Duodenal Diverticula

• • 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