Manejo inicialmente conservador de la perforación duodenal de origen diverticular

Abstract

Objective. To show the possibility of initial conservative management of a perforaed duodenal diverticulum with intravenous antibiotherapy, percutaneous drainage and deferred surgical intervention. Methods. Description of a clinical case –following the CONSORT recommendations–, the reasons of the conservative management and the type of surgical intervention. Results. It was initially possible to control the infectious site with the combination of intravenous antibiotherapy (piperacyline-tazobactam) and a retroperitoneal ecoguided drainage. After 15 days the definitive surgical procedure was made. A laparotomy, resection of the third and fourth duodenal segments and manual latero-lateral duodenojejunostomy was performed. Discussion. Event thought surgical intervention should be evaluated in all the duodenal perforations as the first procedure, the conservative management with antibiotherapy and percutaneous drainage can make possible the deferred surgery. Conclusion. In selected patients –absence of septic or hemodynamic repercussion– a step strategy, combination of intravenous antibiotherapy and percutaneous drainage, with a deferred surgical procedure can be an effective treatment strategy with low morbimortality of this infrequent entity.