George Washington University School of Medicine and Health Sciences Washington, DC
Pavan Vemulakonda, MD1, Jasjit Multani, MD2, Vinay Rao, MD3, Ankit Patel, MD1, Leen Raddaoui, MD3, Hemanth Gavini, MD, MPH4, Marie L. Borum, MD, EdD, MPH, FACG4 1George Washington University School of Medicine and Health Sciences, Washington, DC; 2Unity Health-White County Medical Center, Searcy, AR; 3George Washington University Hospital, Washington, DC; 4Division of Gastroenterology and Liver Disease, Department of Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC Introduction: Duodenal perforation resulting in the leakage of intestinal contents necessitates timely recognition and surgical intervention due to reported mortality ranging from 8-25%1. The most common etiology of duodenal perforation is peptic duodenal ulcers due to H. Pylori infection or NSAIDs. A duodenal perforation due to a large central retroperitoneal mass is rare. We report an unusual case of a duodenal perforation due to a leiomyoma.
Case Description/
Methods: A 58-year-old female with hypertension, gastric bypass, and cholecystectomy presented with 36 hours of acute abdominal pain and melena. Two weeks prior, she was admitted for abdominal pain and found to have active extravasation from the pancreaticoduodenal artery. Successful embolization of the third branch of the gastroduodenal/inferior pancreaticoduodenal artery was performed. On re-presentation, significant labs revealed WBC 15.7, Hgb 10.7, and total bilirubin 1.7. Exam was pertinent for diffuse abdominal tenderness. A CT scan revealed a perforation in the third portion of the duodenum with a large, complex retroperitoneal collection. On upper endoscopy two perforation sites were identified, with visible retroperitoneal content inflow, which were not amenable to endoscopic repair. General surgery performed laparoscopic omental patch duodenorrhaphy, drainage of a retroperitoneal hematoma, and intraoperative identification of a large (13-18 cm), centrally located retroperitoneal mass. Pathology at the periphery found rare spindle cells positive for SMA and desmin with stains potentially consistent with leiomyoma and pending confirmation with repeat EGD and EUS. Discussion: Retroperitoneal masses can be asymptomatic or have non-specific symptoms until large in size. As a result, these masses can be challenging to diagnose and may present with local extension. Literature review found one prior report of two patients with retroperitoneal sarcoma presenting with colonic perforations necessitating colectomies2. This case uniquely demonstrates the consequences of a large, extrinsic retroperitoneal leiomyoma resulting in duodenal perforation.
Duodenal perforation is an urgent, life-threatening consequence of the insidious growth of retroperitoneal masses which requires prompt diagnosis to reduce morbidity and mortality.
1. Amini, A., & Lopez, R. A. (2025). Duodenal Perforation. In StatPearls.
2. Kopplin, L., & Kim, J. (2011). Retroperitoneal sarcoma: A rare cause of intestinal perforation in two cases. Journal of Surgical Case Reports, 2011(5), 3.
Disclosures: Pavan Vemulakonda indicated no relevant financial relationships. Jasjit Multani indicated no relevant financial relationships. Vinay Rao indicated no relevant financial relationships. Ankit Patel indicated no relevant financial relationships. Leen Raddaoui indicated no relevant financial relationships. Hemanth Gavini indicated no relevant financial relationships. Marie Borum indicated no relevant financial relationships.
Pavan Vemulakonda, MD1, Jasjit Multani, MD2, Vinay Rao, MD3, Ankit Patel, MD1, Leen Raddaoui, MD3, Hemanth Gavini, MD, MPH4, Marie L. Borum, MD, EdD, MPH, FACG4. P6244 - A Rare Case of Duodenal Perforation Due to Large Retroperitoneal Mass, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
