Perforated Duodenal Diverticulum With Severe Complications Treated Successfully With Endoscopic Therapy

A 74-year-old man presented with 3 days of fever and chills without gastrointestinal symptoms. Blood cultures repeatedly grew polymicrobial enteric organisms and Candida glabrata despite appropriate antimicrobials. Initial evaluation, including computed tomography abdomen/pelvis, colonoscopy, and esophagogastroduodenoscopy (EGD), was negative. Subsequent computed tomography enterography showed a proximal duodenal outpouching with surrounding inflammation and nonocclusive inferior vena cava thrombus. Repeat EGD by an advanced endoscopist identified a 15-mm duodenal diverticulum with ingested vegetable matter impaling the diverticular wall. Foreign body removal and clip closure achieved source control, with rapid clinical resolution. This case highlights endoscopic management of perforated duodenal diverticulum likely causing relapsing polymicrobial bacteremia, sepsis, and thrombosis.