# Duodenal diverticulum perforation with pneumo-retroperitoneum: a case report of rare presentation

## TL;DR

A rare case of a perforated duodenal diverticulum causing retroperitoneal infection is reported, emphasizing the need for timely diagnosis and treatment.

## Contribution

This case report highlights the diagnostic challenges and management of a rare retroperitoneal perforation from a duodenal diverticulum.

## Key findings

- A 48-year-old woman presented with perforated duodenal diverticulum following influenza A infection.
- Persistent bilious drainage and imaging confirmed retroperitoneal abscess and third portion duodenal perforation.
- Surgical intervention with segmental duodenectomy was required after initial conservative measures failed.

## Abstract

Perforation of a duodenal diverticulum is rare but associated with high morbidity and mortality. Retroperitoneal perforations often present atypically, delaying diagnosis and management. We describe a 48-year-old woman presented to the hospital with abdominal pain after influenza A infection. Initial computed tomography suggested hollow viscus perforation, and she underwent laparoscopic lavage and drainage. Persistent bilious drainage and follow-up imaging revealed perforation of the third portion of the duodenum with retroperitoneal abscess. Exploratory laparotomy demonstrated a 2 × 2 cm perforated diverticulum at the inferior duodenal angle with surrounding necrosis. Segmental duodenectomy with duodenojejunostomy and feeding jejunostomy was performed. This case highlights the diagnostic difficulty of retroperitoneal duodenal diverticulum perforation and the importance of recognizing bilious drainage as an early warning sign. Conservative measures may be attempted in stable patients, but suspicion of ongoing leakage warrants timely definitive surgery. Early and comprehensive exploration may prevent delayed recognition and reduce morbidity.