Diagnostic Challenges and Management of Blunt Traumatic Duodenal Diverticulum Perforation: A Systematic Review.

Background/Objectives: Traumatic duodenal diverticulum perforation is a rare, potentially fatal consequence of blunt trauma. Nonspecific symptoms and diagnostic challenges often delay recognition. This systematic review characterizes its clinical features, management, and outcomes. Methods: A systematic literature search covering 1960 to December 2025 identified eligible cases. Inclusion criteria were blunt trauma-related duodenal diverticulum perforations confirmed by imaging or surgery. Data were analyzed according to PRISMA 2020 guidelines. Results: Twenty-one cases were identified (mean age 62.9 years; sex ratio (M:F) 8:13). Primary injury mechanisms were traffic accidents (10 of 21) and falls from height (8 of 21). Most injuries involved the descending duodenum (D2; 17 of 21). Common presenting signs included abdominal pain (19 of 21) and epigastric tenderness (16 of 21). Computed tomography confirmed findings consistent with perforation in all scanned patients (17 of 17). Surgical management was employed in 20 of 21 patients, predominantly via manual (11 of 20) or stapled (9 of 20) diverticulectomy, with drainage applied in 18 of 20 operated cases. Complications occurred in 13 of 21 patients. Overall mortality was 4 of 21. Conclusions: Traumatic duodenal diverticulum perforation remains a life-threatening event requiring high clinical vigilance. The data collected suggest that early CT scanning and prompt surgical intervention may be associated with better treatment outcomes, although these conclusions should be treated with caution due to the small sample size. The protocol was registered in PROSPERO (CRD420261285658).