V5 - Successful Endoscopic Drainage of Acute Duodenal Diverticulitis Complicated by Abscess

Billy-Joe Liane, MD¹, John Quiles, MD^2
1Brooke Army Medical Center, San Antonio, TX; ²San Antonio Military Medical Center, Fort Sam Houston, TX

Introduction: Duodenal diverticulitis complicated by abscess formation is a rare clinical entity, usually requiring surgical intervention with high morbidity and mortality. We present a unique case that elucidates the success of endoscopic management of duodenal diverticulitis complicated by an abscess in the 3rd part of the duodenum, via forward-viewing endoscopy. Whereas surgery has been the primary treatment modality, endoscopy is shown more recently to be a safe and effective alternative for this uncommon disease process.

Case Description/Methods: Our patient is a 64-year-old female with history of peptic ulcer disease who presented with severe abdominal pain, along with persistent nausea and non-bloody emesis. She was febrile and her exam was notable for a soft abdomen with tenderness in the epigastric area and left upper quadrant. Labs were notable for a leukocytosis of 24.8k. Abdominal CT was significant for revealing duodenal diverticulitis complicated by adjacent abscess measuring up to 4.3cm, without intraperitoneal free air (A). The patient had persistent pain with fevers. General surgery was initially consulted and determined she did not require urgent surgical intervention. Gastroenterology was consulted with plan for endoscopy. Endoscopic visualization demonstrated a diverticulum in the 3rd portion of the duodenum with impacted debris and purulent drainage (B). Subsequent endoscopic lavage and debridement were successful with complete cavity evacuation. Intraprocedural contrast evaluation of the diverticulum was performed without extravasation to suggest perforation, followed by placement of two 7Fr x 5cm double pigtail plastic stents (C, D). Over the next day, her abdominal pain and fever subsided. At an 8-week outpatient follow-up, she was without symptom recurrence and abdominal radiograph showed interval stent passage.

Discussion: Duodenal diverticulitis is a rare complication with significant morbidity and mortality. We describe a unique case where endoscopic drainage is a viable and effective management modality in the clinically stable patient with complicated acute duodenal diverticulitis. Previous endoscopic interventions described in the literature were localized to the 2nd part of the duodenum, for which a duodenoscope was used. In this case, a unique approach was successful via the use of forward-viewing endoscopic techniques. This case highlights a multi-disciplinary approach to evaluating duodenal diverticulitis and the effectiveness and safety of its endoscopic management.



Disclosures:


Billy-Joe Liane, MD¹, John Quiles, MD², V5, Successful Endoscopic Drainage of Acute Duodenal Diverticulitis Complicated by Abscess, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.