BACKGROUND
A perforated periampullary duodenal diverticulum is a rare but potentially life-threatening condition. Although surgery is considered the standard treatment, minimally invasive treatment strategies have been increasingly documented in carefully selected patients. Here, we report a case of a perforated periampullary duodenal diverticulum successfully managed by endoscopic transdiverticular abscess drainage using a nasobiliary tube.
CASE REPORT
A 64-year-old woman exhibiting poor performance status was admitted with abdominal pain and fever. Contrast-enhanced computed tomography revealed localized retroperitoneal fluid and gas adjacent to a periampullary duodenal diverticulum, without evidence of generalized peritonitis, leading to a diagnosis of perforated periampullary duodenal diverticulum with a localized retroperitoneal abscess. Conservative treatment involving bowel rest, nasogastric decompression, and antibiotics was initiated; however, follow-up imaging revealed enlargement of the abscess cavity. Given the patient’s poor performance status and the technical difficulty of percutaneous drainage, endoscopic drainage was performed on hospital day 8. A 6-French nasobiliary drainage tube was successfully placed into the abscess cavity through the diverticular perforation. The abscess gradually resolved, and the patient was discharged on hospital day 35 without requiring surgery. No recurrence was observed during 13 months of follow-up.
CONCLUSIONS
Endoscopic transdiverticular abscess drainage using a nasobiliary tube may be a feasible minimally invasive alternative to surgery in carefully selected patients exhibiting a perforated periampullary duodenal diverticulum associated with a localized retroperitoneal abscess. Further studies are needed to establish its indications.

Keywords: Abscess; Diverticulum; Drainage; Endoscopy, Gastrointestinal; Intestinal Perforation