Introduction : Perforation is a rare but formidable complication of duodenal diverticulum (DD) with operative mortality of 3~31%. In contrast, it can be managed conservatively in selected cases.

Methods : The authors experienced 2 extreme cases of DD perforation recently and report here.

Results : Case 1. A 56 years old lady showed a DD with microperforation at 3rd portion and mild pneumoretroperitoneum on CT scan. NPO was unfastened 2 days later. Antibiotics were given for 5 days. She was discharged next day. 6 weeks later, follow CT showed duodenal diverticulosis with no evidence of adjacent inflammation. Case 2. (Fig) A 67 years old man showed massive abscess-like lesion in retropancreaticoduodenal space; extending into the right scrotum space on CT scan. It was originated from the 3rd portion DD rupture. Massive retroperitoneal necrosectomy, diverticulectomy and then pyloric exclusion and gastrojejunostomy were done just in case. Additionally, right scrotal necrosectomy including orchiectomy was done. 13 days after the operation, suddenly, colors of the abdominal drain changed from serous to bilous. However he could continue to take food by mouth. 34 days after the operation he was discharged from the hospital on foot with the drainage catheter.

Conclusions : With CT scanning DD perforation can be diagnosed early in the course. Management of DD perforation would be dictated by the extent of retroperitoneal contamination on CT and clinical findings, from conservative management to massive retroperitoneal necrosectomy and diverticulectomy. When operative diverticulectomy is performed, pyloric exclusion seems to be prudent in anticipation of possible delayed duodenal leakage.