Description

Duodenal perforation is an uncommon complication of endoscopic retrograde cholangiopancreatography (ERCP) and a rare complication of upper gastrointestinal endoscopy. Most are small perforations that resolve with conservative management. Laparoscopic repair of perforated duodenal ulcers is safe and effective in experienced centers and is increasingly performed by laparoscopic surgeons. However, the role of laparoscopy in the management of large duodenal perforations (>1 cm) is unclear. To date, no experience has been reported with emergency laparoscopic repair of large perforations for gastroduodenal ulcers. The most common reason for conversion to open surgery is a perforation size greater than 1 cm. This paper reports a case of a large duodenal perforation caused by a nasogastric tube in a 26-year-old man who underwent a tracheostomy following a laceration injury. This large perforation was successfully diagnosed and repaired laparoscopically. This is possibly the first paper in the English literature to report duodenal perforation due to a nasogastric tube in an adult and the first report of successful laparoscopic repair of a large duodenal perforation. Laparoscopic repair of perforated duodenal ulcers is safe and effective in experienced centers and is increasingly performed by laparoscopic surgeons. However, based on the existing literature, it is uncertain whether large duodenal perforations are managed laparoscopically. Studies have shown that the most frequent reason for conversion from laparoscopic to open surgery is the discovery of a large perforation (>1 cm). A consensus conference recently reported that laparoscopic repair of perforated gastric and duodenal ulcers is safe and effective in experienced centers, and to date, no experience has been reported with emergency laparoscopic repair of large perforations. In all these studies of the laparoscopic technique, patients had small ulcers (mean diameter 1 cm) and all patients received simple sutures, mostly omental patches, or suture-less repairs. Duodenal perforation due to nasogastric tubes is a recognized complication in pediatric patients. The present paper reports a case of a large duodenal perforation in a tracheotomy adult, caused by an indwelling feeding nasogastric tube, which was managed laparoscopically. The paper discusses the potential complications of gastrointestinal intubation, the diagnostic role of laparoscopy in such situations, and its potential in the management of large duodenal perforations.