From the Guidelines
Air will accumulate in the retroperitoneal space, which is behind the peritoneum, if a perforation occurs in the duodenum (first portion of the small intestine) [@\1@, @\2@, @\3@].
Key Points
- The duodenum is a retroperitoneal organ, meaning it is located behind the peritoneum, and therefore, air will accumulate in the retroperitoneal space in the event of a perforation.
- The retroperitoneal space is not the same as the retrocolic space, which is located behind the colon.
- The lesser sac (peritoneal cavity) and Morrison's pouch (hepatorenal recess) are not directly related to the duodenum and are less likely to be involved in the event of a duodenal perforation.
- The provided evidence [@\1@, @\2@, @\3@] discusses the management of duodenal perforations, but it does support the fact that air will accumulate in the retroperitoneal space in the event of a perforation.
Evidence Summary
The evidence provided focuses on the management of duodenal perforations, including the use of endoscopic closure devices and the importance of early recognition and treatment [@\1@, @\2@, @\3@]. While the evidence does not directly address the question of where air will accumulate in the event of a duodenal perforation, it does imply that the retroperitoneal space is involved, as it discusses the use of fluoroscopy to assess the gas pattern and the placement of a fully covered SEMS into the bile duct across the ampulla to close type 2 periampullary (retroperitoneal) perforations [@\3@].
From the Research
Air Accumulation in Case of Duodenal Perforation
- If a perforation occurs in the duodenum, air can accumulate in various spaces depending on the location and extent of the perforation.
- According to the study 1, in cases of duodenal perforation, air can extend into the right perirenal space, which is located behind the colon and kidney.
- The study 2 reports a case of spontaneous duodenal perforation in a newborn, where the perforation occurred into the lesser sac, which is a peritoneal cavity.
- However, there is no direct evidence to suggest that air will accumulate in the retrocolic space or Morrison's pouch specifically in case of a duodenal perforation.
- The study 3 describes Morrison's pouch as a dependent location that can be involved in various pathological processes, but it does not specifically mention duodenal perforation.
- The study 4 discusses retroperitoneal perforation of the duodenum, but it does not provide information on the accumulation of air in specific spaces.
- The study 5 reports cases of duodenal perforation following blunt abdominal trauma, but it does not provide detailed information on the distribution of air in the abdominal cavity.