Case on leakage after closure of a perforated duodenal diverticulum

In view is a 76-year-old female patient, who presented at our cardiac care unit because of acute distress, dyspnoe, and chest pain. Her medical history included arterial hypertension, hypercholesterolemia, a cholecystectomy, hysterectomy, and a diaphragmatic hernia. On physical examination, she was acutely ill, in shock, without fever. Her abdomen was painful with signs of generalized peritonitis. The electrocardiogram did not show any sign of acute ischemia. A CT scan with double contrast revealed free fluid and air in the retroperitoneal space as well as in the right upper quadrant. The diagnosis of a perforation of a hollow organ-probably a duodenal ulcer-was made, and a laparoscopic exploration was proposed. Due to reduced visibility, conversion to a laparotomy was performed, showing a perforated duodenal diverticulum. The diverticulum was resected. On the sventh day after operation her clinical condition deteriorated.