-old man was referred to our hospital with a diagnosis of early gastric cancer. Radiological findings revealed severe compression at the root of the celiac axis (CA), demonstrating the characteristic hook sign of MALS. Mild enlargement of the pancreaticoduodenal arcade arteries was observed without evidence of aneurysm formation. Concurrent surgery for gastric cancer and MALS was performed. A transit-time flowmeter (TTFM; Transonic Systems) revealed a mean flow of -119 mL/min in the common hepatic artery (CHA), indicating retrograde blood flow. After releasing the compression of the CA, the blood flow in the CHA was restored, with a mean flow of 317 mL/min. The postoperative course was uneventful, and the patient was discharged on postoperative day 21. Postoperative CT showed enlargement of the CA; however, the root lumen diameter remained smaller than that of the midsection of the CHA.</p><p><strong>Conclusion: </strong>The TTFM effectively detected retrograde blood flow in the CHA and its recovery after decompression. It may serve as a reliable method for determining the indication for MALS surgery and for evaluating surgical success intraoperatively.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"427"},"PeriodicalIF":1.8,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12495741/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145226205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Petroleum jelly vs. Saline in tracheostomy wound care and pressure injury prevention: a randomized controlled trial.","authors":"Chidchanok Chutimasaengtrakul, Sarinya Urathamakul, Kanokrat Bunnag","doi":"10.1186/s12893-025-03224-w","DOIUrl":"10.1186/s12893-025-03224-w","url":null,"abstract":"<p><strong>Background: </strong>Tracheostomy-related pressure injuries (TRPIs) compromise recovery and prolong hospital stay.</p><p><strong>Methods: </strong>We conducted a prospective randomized controlled trial at a tertiary hospital to compare the efficacy of petroleum jelly application versus normal saline irrigation in preventing peristomal pressure injuries and promoting tracheostomy wound healing. This study enrolled 28 participants, aged 18-80 years, who underwent tracheostomy procedures at Vajira Hospital, Navamindradhiraj University. They were randomly assigned using a permuted-block randomization methods (block size = 4) to either the petroleum jelly application group or the sodium chloride irrigation (0.9% NaCl solution) group. The outcomes were evaluated by one physician and one nurse at first, second, and fourth weeks postoperatively using the Pressure Ulcer Scale for Healing (PUSH) Tool and Skin Integrity Score.</p><p><strong>Results: </strong>The petroleum jelly application group demonstrated significantly lower mean scores on the PUSH Tool at first, second, and fourth weeks than the sodium chloride irrigation group. Moreover, the petroleum jelly application group exhibited significantly higher median scores for skin integrity at first, second, and fourth weeks than the sodium chloride irrigation group. The interrater reliability between the two observers was good to excellent. The petroleum-jelly arm showed faster improvement on both scoring tools across all follow-up points.</p><p><strong>Conclusions: </strong>The participants who received petroleum jelly application following tracheostomy demonstrated better results in preventing pressure injuries and maintaining skin integrity compared with those who received sodium chloride irrigation.</p><p><strong>Trial registration: </strong>TCTR20240806002 (Thai Clinical Trials Registry), registered on August 6, 2024. Retrospectively registered. ( https://www.thaiclinicaltrials.org/show/TCTR20240806002 ).</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"452"},"PeriodicalIF":1.8,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12495661/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145226244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A convenient and self-adjustable laparoscopic intracorporeal pringle maneuver using He's belt.","authors":"Huilan Zeng, Jiaqiang Mo, Sili Lu, Qing Ye, Zhangyuanzhu Liu, Jianyi Wang, Yanbei Yin, Peiying Zhong, Ting Xiao, Yanjiao Hu, Lijun Lin, Jianxin Peng, Junming He","doi":"10.1186/s12893-025-03214-y","DOIUrl":"10.1186/s12893-025-03214-y","url":null,"abstract":"","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"451"},"PeriodicalIF":1.8,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12495834/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145226082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and radiologic outcomes of minimally invasive locking plate versus screw fixation for displaced intra-articular calcaneal fractures (DIACFs) via sinus tarsi approach: a comparative study.","authors":"Yu-Jui Chang, Chi-Hsiang Hsu, Chien-Chang Liao, Feng-Chih Kuo, Yu-Der Lu, Shan-Ling Hsu, Jen-Hung Chen","doi":"10.1186/s12893-025-03208-w","DOIUrl":"10.1186/s12893-025-03208-w","url":null,"abstract":"<p><strong>Introduction: </strong>The optimal surgical treatment approach for calcaneal fractures remains controversial. This retrospective comparative study aimed to compare the clinical and radiological outcomes of minimally invasive locking plate fixation with those of screw fixation for displaced intra-articular calcaneus fractures (DIACFs) treated via the sinus tarsi approach (STA).</p><p><strong>Methods: </strong>A total of 38 patients and 40 feet with DIACFs from 2015 to 2020 were retrospectively reviewed with a minimum of 3 years of follow-up. Patients were divided into two groups based on fixation method: minimally invasive locking plate fixation (MIP group) versus screw fixation (SW group) (17 vs 23, respectively). The clinical outcomes were evaluated by the Visual Analogue Scale (VAS), Maryland Foot Score (MFS), Olerud-Molander (OM) ankle score, American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score, and occurrence of complications. Radiological outcomes were assessed by radiographs for multiple parameters, including calcaneal height, length, width, and Böhler's angle.</p><p><strong>Results: </strong>The patients were followed up for an average of 63.37 months. There was no significant difference in the final VAS score, MFS, OM score, AOFAS score, and the total incidence of complications between the two groups (P>0.05). Regarding the radiological outcome, there was also no significant difference in the reduction loss of calcaneal height, length, width, and Böhler's angle (P>0.05) after a one-year follow-up period. However, the rate of implant removal in the MIP group was significantly greater than that in the SW group (P< 0.05).</p><p><strong>Conclusions: </strong>Minimally invasive locking plate fixation versus screw fixation of DIACFs via sinus tarsi approach may yield comparable radiological and functional outcomes. The screw fixation group suggested a shorter surgical time and lower implant removal rate. Both surgical methods are viable options for DIACFs. However, further large-scale prospective studies are warranted to confirm these results.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"449"},"PeriodicalIF":1.8,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12495791/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145226106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When to remove implantable vascular access ports? a retrospective analysis of 376 patients with breast cancer and implantable vascular access ports.","authors":"Jun Luo, Zheng Yao, Weiren Liang, Gu Zhao, Jiaping Zheng, Yuwei Liu, Zifang Jiang, Xinyan Yu","doi":"10.1186/s12893-025-03173-4","DOIUrl":"10.1186/s12893-025-03173-4","url":null,"abstract":"<p><strong>Background: </strong>The optimal timing of removal of implanted vascular access ports (PORTs) in cancer patients is unknown. This study aimed to explore the timing of PORT removal and the impact of PORT removal within 2 years in breast cancer patients.</p><p><strong>Methods: </strong>This retrospective study included breast cancer patients who underwent PORT implantation at our Hospital between July 2012 and May 2022 and ultimately had their PORTs removed. QoL scores were assessed using the Karnofsky method. The primary endpoint was quality of life (QoL) (A: 80-100 points, basically normal self-care ability; B: 60-79 points, mild dependence on self-care ability; C: <60 points, moderate to severe dependence). The secondary endpoints included the proportion of unplanned PORT removal, secondary catheterization, medical costs, and complications.</p><p><strong>Results: </strong>This study included 376 female patients with a median age of 52 (range, 22-72) years. The median PORT indwelling time was 464 (range, 16-2717) days. No significant differences were observed in the QoL scores between patients with PORT indwelling time ≤ 2 vs. >2 years [A/B/C: 90.87%/7.94%/1.19% vs. 95.97%/4.03%/0, P = 0.185]. Patients with PORT indwelling time ≤ 2 years exhibited higher probabilities of unplanned port removal (16.76% vs. 3.99%, odds ratio = 2.42, P = 0.004), higher secondary catheterization (28.99% vs. 3.72%, odds ratio = 5.08, P = 0.004), and higher medical costs (24.57 ± 31.36 vs. 7.16 ± 1.19 CNY/day, P < 0.001) compared with patients with PORT indwelling time > 2 years. There were no significant differences in the frequency of complications between groups (P = 0.751). In the subgroup of patients with planned PORT removal, the ≤ 2-year group still showed significantly higher secondary catheterization rates (31.22% vs. 8.26%, P < 0.001) and daily costs (14.83 vs. 6.83 CNY/day, P < 0.001).</p><p><strong>Conclusion: </strong>In patients with breast cancer who do not require regular intravenous administration, it may be recommended to consider removing the infusion port after 2 years to reduce the risks of secondary catheterization and reduce medical costs, unless irreversible adverse events affect the correct use of the PORT.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"420"},"PeriodicalIF":1.8,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12495737/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145226263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors affecting the risk of conversion from laparoscopy to open surgery in xanthogranulomatous cholecystitis: a retrospective cohort study.","authors":"Ergün Yüksel, Burak Dinçer, Sinan Ömeroğlu","doi":"10.1186/s12893-025-03097-z","DOIUrl":"10.1186/s12893-025-03097-z","url":null,"abstract":"<p><strong>Background: </strong>Xanthogranulomatous cholecystitis is a rare benign pathology that can mimic gallbladder cancer. Due to inflammation-related adhesions in the gallbladder, cholecystectomy can be particularly challenging in these patients, and the conversion rates from laparoscopy to open surgery are significantly higher than normal. This study aimed to evaluate the factors influencing conversion rates in cases of xanthogranulomatous cholecystitis.</p><p><strong>Methods: </strong>Patients who underwent cholecystectomy and were pathologically diagnosed with xanthogranulomatous cholecystitis between 2018 and 2024 were included in the study. Patients were categorized into two groups: those who underwent laparoscopic cholecystectomy and those requiring conversion to open surgery. Demographic, clinical, biochemical, and radiological data were analyzed.</p><p><strong>Results: </strong>A total of 46 patients were evaluated. The median age was 56 years (range: 29-80), and 23 patients (50%) were female. Conversion to open surgery was required in 18 patients (39.2%). In univariate analysis, a history of prior ERCP (p = 0.004), increased gallbladder wall thickness (p = 0.004), and an enlarged common bile duct diameter (p = 0.032) were associated with a higher risk of conversion. Multivariate analysis identified prior ERCP (Odds Ratio [OR]: 24.48, 95% Confidence Interval [95%-CI]: 2.25-265.95, p = 0.009) and increased gallbladder wall thickness (OR: 5.94, 95%-CI: 1.31-26.89, p = 0.021) as independent risk factors for conversion.</p><p><strong>Conclusion: </strong>The conversion rate from laparoscopy to open surgery is considerably high in cases of xanthogranulomatous cholecystitis compared to other etiologies. The risk is even greater in patients with a history of ERCP and increased gallbladder wall thickness.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"416"},"PeriodicalIF":1.8,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12482405/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tailoring treatment for esophageal cancer: a retrospective comparison of chemoradiation with and without esophagectomy.","authors":"Piyapasara Toapichattrakul, Kittinon Santasup, Kittisak Kittirungsi, Thanapat Seemakajohn, Phubodee Kittiwan, Ausareeya Chumachote, Bandhuphat Chakrabandhu, Somvilai Chakrabandhu","doi":"10.1186/s12893-025-03211-1","DOIUrl":"10.1186/s12893-025-03211-1","url":null,"abstract":"<p><strong>Background: </strong>Locally advanced esophageal cancer remains a significant therapeutic challenge, with the optimal treatment strategy still debate. While previous studies suggest that concurrent chemoradiation therapy (CCRT) can improve survival, the role of esophagectomy following CCRT in patients with partial or no response has not been well-characterized, particularly in resource-limited settings. This study aimed to evaluate the survival benefit of esophagectomy following CCRT, with particular focus on non-complete responders (non-CR).</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of 132 patients with locally advanced esophageal cancer treated at Maharaj Nakorn Chiang Mai Hospital between 2013 and 2022. Patients were categorized based on initial treatment into preoperative CCRT or definitive CCRT groups. Overall survival (OS) and progression-free survival (PFS) were compared using multivariable Cox regression. A secondary analysis stratified patients into three groups by clinical response and surgical status: CR without surgery, non-CR with surgery, and non-CR without surgery. To reduce baseline imbalances and selection bias, inverse probability of treatment weighting (IPTW) was applied in the non-CR subgroup initially intended for preoperative CCRT.</p><p><strong>Results: </strong>Baseline characteristics were balanced except for tumor location. Median follow-up was 1.23 years (IQR: 0.64-2.50). Overall, 1-/2-year PFS was 27.97%/17.80%, while OS was 60.47%/37.33%. Median survival did not differ between preoperative versus definitive CCRT (1.20 vs. 1.52 years, p = 0.346). However, in the surgical-status analysis, patients undergoing post-CCRT esophagectomy showed significantly improved PFS and OS versus non-surgical non-CR patients (PFS HR: 2.89, p < 0.001; OS HR: 2.97, p = 0.001). Notably, surgical non-CR patients achieved OS comparable to CR patients without esophagectomy (HR: 1.12, p = 0.812). To minimize selection bias, we conducted an IPTW-adjusted analysis in the subgroup of non-CR patients initially assigned to preoperative CCRT. After IPTW, the survival benefit of surgery remained significant, with improved PFS (HR: 3.75; 95% CI: 1.40-10.08; p = 0.009) and OS (HR: 2.74; 95% CI: 1.57-4.77; p < 0.001) compared to CCRT alone.</p><p><strong>Conclusion: </strong>Esophagectomy after CCRT provides survival benefits equivalent to achieving CR with CCRT alone, particularly for non-CR patients. These results advocate for surgical integration as a salvage strategy for incomplete responders in locally advanced esophageal cancer.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"417"},"PeriodicalIF":1.8,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12482222/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robot-assisted ureteral reimplantation using the KangDuo surgical Robot-01 system: a prospective, single-center, single-arm pilot study.","authors":"Guanpeng Han, Liqing Xu, Zhihua Li, Shubo Fan, Shengwei Xiong, Xiang Wang, Yiwei Huang, Guoli Wang, Xiaofei Dai, Liang Cui, Kunlin Yang, Liqun Zhou, Yicong Du, Xuesong Li","doi":"10.1186/s12893-025-03216-w","DOIUrl":"10.1186/s12893-025-03216-w","url":null,"abstract":"<p><strong>Background: </strong>Ureteral reimplantation plays a crucial role in distal ureteral reconstruction, and the integration of robotic systems has greatly enhanced minimally invasive surgical techniques. This pilot study aims to evaluate the technically feasibility and safety of the newly developed KangDuo Surgical Robot-01 (KD-SR-01) system in performing robot-assisted ureteral reimplantation.</p><p><strong>Methods: </strong>This prospective, single-center, single-arm pilot study was conducted from February 2022 to June 2024. Thirty-one ureteral reimplantation procedures were performed using the KD-SR-01 system. We collected the patients' characteristics, perioperative data and follow-up findings prospectively. We used the NASA-TLX (National Aeronautics and Space Administration Task Load Index) to assess ergonomics.</p><p><strong>Results: </strong>All 31 procedures were completed successfully without conversion. The median operative time was 153 min (IQR, 136-178.5 min). The median estimated blood loss was 20 mL (IQR, 15-35 mL). No patients needed blood transfusions during the operation. No severe complications occurred either intraoperatively or postoperatively. The median postoperative hospital stay was 4 days (IQR, 4-4 days). At a median follow-up of 22 months (IQR, 13-35 months), the subjective success rate was 96.8% (95% confidence interval: 83.3-99.9%). The surgeon indicated a high level of comfort, with a NASA-TLX global score of 9.47 ± 4.97.</p><p><strong>Conclusions: </strong>The KD-SR-01 system is technically feasible and safe for robot-assisted ureteral reimplantation.</p><p><strong>Trial registration: </strong>This study was registered at www.chictr.org.cn (ChiCTR2200056553) on February 7, 2022.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"418"},"PeriodicalIF":1.8,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12482228/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The submission title: management of retroperitoneal perforated descending duodenal diverticulum using de pezzer catheter drainage combined with nutritional jejunostomy: a case report and review of the literature.","authors":"Limin Guo, Shuk Ying Wong, Dongdong Zhang, Lei Guo, Simin Chen, Peng Guo","doi":"10.1186/s12893-025-03163-6","DOIUrl":"10.1186/s12893-025-03163-6","url":null,"abstract":"<p><strong>Introduction: </strong>Duodenal diverticulum (DD) ranks as the second most prevalent form of intestinal diverticulum and is typically asymptomatic. However, perforations of DD, while rare, are associated with potentially fatal outcomes.</p><p><strong>Presentation of case: </strong>A 78-year-old Chinese male patient presented with epigastric pain after overeating the day before admission. A contrast-enhanced computed tomography (CT) of the abdomen revealed cystic areas of extraluminal air in the posterior periduodenal area. We operated on the patient. A De Pezzer catheter and a nasogastric tube were placed in the duodenal cavity, supplemented by two external drainage tubes. Early postoperative enteral nutrition was facilitated through a jejunal feeding tube. The patient underwent successful surgical intervention and was discharged on the 12th post-operative day without any complications.</p><p><strong>Discussion: </strong>Non-operative management may be suitable for carefully selected patients with stable vital signs and a timely diagnosis. Surgical intervention is necessary if conservative approaches fail or in cases leading to generalized peritonitis or severe sepsis. For posterior DD perforations, it is critical to focus not only on wound repair but also on ensuring adequate drainage and decompression of the periduodenal and intestinal cavities to reduce the risk of fistulas.</p><p><strong>Conclusion: </strong>For patients with perforations of DD, surgical intervention should be advocated, emphasizing on the prevention and treatment of duodenal fistula during the operation. The application of a De Pezzer catheter, nasogastric tube, and additional duodenal drainage, combined with jejunal feeding for nutritional support, adheres to damage control principles and leads to favorable clinical outcomes.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"414"},"PeriodicalIF":1.8,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12465761/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145151677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}