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  • • Endoscopic or contrast radiographic evidence of diverticulum

Epidemiology

  • • Duodenal pulsion diverticula are acquired outpouchings of the mucosa and submucosa

    • Found in 20% of autopsies and 5-10% of upper GI series

    • 90% are on the medial aspect of the duodenum

    • Most are solitary and within 2.5 cm of the ampulla of Vater

    • Rare before age 40

    • Symptoms are uncommon, and only 1% of cases found by x-ray warrant surgery

    • Wind sock type of congenital intraluminal diverticulum is rare

Symptoms and Signs

  • • Most are asymptomatic

    • A few patients have chronic postprandial abdominal pain or dyspepsia

    • May present with symptoms from complications of diverticulum

    • -Hemorrhage

      -Perforation

      -Pancreatitis

      -Biliary obstruction

    • Wind sock type of intraluminal diverticulum usually presents with vague epigastric pain and postprandial fullness

    • -Intestinal bleeding or pancreatitis is occasionally seen

Laboratory Findings

  • • Anemia

Imaging Findings

  • • Diverticulum visualized on upper GI contrast radiographic studies or upper GI endoscopy

  • • Suspect duodenal diverticula in patients with upper GI bleeding, perforation or biliary obstruction in which no other source is evident

Rule Out

  • • Other causes of upper GI perforation, bleeding, acute pancreatitis, or biliary obstruction

  • • Signs and symptoms of duodenal diverticula or complications

    • The diagnosis can be made by upper GI contrast radiographic studies or upper GI endoscopy

When to Admit

  • • Upper GI bleeding

    • Perforation

    • Biliary obstruction

    • Pancreatitis

    • Severe abdominal pain

  • • Excision and a 2-layer closure

    • Endoscopic sphincterotomy or stent placement may be preferable to treat biliary obstruction

Surgery

Indications

  • • All complications

    • Severe persistent postprandial abdominal pain or dyspepsia

Contraindications

  • • Asymptomatic patients

Medications

  • • Antacids and anticholinergics

Complications

  • • Bleeding

    • Perforation

    • Acute pancreatitis

    • Biliary obstruction

Prognosis

  • • Good with expedient surgical treatment of complications

References

Lobo DN et al. Periampullary diverticula and pancreaticobiliary disease. Br J Surg. 1999;86:588.  [PubMed: 10361174]

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