Duodenal diverticulum

Type III Cystic dilatation of the intramural portion of the common bile duct and is contended by some to represent a duodenal diverticulum rather than a choledochal cyst. 

Fig. 2.39a,b. Intraluminal Duodenal Diverticulum. ERCP (a) demonstrates a smooth well-delineated air collection extending caudally from the region of the major papilla, shown against a background of contrast in the rest of the lumen. The patient presented with intermittent bouts of acute pancreatitis. Subsequent Double Contrast barium study (b) demonstrates the inner and outer border of the diverticulum, which exhibits the typical windsock sign... 

Intestinal Malrotation 168 Duodenal Diverticulum 169 Duodenal Duplication 169 Preduodenal Portal Vein 170 Inflammatory Diseases 170 Peptic Disease and Its Complications 170 Crohn s Disease 171... 

Fig. 9.3. Duodenal diverticulum. A large rounded collection of the oral contrast medium with an air-fluid level seen medially to the duodenal loop...

Duodenal diverticulum is a frequent incidental finding, found in up to 10% of upper GIT barium studies. The most common site is at the mesenteric border of the descending and horizontal parts of the duodenum, particularly near the ampulla of Vater. Indeed the ampulla may be situated within a diverticulum so that the common bile duct drains into such a periampullary diverticulum. On CT, the diverticulum is seen as an air-filled pocket, or it may demonstrate an air-fluid level with contrast medium and food debris in the dependent part (Fig. 9.3) (Stone et al. 1989 Jayaraman et al. 2001 ZissiN et al. 2002). 

Intraluminal duodenal diverticulum (ILDD) is a rare congenital duodenal anomaly caused by an incomplete congenital web of membrane in which a... 

Fidler JL, Saigh JA, Thompson JS et al (1998) Demonstration of intraluminal duodenal diverticulum by computed tomography. Abdom Imaging 23 38-39... 

Peptic ulceration occurs as an acute or chronic non-traumatic epithelial breach typically in the gastric or duodenal mucosa, but also in the oesophagus (see above) and occasionally in the small intestine with the Zollinger-Ellison syndrome of gastrin overproduction or with an acid-secreting Meckel s diverticulum. Symptoms overlap with those of non-ulcer dyspepsia and cancer and the diagnostic cornerstone is endoscopy. Biopsy may be necessary to distinguish ulcer from cancer. 

Perforation can occur elsewhere than in the colon in one case a duodenal ulcer was apparently made to perforate. In both this and another case of perforation of a sigmoid diverticulum the complication was not immediately recognized, the duodenal perforation only being detected 5 days after administration of the barium meal (SEDA-17, 535). 

In children, localized gastrointestinal bleeding is usually secondary to duodenal ulcer and less frequently to gastric ulcer, Meckel s diverticulum, and vascular malformations. Diffuse bleeding can occur in vasculitis and coagulopathy. 

Duodenal duplication and diverticulum are usually asymptomatic lesions, often diagnosed incidentally by imaging. They may, infrequently, become symptomatic owing to complications such as acute inflammation, perforation, hemorrhage, acute pancreatitis, intussusception, or biliary obstruction (OsHiMOA et al. 1998 Rao 1999). 

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