CASE OF DU PERFORATION WITH SECONDARY OMENTAL NECROSIS- A RARE CASE REPORT

Abstract

Introduction: The Omentum is rich in blood supply. Omental Infarction can be classified as primary or secondary depending on the pathogenesis.

Aims and Objectives: To report a case of DU perforation with secondary Omental Infarction.

Case Details: A 21 year old male patient came with complaints of generalized dull aching abdominal pain, associated with persistent vomiting and high grade fever since 3 days. On examination, he was drowsy, BP was not recordable and peripheral pulses were not palpable. Abdominal examination revealed guarding and rigidity. X-ray erect abdomen showed gas under the right dome of the diaphragm (pneumoperitoneum).

The patient was taken up for an exploratory laparotomy. Intraoperatively, findings included: 1) A 0.5*0.5cm in size perforation over the anterior first part of the duodenum, 2) approximately 3L of haemorrhagic peritoneal fluid 3) necrosed omentum and 4) petechial patches over the parietal wall of peritoneum. Primary repair of the DU perforation with omental plug (modified graham’s repair) with omentectomy of the necrosed part of omentum was done.

The HPE report of excised specimen of omentum was suggestive of intense congestion and necro-inflammatory reaction of the omentum with necrosis and netrophilic infiltrate.

Conclusion: A rare case of DU perforation with secondary omental necrosis is being reported.

Keywords: DU Perforation; Omental Necrosis; Omental Infarction; Modified Graham’s patch

Abbreviations: OI- Omental Infarction, DU- Duodenum.