LAUSR

A 75-year-old woman with a history of gastric ulcers, reflux, Barrett’s esophagus, and a complex surgical history involving previous gastroenterostomy, fundoplication, cholecystectomy, appendectomy, and hysterectomy, presented with a 4-day history of generalized crampy abdominal pain, anorexia, and vomiting. On initial examination she was tachycardic with a pulse rate of 108 beats per minute, but afebrile at 36.7 C, and clinically well with a blood pressure of 130/90 mm Hg, respiratory rate of 19 breaths per minute, and oxygen saturation of 96% in room air. Her abdomen was soft, mildly distended, and tender over the epigastrium. Her blood biochemistry studies revealed a mild leukocytosis of 11.14 10 cells/L, lactate dehydrogenase of 1.4 mmol/L, and C-reactive protein of 337 mg/L. Her electrolytes and liver functions were in the normal range. CT of her abdomen was suggestive of a perforated duodenal diverticulum (Fig. 1). The patient’s pain did not improve with 2 days of bowel rest and intravenous antibiotics; therefore, endoscopy was performed (Video 1, available online at www. VideoGIE.org). Endoscopy identified a large collection of pus in the second part of the duodenum with a necrotic and inflamed duodenal diverticulum containing a foreign body (Fig. 2-3). The esophagus and stomach were normal, and the gastrojejunal anastamosis was functioning well. The foreign body in the diverticulum was removed, the abscess cavity was washed out, and a 7F, 7-cm double-pigtail drain was internally placed by endoscopy to drain the abscess (Fig. 3-6). There were no postprocedural adverse events. The patient was given a fluid diet the next day. Repeated CT 1 month later showed the drain in a satisfactory position within the duodenal diverticulum, with no evidence of