{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T15:22:18Z","timestamp":1784647338568,"version":"3.55.0"},"reference-count":11,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T00:00:00Z","timestamp":1772064000000},"content-version":"vor","delay-in-days":26,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,31]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Perforation of a duodenal diverticulum is rare but associated with high morbidity and mortality. Retroperitoneal perforations often present atypically, delaying diagnosis and management. We describe a 48-year-old woman presented to the hospital with abdominal pain after influenza A infection. Initial computed tomography suggested hollow viscus perforation, and she underwent laparoscopic lavage and drainage. Persistent bilious drainage and follow-up imaging revealed perforation of the third portion of the duodenum with retroperitoneal abscess. Exploratory laparotomy demonstrated a 2\u2009\u00d7\u20092\u00a0cm perforated diverticulum at the inferior duodenal angle with surrounding necrosis. Segmental duodenectomy with duodenojejunostomy and feeding jejunostomy was performed. This case highlights the diagnostic difficulty of retroperitoneal duodenal diverticulum perforation and the importance of recognizing bilious drainage as an early warning sign. Conservative measures may be attempted in stable patients, but suspicion of ongoing leakage warrants timely definitive surgery. Early and comprehensive exploration may prevent delayed recognition and reduce morbidity.<\/jats:p>","DOI":"10.1093\/jscr\/rjag085","type":"journal-article","created":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T12:47:59Z","timestamp":1770209279000},"source":"Crossref","is-referenced-by-count":1,"title":["Duodenal diverticulum perforation with pneumo-retroperitoneum: a case report of rare presentation"],"prefix":"10.1093","volume":"2026","author":[{"given":"Yung-De","family":"Kuo","sequence":"first","affiliation":[{"name":"School of Medicine, College of Medicine, National Sun Yat-sen University , No. 100, Shiquan 1st Rd., Sanmin Dist., Kaohsiung City 807378 ,","place":["Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chih-Ying","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of General surgery, Chi-Mei Medical Center , No. 901, Zhonghua Rd., Yongkang Dist., Tainan City 71004 ,","place":["Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinn-Rung","family":"Kuo","sequence":"additional","affiliation":[{"name":"Faculty Development Center, Chi-Mei Medical Center , No. 901, Zhonghua Rd., Yongkang Dist., Tainan City 71004 ,","place":["Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chang-Yao","family":"Chu","sequence":"additional","affiliation":[{"name":"Department of Pathology, Chi-Mei Medical Center , No. 901, Zhonghua Rd., Yongkang Dist., Tainan City 71004 ,","place":["Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,2,26]]},"reference":[{"key":"2026022612154882400_ref1","first-page":"1005","article-title":"Characteristic signs and symptoms of duodenal diverticula: a case report and a brief review of literature","volume":"2","author":"Fatakhova","year":"2017","journal-title":"JSM Med Case Rep"},{"key":"2026022612154882400_ref2","volume-title":"Duodenal Perforation","author":"Amini","year":"2025"},{"key":"2026022612154882400_ref3","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1007\/s00423-021-02238-1","article-title":"A systematic review of the perforated duodenal diverticula: lessons learned from the last decade","volume":"407","author":"Kapp","year":"2022","journal-title":"Langenbecks Arch Surg"},{"key":"2026022612154882400_ref4","doi-asserted-by":"publisher","first-page":"939","DOI":"10.1080\/00365521.2019.1647456","article-title":"Diagnosis and management of duodenal perforations: a narrative review","volume":"54","author":"Ansari","year":"2019","journal-title":"Scand J Gastroenterol"},{"key":"2026022612154882400_ref5","doi-asserted-by":"publisher","first-page":"e74707","DOI":"10.7759\/cureus.74707","article-title":"Etiologies and outcomes following duodenal perforation in acute peritonitis: a systematic review","volume":"16","author":"Shahi","year":"2024","journal-title":"Cureus"},{"key":"2026022612154882400_ref6","first-page":"S42","article-title":"Rare cause of peritonitis \u2013 perforated duodenum diverticulum: case report","volume":"28","author":"T\u00f6r\u00f6k","year":"2023","journal-title":"Surg Gastroenterol Oncol"},{"key":"2026022612154882400_ref7","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1186\/s12876-019-1154-2","article-title":"The challenging diagnosis and treatment of duodenal diverticulum perforation: a report of two cases","volume":"20","author":"Moysidis","year":"2020","journal-title":"BMC Gastroenterol"},{"key":"2026022612154882400_ref8","doi-asserted-by":"crossref","first-page":"936492","DOI":"10.3389\/fsurg.2022.936492","article-title":"Spontaneous perforation of a primary duodenal diverticulum stepped treatment model: a 10-patient case report","volume":"9","author":"Zhong","year":"2022","journal-title":"Front Surg"},{"key":"2026022612154882400_ref9","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1186\/s40792-020-00891-0","article-title":"Perforated duodenal diverticulum successfully treated with a combination of surgical drainage and endoscopic nasobiliary and nasopancreatic drainage: a case report","volume":"6","author":"Shimada","year":"2020","journal-title":"Surg Case Rep"},{"key":"2026022612154882400_ref10","doi-asserted-by":"publisher","first-page":"e6619","DOI":"10.1002\/ccr3.6619","article-title":"Duodenal diverticula perforation caused by an impacted bezoar successfully treated by endoscopic drainage and lithotripsy: a case report and literature review","volume":"10","author":"Tadokoro","year":"2022","journal-title":"Clin Case Reports"},{"key":"2026022612154882400_ref11","doi-asserted-by":"publisher","first-page":"792","DOI":"10.1055\/a-1222-3191","article-title":"Diagnosis and management of iatrogenic endoscopic perforations: European Society of Gastrointestinal 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