# Delayed diagnosis of retroperitoneal duodenal perforation after endoscopic treatment: Management challenges and a novel surgical strategy case series reports

## TL;DR

This paper presents four cases of delayed retroperitoneal duodenal perforation after endoscopic procedures and introduces a new surgical strategy to improve outcomes.

## Contribution

The study introduces a novel surgical management strategy for delayed retroperitoneal duodenal perforation using right hemicolectomy.

## Key findings

- Delayed retroperitoneal duodenal perforation can lead to extensive fluid collections and colonic perforation.
- Right hemicolectomy improves duodenal exposure and facilitates effective debridement.
- Early surgical intervention is crucial for better outcomes in these cases.

## Abstract

Retroperitoneal duodenal perforation is a rare but severe complication of endoscopic procedures such as ERCP and ESD, often leading to significant morbidity and mortality when diagnosed late. Previous studies have focused on early diagnosis, but data on delayed diagnosis cases are limited. This study presents four cases of delayed-diagnosis retroperitoneal duodenal perforation and introduces a novel surgical management strategy.

We report four cases diagnosed more than one month after the initial endoscopic procedure, with CT scans revealing extensive retroperitoneal fluid collections and secondary colonic perforation in some cases. Surgical interventions included right hemicolectomy and proximal jejunostomy to facilitate duodenal exposure and clearance of infectious debris. Outcomes varied, with some patients achieving full recovery while others succumbed to complications.

The symptoms of retroperitoneal duodenal perforation are often subtle, leading to delayed diagnosis. Early surgical intervention is crucial if CT shows retroperitoneal fluid collections. Right hemicolectomy provides better duodenal exposure and facilitates effective debridement, improving outcomes.

Early diagnosis and prompt surgical intervention, including right hemicolectomy, are essential for managing delayed retroperitoneal duodenal perforation. Further studies are needed to establish optimal management protocols for these complex cases.

•Retroperitoneal duodenal perforations are often subtle, leading to delayed diagnosis.•Delayed retroperitoneal duodenal perforations cause extensive retroperitoneal fluid collections and colonic perforation.•Early surgical intervention is recommended if CT shows retroperitoneal fluid collections.•Right hemicolectomy provides full duodenal exposure for effective management of perforations.

Retroperitoneal duodenal perforations are often subtle, leading to delayed diagnosis.

Delayed retroperitoneal duodenal perforations cause extensive retroperitoneal fluid collections and colonic perforation.

Early surgical intervention is recommended if CT shows retroperitoneal fluid collections.

Right hemicolectomy provides full duodenal exposure for effective management of perforations.