From: Endoscopic duodenal perforation: surgical strategies in a regional centre
Case (year) | 1 (2002) | 2 (2004) | 3 (2005) | 4 (2006) | 5 (2007) |
---|---|---|---|---|---|
Age/Sex | 51 male | 69 male | 42 female | 61 female | 72 male |
Indication for ERCP/endoscopy | Post-cholecystectomy pain | Choledocholithiasis | Post- cholecystectomy pancreatitis | Choledocholithiasis | Post-cholecystectomy pain |
Post-procedure symptoms, signs | Severe abdominal pain, tachycardia | Severe abdominal pain | Mild abdominal pain | Abdominal pain | Abdominal pain |
Type of perforation | Not identified | Not identified (Duodenal diverticulum) | Type 2 (see Results) | Not identified | Type 1 (see Results) (Duodenal diverticulum) |
Delay to Diagnosis/Intervention | 48Â hours then 5 weeks | 5Â days | Immediate diagnosis | Immediate diagnosis, surgery within 24 hours | Immediate diagnosis, surgery at 6 hours |
Indications for surgery | a) Duodenal perforation | a) Duodenal perforation | Nil | a) Duodenal perforation | a) Large defect duodenum, |
a) at diagnosis | b) Infected retroperitoneal necrosis/collections | b) Extensive retroperitoneal necrosis/collections Persistent duodenal leak | Â | Â | b) Extensive retroperitoneal necrosis/collections |
b) subsequent | Duodenal stenosis, Necrosis of posterior caecal wall | Â | Â | b) Extensive retroperitoneal necrosis | a) Laparotomy, repair duodenum |
Management | a) Laparotomy | a) Laparotomy | Conservative | a) Laparotomy, retroperitoneal washout, pyloric, exclusion, gastrojejunostomy, jejunal feeding tube | b) Open drainage/evacuation right retroperitoneal space x 2 |
a) on diagnosis | b) Attempted percutaneous drainage | b) 7 x debridement of necrosis | (no surgery) | Â | Drainage right scrotum |
b) subsequent | 2 x Open drainage procedure right retroperitoneal space | Open drainage right inguinoscrotal tract | Â | Â | Â |
 | Right hemicolectomy, end ileostomy and mucous fistula | Pyloric exclusion, gastrojejunostomy |  |  |  |
Complications of treatment | Deep vein thrombosis | Gastroparesis, UTI, CVL infection, wound infection, left brachial plexopathy | Nil | Necrotising fasciitis right thigh/abdomen | Right inguinal haematoma |
Incisional hernia | |||||
Seroma | |||||
Length of stay (days) | 99 | 132 | 4 | 6 | 63 |
Case fatality | No | No | No | Yes | No |
Residual disability | Residual presacral collection and sinus to right iliac fossa | Retained CBD stones removed 2007 | Nil | Died | Nil |