# Navigating a Surgical Dilemma: Conservative Management of a Rare Case of Spontaneous Duodenal Perforation in a Resource-Limited Setting

## TL;DR

This case report shows that non-surgical treatment can successfully manage a rare duodenal perforation in a high-risk patient with limited medical resources.

## Contribution

The paper presents a rare case of successful conservative management of duodenal perforation in a high-risk patient in a resource-limited setting.

## Key findings

- A 78-year-old woman with multiple comorbidities was successfully treated non-surgically for a localized duodenal perforation.
- Conservative management included intravenous fluids, antibiotics, and monitoring, leading to full recovery within 11 days.
- The case highlights the feasibility of non-operative treatment in high-risk patients with limited access to surgical care.

## Abstract

Non-traumatic duodenal perforation is a rare and potentially life-threatening condition, typically caused by peptic ulcer disease, and traditionally requires urgent surgical intervention. However, in resource-limited settings, conservative management can be an effective alternative for selected patients, particularly those with localized contamination and comorbidities that make surgery high-risk. This case report describes the successful non-operative management of a 78-year-old woman with poorly controlled type 2 diabetes, hypertension, dyslipidemia, and bronchial asthma, who presented with a seven-day history of right upper quadrant pain. Imaging with contrast-enhanced computed tomography revealed a localized second-part duodenal perforation with perihepatic extravasation of contrast, but no diffuse peritonitis. Given her frailty, a non-surgical approach was adopted, involving intravenous fluids, broad-spectrum antibiotics, proton pump inhibitors, and careful monitoring. The patient’s condition improved progressively, with pain resolution and return to a light diet by day 10, and she was discharged on day 11. This case underscores the importance of precise imaging, judicious patient selection, and adaptive resource utilization in managing duodenal perforation in settings with limited resources, highlighting the feasibility of conservative management in high-risk patients.