Extension of Air into the Right Perirenal Space after Duodenal Perforation: CT Findings

NedaYagan, MD YongH.Auh., MD Andrea Fisher, MD

Purpose: To determine the extraperitoneal distribution of air follow­ing perforation of the second portion of the duodenum.

Materials and Methods: Institutional review board approval was obtained for this HIPAA-compliant study. The requirement for written in­formed, consent was waived. Two reviewers who were aware of the presence of duodenal perforation after duo­denal endoscopy retrospectively reviewed computed to­mographic (CT) images in eight patients (one man, seven women; mean age, 68 years; age range, 27-88 years) to assess and categorize the location of extraluminal air.

Results: Intraluminal air was detected in the following locations: right anterior pararenal space (n = 8), right perirenal space (n = 7), right posterior pararenal space (n = 4), right preperitoneal compartment (n = 4), bare area of the liver (n = 6), right extraperitoneal pelvis (n = 7), hepa­toduodenal ligament (n = 3), mesentery (n = 2), medias­tinum (n =4), portal venous system (n = 1), and perito­neal cavity (n = 1).

Conclusion: Air extended posteriorly into the right perirenal space in seven (88%) of eight patients following perforation of the second portion of the duodenum. Duodenal perforation introduces potential for direct communication between the right anterior pararenal space and the right perirenal space.