Diagnosis and management of duodenal perforations: a narrative review

Authors

Daniel Ansari, Department of Surgery, Division of Clinical Sciences, Lund University, Skane University Hospital , Lund , Sweden.Follow
William Torén, Department of Surgery, Division of Clinical Sciences, Lund University, Skane University Hospital , Lund , Sweden.
Sarah Lindberg, Department of Surgery, Division of Clinical Sciences, Lund University, Skane University Hospital , Lund , Sweden.
Helmi-Sisko Pyrhönen, Department of Surgery, Division of Clinical Sciences, Lund University, Skane University Hospital , Lund , Sweden.
Roland Andersson, Department of Surgery, Division of Clinical Sciences, Lund University, Skane University Hospital , Lund , Sweden.

Document Type

Article

Publication Date

8-1-2019

Journal

Scandinavian journal of gastroenterology

Volume

54

Issue

8

First Page

939

Last Page

944

URL with Digital Object Identifier

10.1080/00365521.2019.1647456

Abstract

Duodenal perforation is a rare, but potentially life-threatening injury. Multiple etiologies are associated with duodenal perforations such as peptic ulcer disease, iatrogenic causes and trauma. Computed tomography with intravenous and oral contrast is the most valuable imaging technique to identify duodenal perforation. In some cases, surgical exploration may be necessary for diagnosis. Specific treatment depends upon the nature of the disease process that caused the perforation, the timing, location and extent of the injury and the clinical condition of the patient. Conservative management seems to be feasible in stable patients with sealed perforations. Immediate surgery is required for patients presenting with peritonitis and/or intra-abdominal sepsis. Minimally invasive techniques are safe and effective alternatives to conventional open surgery in selected patients with duodenal perforations. Here we review the current literature on duodenal perforations and discuss the outcomes of different treatment strategies.