TY - JOUR
T1 - The perforated duodenal diverticulum
AU - Thorson, Chad M.
AU - Paz Ruiz, Pedro S.
AU - Roeder, Rosiane A.
AU - Sleeman, Danny
AU - Casillas, Victor J.
N1 - Copyright:
Copyright 2012 Elsevier B.V., All rights reserved.
PY - 2012/1
Y1 - 2012/1
N2 - Objective: To perform a literature review of perforated duodenal diverticulum with attention to changes in management. Data Sources: We searched PubMed for relevant studies published from January 1, 1989, through August 1, 2011. In addition, we identified and reviewed 4 cases at our institution. Study Selection: Search phrases were perforated duodenal diverticulum and duodenal diverticulitis. Data Extraction: Patient demographics, clinical characteristics, radiologic findings, treatment, and outcomes were obtained. Results: We reviewed 39 studies producing 57 cases, which were combined with the 4 at our institution for a total of 61 patients. The addition of 2 previous series revealed a total of 162 patients in the world literature. Perforations were most commonly located in the second or third portion of the duodenum (60 of 61 cases [98%]), and the most frequent cause was diverticulitis (42 of 61 [69%]). There has been a dramatic improvement in the preoperative diagnosis of perforated diverticula. Only 13 of 101 reported cases (13%) were correctly diagnosed before 1989, and 29 of 61 (48%) in the present series were identified with radiologic examinations. Most patients in the current series (47 of 61) underwent operative treatment for their perforation, although 14 underwent successful nonoperative management. Complications were reported in 17 of 47 patients in the surgical group (36%), whereas only 1 complication was seen in patients undergoing nonoperative management. Mortality in the surgical group was 6% (3 of 47), and no deaths were reported in the nonoperative group. Conclusions: Perforation of a duodenal diverticulum is rare, with only 162 cases reported in the world literature. Nonoperative management has emerged as a safe, practical alternative to surgery in selected patents.
AB - Objective: To perform a literature review of perforated duodenal diverticulum with attention to changes in management. Data Sources: We searched PubMed for relevant studies published from January 1, 1989, through August 1, 2011. In addition, we identified and reviewed 4 cases at our institution. Study Selection: Search phrases were perforated duodenal diverticulum and duodenal diverticulitis. Data Extraction: Patient demographics, clinical characteristics, radiologic findings, treatment, and outcomes were obtained. Results: We reviewed 39 studies producing 57 cases, which were combined with the 4 at our institution for a total of 61 patients. The addition of 2 previous series revealed a total of 162 patients in the world literature. Perforations were most commonly located in the second or third portion of the duodenum (60 of 61 cases [98%]), and the most frequent cause was diverticulitis (42 of 61 [69%]). There has been a dramatic improvement in the preoperative diagnosis of perforated diverticula. Only 13 of 101 reported cases (13%) were correctly diagnosed before 1989, and 29 of 61 (48%) in the present series were identified with radiologic examinations. Most patients in the current series (47 of 61) underwent operative treatment for their perforation, although 14 underwent successful nonoperative management. Complications were reported in 17 of 47 patients in the surgical group (36%), whereas only 1 complication was seen in patients undergoing nonoperative management. Mortality in the surgical group was 6% (3 of 47), and no deaths were reported in the nonoperative group. Conclusions: Perforation of a duodenal diverticulum is rare, with only 162 cases reported in the world literature. Nonoperative management has emerged as a safe, practical alternative to surgery in selected patents.
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U2 - 10.1001/archsurg.2011.821
DO - 10.1001/archsurg.2011.821
M3 - Review article
C2 - 22250120
AN - SCOPUS:84856017782
VL - 147
SP - 81
EP - 88
JO - JAMA Surgery
JF - JAMA Surgery
SN - 2168-6254
IS - 1
ER -