PMC8202293_01
(a) Thickened capsule of the right kidney (curved haemostat), with the distal duodenum firmly adhered (white arrow) and nephrostomy tubing passing intraluminally (black arrow). (b) Dacron cuff (forceps) perforating the duodenum with leakage of intestinal contents
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The distal descending duodenum at the level of the duodenocolic ligament and the tip of the right pancreatic limb was firmly adhered to the right kidney (Figure 3a). The Dacron cuff of the nephrostomy tube was incorporated into the duodenum, resulting in perforation of the bowel at its mesenteric border with leakage of intestinal contents (see Figure 3b).
Resultant duodenectomy with full-thickness perforation at the mesenteric border
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The duodenocolic ligament was freed to allow resection of approximately 80 mm of affected small intestine (see Figure 4).
PMC8202293_02
Ultrasound image of the plicating jejunum (yellow arrow) with the right nephrostomy tubing entering the descending duodenum (white arrow)
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Repeat abdominal ultrasonography revealed a hyperechoic tube-like object perforating the small intestine with regional free abdominal fluid and partial intussusception (see Figure 5).
Ultrasound image of the hyperechoic structure within the distal duodenum (white arrow); proximally it is slightly filled with ingesta (yellow arrow)
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Distally, the tube-like object was seen to pass through the duodenal wall into the peritoneum, where it was traced towards the urinary bladder (see Figure 6).
(a) Right Dacron cuff (white arrow) perforating the descending duodenum with perinephric adhesions. (b) Scant volume of blood-tinged peritoneal fluid (yellow arrow) and explantation of the Dacron cuff (black arrow). (c) Additional partial jejunal perforation (white arrow)
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Multiple adhesions of the greater omentum were identified and a firm disc-like foreign body was palpated in the descending duodenum within the perinephric adhesions (see Figure 7a). There was a scant volume of blood-tinged peritoneal fluid (see Figure 7b). Dacron cuff of the right nephrostomy tube (see Figure 7b). Dissection of the adhesions of the distal aspect of the right urinary catheter to the mid-jejunum revealed an additional partial thickness jejunal perforation through the seromuscular layer (see Figure 7c).