Delayed diagnosis of retroperitoneal duodenal perforation after endoscopic treatment: Management challenges and a novel surgical strategy case series reports.

INTRODUCTION

Retroperitoneal duodenal perforation is a rare but severe complication of endoscopic procedures such as ERCP and ESD, often leading to significant morbidity and mortality when diagnosed late. Previous studies have focused on early diagnosis, but data on delayed diagnosis cases are limited. This study presents four cases of delayed-diagnosis retroperitoneal duodenal perforation and introduces a novel surgical management strategy.

PRESENTATION OF CASE: We report four cases diagnosed more than one month after the initial endoscopic procedure, with CT scans revealing extensive retroperitoneal fluid collections and secondary colonic perforation in some cases. Surgical interventions included right hemicolectomy and proximal jejunostomy to facilitate duodenal exposure and clearance of infectious debris. Outcomes varied, with some patients achieving full recovery while others succumbed to complications.

DISCUSSION: The symptoms of retroperitoneal duodenal perforation are often subtle, leading to delayed diagnosis. Early surgical intervention is crucial if CT shows retroperitoneal fluid collections. Right hemicolectomy provides better duodenal exposure and facilitates effective debridement, improving outcomes.

CONCLUSION

Early diagnosis and prompt surgical intervention, including right hemicolectomy, are essential for managing delayed retroperitoneal duodenal perforation. Further studies are needed to establish optimal management protocols for these complex cases.