Retroperitoneal Duodenal Foreign Body Perforation - A Novel Laparoscopic Approach-Juniper Publishers

JUNIPER PUBLISHERS- OPEN ACCESS JOURNAL OF CASE STUDIES

Retroperitoneal Duodenal Foreign Body Perforation - A Novel Laparoscopic Approach

Authored by Sunder Balasubramaniam

  

Abstract

Gastrointestinal perforation from foreign bodies can lead to life threatening sepsis, and pose a significant challenge given the need to drain the septic source as well as safely extract the offending object. A 71-year-old Chinese lady presented with abdominal pain without peritonitis or fever. A computed tomographic (CT) scan of the abdomen revealed two contiguous retroperitoneal abscesses with a 4cm fishbone. One of the cavities was surrounding the right external iliac artery and had a visible connection from the third portion of the duodenum to the superior abscess cavity. 

She underwent radiology-guided drainage of the collections, followed by a gastrografin swallow which did not demonstrate a leak. Retrieval of the fishbone was first attempted endoscopically by placing a 5 mm laparoscopic port into the cavity to insufflate it with gas, followed by introduction of a flexible choledochoscope. Unfortunately, the bone could not be visualised, and the procedure was converted to open retroperitoneal approach via a 4 cm incision. The bone was successfully retrieved, and a repeat CT done post-operatively showed near resolution of the abscess and complete removal of the fishbone. The patient was fit for discharge on the 4th post-operative day.

To our knowledge, this is the first such report of retroperitoneal abscess due to a foreign body managed by minimally invasive techniques. Fluoroscopic extraction by the radiologist was considered in this case but deemed unsuitable due to the risk of fragmentation and having pieces left behind. The retroperitoneal approach combined with interventional radiology allowed us to avoid the morbidity of laparotomy and speed the patient’s recovery.

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