PMC5822869_01
Coronal abdominal CT scan image showing retroperitoneal abscess.
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The initial computed tomography (CT) abdomen at our hospital revealed a loculated air and fluid filled, rim enhancing collection in the right retroperitoneum extending to the pelvis measuring approximately 20.8 x 6.7 x 5.3 cm with a JP drain (Figure 1).
Fistulous opening in the duodenum.
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Finally, an upper endoscopy was performed after 12 weeks of initial admission revealed a small mucosal defect in medio-posterior wall of distal portion of the duodenal bulb that was draining pus intermittently, suspicious for the site of perforation (Figure 2).
Endoscopic closure of luminal perforation of the duodenum with OVESCO over-the-scope clip.
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An OVESCO over-the-scope clip (12/6T) was used to close the defect and a second injection of methylene blue via the catheter did not show further luminal drainage (Figure 3).
Coronal abdominal CT scan images after the closure of the fistula.
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Repeat CT scan after 8 weeks from the endoscopic closure showed near complete resolution of the abscess (Figure 4).