Mesenteric Root Abscess due to Perforated Diverticulum of the Third Part of the Duodenum with Concurrent Incidental Discovery of Sigmoid Colorectal Cancer

Author(s): Panagiotis Patrikakos, Nikiforos Rodis, Nikolaos Mpogiatzopoulos, Konstantina Soukouli, Aspasia Kapetanopoulou, Konstantinos Syggounis, Panagiota Xaplanteri, Pavlos Athanasopoulos.

Retroperitoneal abscesses originating from complicated duodenal diverticula are rare surgical entities. Herein we describe the case of an 81-year-old male patient who presented to the emergency department of our hospital, in a septic state. Computerized Tomography (CT) of the abdomen and retroperitoneal space revealed the presence of intraabdominal air. In the light of these findings the patient was submitted to emergency exploratory laparotomy that revealed a mesenteric root abscess with concurrent incidental discovery of sigmoid colorectal cancer. The abscess was drained, and Hartmann’s procedure was performed. Post-operative course was uneventful, and the patient was released on the tenth postoperative day. The patient returned 15 days later, due to fluid drainage from the site of the surgical drain. Minor leak from a diverticulum of the third duodenal part was documented by means of CT. Conservative treatment was chosen. The patient was discharged without any further complications and on follow up he is well three months afterwards. Conservative treatment was chosen due to the location of the diverticulum and the performance status of the patient. This was an intricate case of retroperitoneal, mesenteric root abscess, caused by a retroperitoneal duodenal diverticulum perforation of the third part.