Operative Management of a Perforated Duodenal Diverticulum With a Retroperitoneal Abscess

Duodenal diverticula are common and usually asymptomatic; however, perforation is a rare and potentially life-threatening complication.Perforation may produce nonspecific clinical and radiographic findings and can be difficult to distinguish from other causes of perforated viscus because much of the duodenum is retroperitoneal.We describe a 71-year-old male with cardiac amyloidosis, hypertension, atrial fibrillation on apixaban, and congestive heart failure who was transferred after more than one day of predominantly epigastric abdominal pain.Computed tomography demonstrated extraluminal air and retroperitoneal fluid in the region of the duodenum concerning for perforated viscus.Exploratory laparotomy revealed a perforated diverticulum arising from the lateral aspect of the second portion of the duodenum with a contained retroperitoneal abscess.The diverticulum was resected using a linear stapler, followed by stapleline imbrication and omental reinforcement.Histopathologic examination confirmed a duodenal diverticulum with marked surrounding acute serositis compatible with perforation.Postoperative upper gastrointestinal imaging demonstrated no contrast extravasation, and there was no clinical evidence of duodenal leak during the index hospitalization.This case highlights the diagnostic challenge of duodenal diverticular perforation and demonstrates that, when local anatomy and tissue quality permit, stapled diverticulectomy with reinforcement can provide definitive source control without more complex duodenal reconstruction.