SHM Converge Scientific Abstract ePoster Gallery-From Back Pain to Bowel Crisis: Navigating the Therapeutic Challenge of Duodenal Diverticular Perforation in a High-Risk Patient

From Back Pain to Bowel Crisis: Navigating the Therapeutic Challenge of Duodenal Diverticular Perforation in a High-Risk Patient

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This case describes a 75-year-old man with coronary artery disease, prior diverticulitis surgery, chronic NSAID use, and long-term prednisone who presented with left upper quadrant/epigastric pain, hypotension, leukocytosis, and mild lactic acidosis. CT imaging revealed retroperitoneal air and inflammation of the third portion of the duodenum, consistent with a perforated duodenal diverticulum.<br /><br />Because the patient was a high operative risk, he was initially managed non-operatively with bowel rest, IV antibiotics, and total parenteral nutrition. However, persistent fevers and leukocytosis prompted further evaluation. Interventional radiology then drained a purulent collection, and culture grew carbapenem-resistant Proteus species. After targeted antibiotic therapy, the patient improved clinically, completed 10 weeks of IV antibiotics, and was asymptomatic at follow-up.<br /><br />The report emphasizes that duodenal diverticular perforation is rare, often presents with nonspecific symptoms, and may lack classic signs of peritonitis because of its retroperitoneal location. Diagnosis can be delayed, especially in elderly or immunosuppressed patients. Chronic steroid use likely contributed to tissue fragility and impaired healing in this case.<br /><br />The key lesson is that stepwise conservative management can succeed in selected high-risk patients, but requires close monitoring and readiness to escalate care. Early CT imaging, persistent reassessment when inflammatory markers do not improve, and multidisciplinary collaboration were essential to this patient’s recovery.

Asset Subtitle

Fardil Khan

Meta Tag

Author List Bruce E. Hirsch, Christopher A. Dorizas, Fardil Khan

Category Clinical Vignettes

Concept Duodenal Diverticular Perforation

Concept Retroperitoneal Perforation

Concept Observation

Concept Close Monitoring

Concept Abdominal Pain

Distinguished Non-Finalist

Presenter Organization Binghamton University

Presenting Author Fardil Khan

Track Adult

Keywords

perforated duodenal diverticulum

retroperitoneal air

non-operative management

chronic prednisone

NSAID use

elderly patient

leukocytosis

total parenteral nutrition

interventional radiology drainage

carbapenem-resistant Proteus

Duodenal Diverticular Perforation

Retroperitoneal Perforation

Observation

Close Monitoring

Abdominal Pain