Diagnosis and management of the symptomatic duodenal diverticulum: a case series and a short review of the literature.
BACKGROUND
The incidence of duodenal diverticula (DD) found at autopsy may be as high as 22%. Perforation is the least frequent but also the most serious complication. This case series gives an overview of the management of this rare entity.


METHODS
This study is a case series of eight patients treated for symptomatic DD.


RESULTS
Two patients had a perforated DD. One perforation was in segments III-IV, which to our knowledge is the first published case; the other perforation was in segment II. A segmental duodenectomy was performed in the first patient and a pylorus-preserving duodeno-pancreatectomy (pp-Whipple) in the second. A third patient with chronic complaints and recurring episodes of fever required an excision of the DD. In a fourth patient with biliary and pancreatic obstruction, a pp-Whipple was carried out, and a DD was discovered as the underlying cause. Four patients (one small perforation, one hemorrhage, and two recurrent cholangitis/pancreatitis caused by a DD) were treated conservatively.


CONCLUSIONS
Symptomatic DD and, in particular, perforations are rare, encompass diagnostic challenges, and may require technically demanding surgical or endoscopic interventions. The diagnostic value of forward-looking gastroduodenoscopy in this setting seems limited. If duodenoscopy is performed at all, the use of a side-viewing endoscope is mandatory.
Department of Visceral and Transplantation Surgery, University Hospital Bern, CH-3010, Bern, Switzerland. beat.schnueriger@insel.ch
Beat
B
Schnueriger
Stephan A
SA
Vorburger
Vanessa M
VM
Banz
Alain M
AM
Schoepfer
Daniel
D
Candinas
D000368:Aged; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods; D004240:Diverticulum / Q000175:diagnosis* / Q000601:surgery*; D004378:Duodenal Diseases / Q000175:diagnosis* / Q000601:surgery*; D004384:Duodenoscopy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007416:Intestinal Perforation / Q000175:diagnosis / Q000601:surgery*; D007813:Laparotomy / Q000379:methods; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis / Q000628:therapy; D018570:Risk Assessment; D012494:Sampling Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome