Successful Medical Management of Intramural Duodenal Abscess

Document Type

Conference Proceeding

Publication Date

10-2024

Publication Title

American Journal of Gastroenterology

Abstract

Introduction: Intramural duodenal abscesses are rarely reported in literature, and are mostly caused by complications of a duodenal ulcer perforation. We present a case of intramural duodenal abscess in a patient with a complicated pancreatitis course. Case Description/Methods: We present a 71-year-old woman with a past history of gallstone pancreatitis 3 years prior, complicated with infected necrosis, managed with cyst gastrostomy and necrosectomy. Course was also complicated with common bile duct stricture, choledocholithiasis requiring multiple endoscopic retrograde cholangio-panreatography procedures. She eventually underwent cholecystectomy 1.5 years prior to her current presentation to the emergency department (ED). She presented to the ED with epigastric pain, nausea and vomiting. In the ED, she was vitally stable and afebrile. Exam was notable for epigastric tenderness without peritoneal signs. Laboratory work-up was remarkable for white blood cells 11.6 bil/L (3.5-10.1 bil/L) with neutrophils 9.2 bil/L (1.6-7.2 bil/L). Blood cultures were negative. Computed tomography abdomen and pelvis (with intravenous contrast showed a bilobed peripherally enhancing fluid collection within the third portion of the duodenum measuring 4.4 cm x 2.3 cm x 4.8 cm with surrounding fat stranding suggestive of an intramural abscess (Figure 1A). She was started on intravenous piperacillin-tazobactam and intravenous pantoprazole. Her symptoms completely resolved after 3 days and she was discharged with a 1-week course of oral amoxicillin-clavulanic acid and oral omeprazole with plan for repeat imaging. Computed tomography abdomen and pelvis with intravenous contrast after 1 week showed near complete resolution of previously seen fluid collection with a minimal remaining fluid focus measuring 1.5 x 1 cm and decreased degree of surrounding inflammatory changes (Figure 1B). Endoscopic evaluation was not pursued given resolution of symptoms and significant improvement on surveillance imaging. Discussion: There are no clear guidelines on the management of duodenal abscesses, and previously reported cases required endoscopic or surgical drainage. Our case highlights the successful management of duodenal abscess with antibiotic treatment without a need for an endoscopic procedure or drainage.

Volume

119

Issue

10S

First Page

S3051

Comments

American College of Gastroenterology Annual Scientific Meeting, October 25-30, 2024, Philadelphia, PA

DOI

10.14309/01.ajg.0001048716.88586.bf

Link to Full Text

Share

COinS