title: Ampullary but not periampullary duodenal diverticula are an etiologic factor for chronic pancreatitis.
abstract: BACKGROUND
  Duodenal diverticula are common incidental findings. Although a definite treatment is rarely required, an association with biliary and pancreatic diseases is often suggested. Our aim was to determine the frequency of complications in relation to the location of the diverticulum.
  
  
  METHODS
  We reviewed 64 patients with extraluminal duodenal diverticula. In 24 of these patients the diverticulum was treated surgically. The incidence of symptoms and complications is analyzed and follow-up in 88% of operated patients is presented.
  
  
  RESULTS
  Thirty-one patients presented with ampullary, 36 patients with periampullary diverticula. Three patients had both types of diverticula. The indication for surgery in 24 patients was chronic pancreatitis (n = 12), chronic pain (n = 6), diverticular perforation (n = 3), bleeding (n = 2), or jaundice (n = 1). In 7 out of 31 patients with ampullary and none out of 36 patients with periampullary diverticula, chronic pancreatitis was considered to be induced by the diverticulum. Morbidity in 24 operated patients was 17%, no patient died. At follow-up all patients were free of symptoms.
  
  
  CONCLUSIONS
  Extraluminal duodenal diverticula are frequently found. They rarely cause symptoms and need no surgical treatment. While ampullary duodenal diverticula can cause chronic pancreatitis, periampullary duodenal diverticula are no etiologic factor.
authors.affiliation: Department of General Surgery, University of Ulm, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Naranjo-Chavez
authors.forename: M
authors.initials: M
authors.lastname: Schwarz
authors.forename: G
authors.initials: G
authors.lastname: Leder
authors.forename: H G
authors.initials: HG
authors.lastname: Beger
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D004240:Diverticulum / Q000150:complications* / Q000628:therapy; D004378:Duodenal Diseases / Q000150:complications* / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000209:etiology*; D012307:Risk Factors