TY - JOUR T1 - Management of the perforated duodenal diverticulum JF - Trauma Surgery & Acute Care Open JO - Trauma Surg Acute Care Open DO - 10.1136/tsaco-2023-001087 VL - 8 IS - 1 SP - e001087 AU - William Ian McKinley AU - Trever Symalla AU - Andrew Benjamin Y1 - 2023/02/01 UR - http://tsaco.bmj.com/content/8/1/e001087.abstract N2 - A woman in her 70s presented to the emergency department after having sudden-onset right lower quadrant pain 2 hours earlier. She noted the pain to be 10/10 in severity, non-radiating, and cramping in character. Vitals and labs including a basic metabolic panel and complete blood count were within normal limits; however a lactic acid level was elevated at 3.4 (normal <2). A CT scan was performed with findings of free air and fluid in the lesser sac, a significantly distended stomach, and retroperitoneal debris (figure 1). General surgery was consulted at this time; the patient was found to be distended, tympanitic, and peritonitic on examination. Intravenous fluid resuscitation and broad-spectrum antibiotics were initiated. She was taken directly to the operating room for operative intervention, given her examination and imaging findings. Laparoscopy was performed with minimal findings, though a large collection of fluid was seen in the retroperitoneum surrounding the duodenum. Suspicion of a posterior duodenal perforation was high, and therefore the prior laparoscopy was converted to an exploratory laparotomy. The right colon was mobilized and inspected, and no defect was identified. A Kocher maneuver was performed and copious bilious fluid was encountered. A 3 cm defect was evident on … ER -