A typical case is described in detail here. The patient was an 87-year-old woman admitted to the hospital with a sudden onset of epigastric pain for 8 h. On admission, her vital signs were stable. On examination, she was found to have mid-upper abdominal pressure and suspicious rebound pain, and the rest of her abdomen was free from peritoneal Irritation signs. Laboratory investigations revealed the following: WBC 5.8*109/L, NP 73.2%, PLT 87*109/L; AMY 1,450U/L, TB 34.90 micromol/L, CB 19.00 micromol/L, ALT 492U/L, and AST 515U/L. The CECT scan suggested (Figure 2A) suspected duodenal diverticulum perforation. Given the patient's stable vital signs and the absence of significant peritoneal irritation, but with advanced age and hepatic insufficiency, there was no better surgical access on the CT scan. We decided to treat the patient with nonoperative management for one week (anti-infective, fasting, gastrointestinal decompression, and maintaining acid-base balance). The patient's blood count and liver and kidney function were dynamically reviewed during conservative treatment. During this period, the patient's white blood cells gradually increased, and she developed intermittent fever with a maximum temperature of 38.5 C. One week later, a repeat CECT revealed a significant increase in fluid accumulation around the lateral descending duodenum, posterior ascending colon, and perirenal fat sac (Figure 2B). Gastrointestinal imaging showed that the diverticulum was located at the beginning of the horizontal segment of the duodenum, and contrast leakage was seen, leading to a definite diagnosis of retroperitoneal perforation of the duodenal diverticulum (Figure 2D). We then performed percutaneous retroperitoneal drainage through a small incision in the right lumbar region under basis anesthesia and local anesthesia with ultrasound localization (Figure 3). The patient's temperature and inflammatory indicators (white blood cell count, C-reactive protein, etc.) gradually returned to normal levels after the operation. A review of CT scans on postoperative day 7 showed a significant reduction in retroperitoneal fluid (Figure 2C), and the patient was discharged 9 days after surgery.
Only one patient developed a postoperative complication of incisional infection after surgery. The remaining patient had no long-term complications during the postoperative period and postdischarge follow-up (median follow-up of 12 months). The median length of stay was 12 days (range: 3-21 days). One patient considered himself to be recovering well on the third postoperative day and strongly requested to be discharged. There were no long-term complications during the follow-up period (median follow-up of 12 months). The case characteristics, treatment modalities, and prognosis of the 10 patients are placed in Table 1.