An Unusual Clinical Manifestation of a Rare-Site Duodenal Perforation

Background: The incidence of duodenal perforation is less than 1% [1], and less than 1% of gastrointestinal perforations are caused by ingested bodies [2]. Duodenal perforations often present with rapidly progressing peritonitis and are subsequently managed via emergency laparotomy. In our case, the patient accidentally ingested a sharp object that subsequently perforated the duodenum. We report this case of D3 segment Perforation along with its diagnosis and the attendant management challenges.

Case Presentation: A 70-year-old male visited the emergency department with complaints of scrotal swelling. On examination, the patient was found to be in septic shock. An abdominal computed tomography (CT) scan revealed a foreign body perforating the horizontal segment of the duodenum with a retroperitoneal fluid collection. An emergency laparotomy was planned and executed, with the abscess cavity drained, the foreign body removed, and the perforation repaired. The postoperative period was uneventful.

Conclusion: Foreign body perforation in the duodenum is easily missed due to its atypical presentation. An early CT examination helps to identify the foreign body and the localization of the perforation, which can reduce the mortality and morbidity associated with perforation.