We report the case of an 82-year-old woman with a history of hypertension who came to the emergency room for epigastric abdominal pain of 24 hours duration associated with nausea and hypoxia.
Physical examination showed good general health with hemodynamic stability and fever.
The abdomen was blushing and depressible without signs of peritoneal irritation.
Laboratory tests showed mild leukocytosis of 12,400 with 93.4% neutrophils.
Abdominal X-ray and ultrasound were normal.
Given the persistence of pain, an abdominal CT was requested 12 hours later, which showed a non-complicated second portion DD and a retroperitoneal abscess with an image of calcium density in its interior adjacent to the third duodenal portion.
With the diagnosis of duodenal perforation secondary to foreign body was decided urgent surgery, observing a large retroperitoneal abscess secondary to a third duodenal diverticulum perforated by fish bone.
Excessive washing, removal of the foreign body, dissection with endostapling, invagination of the staple line with silk 2/0 were performed and two vacuum drains were placed.
Postoperative management was based on digestive rest (NGS), total parenteral nutrition, somatostatin and IV antibiotics.
The start of the intake began on the fifth postoperative day, being discharged 14 days after the intravenous antibiotic treatment.
