• Yuri Sasaki, Jun Nakahodo, Tomoko Onishi, Ayu Tachibana, Ryogo Minami, Eriko Noma, Yoshiaki Moriguchi, Hiroki Tabata, Ryoko Shimizuguchi, Akinari Takao, Satomi Shibata, Kazuro Chiba, Takeo Arakawa, Toshiro Iizuka, and Terumi Kamisawa.
• Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Japan.
• Intern. Med. 2023 Nov 15; 62 (22): 332733313327-3331.

AbstractA 59-year-old woman presented with a chief complaint of melena. She had no abdominal findings, such as tenderness or tapping pain. Laboratory tests revealed a white blood cell count of 5,300 cells/μL and C-reactive protein level of 0.07 mg/dL. Inflammation and anemia (hemoglobin 12.4 g/dL) were denied. Contrast-enhanced computed tomography (CT) revealed multiple duodenal diverticula and air surrounding a descending duodenal diverticulum. Based on these findings, duodenal diverticular perforation (DDP) was suspected. Oral food intake was stopped, and nasogastric tube feeding and conservative treatment with cefmetazole, lansoprazole, and ulinastatin were begun. On day 8 of hospitalization, follow-up CT revealed the disappearance of the air surrounding the duodenum, and the patient was discharged on day 19 after the resumption of oral feeding.

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