Navigating a Surgical Dilemma: Conservative Management of a Rare Case of Spontaneous Duodenal Perforation in a Resource-Limited Setting

Non-traumatic duodenal perforation is a rare and potentially life-threatening condition, typically caused by peptic ulcer disease, and traditionally requires urgent surgical intervention. However, in resource-limited settings, conservative management can be an effective alternative for selected patients, particularly those with localized contamination and comorbidities that make surgery high-risk. This case report describes the successful non-operative management of a 78-year-old woman with poorly controlled type 2 diabetes, hypertension, dyslipidemia, and bronchial asthma, who presented with a seven-day history of right upper quadrant pain. Imaging with contrast-enhanced computed tomography revealed a localized second-part duodenal perforation with perihepatic extravasation of contrast, but no diffuse peritonitis. Given her frailty, a non-surgical approach was adopted, involving intravenous fluids, broad-spectrum antibiotics, proton pump inhibitors, and careful monitoring. The patient's condition improved progressively, with pain resolution and return to a light diet by day 10, and she was discharged on day 11. This case underscores the importance of precise imaging, judicious patient selection, and adaptive resource utilization in managing duodenal perforation in settings with limited resources, highlighting the feasibility of conservative management in high-risk patients.