Surgical management of duodenal perforation complicated with retroperitoneal abscesses and paralytic ileus: a case report.

Duodenal perforation is a critical gastrointestinal emergency that poses significant morbidity and mortality risks globally. This case report examines a unique presentation of duodenal perforation in a 78-year-old male patient who initially exhibited chronic abdominal pain and paralytic ileus, a manifestation not commonly associated with this condition. The patient underwent coronary stent implantation 5 years ago following myocardial infarction (MI) and has been on long-term oral aspirin therapy since. Upon admission, he displayed worsening symptoms, which included distension, inability to eat, and minimal bowel movement. Initial management strategies involving fasting, acid suppression, and antibiotics failed to ameliorate his condition. A follow-up abdominal CT scan revealed paralytic ileus, duodenal edema, and ultimately, retroperitoneal gas and abscess. An urgent laparoscopic exploration confirmed duodenal perforation, leading to surgical intervention that included suturing the perforation and draining the retroperitoneal space. This case underscores the importance of recognizing atypical presentations of duodenal perforation, advocating for heightened awareness and prompt intervention to mitigate serious complications associated with delayed diagnosis.