title: Juxtapapillary Duodenal Diverticulum Impacted with Enterolith.
abstract: A 64-year-old man underwent abdominal computed tomography (CT) as periodic follow-up following a distal gastrectomy with lymphadenectomy for gastric cancer and mucosal-associated lymphoid tissue (MALT) lymphoma conducted 31 months earlier. Contrast-enhanced CT demonstrated a well-circumscribed mass lesion with heterogeneous density measuring 2.2 cm in diameter located between the second segment of the duodenum and uncinate process of the pancreas. Esophagogastroduodenoscopy revealed no remarkable findings in the remnant stomach; however, the scope could not reach the duodenum due to altered anatomy by Roux-en-Y reconstruction after the distal gastrectomy. The patient underwent surgical resection of the mass lesion under the clinical diagnosis of MALT lymphoma relapse. An orange calculus was apparent in the thinly extended duodenal wall on stretching, and the hall was closed by meticulous primary suture after the duodenal resection. Macroscopically, the extracted calculus was solid and quite hard, measured 2.2 × 2.1 × 2.1 cm, and the cut surface revealed a layered structure in the outer areas with granulated contents in the center. Although duodenal diverticula are relatively common, an enterolith developing within a juxtapapillary duodenal diverticulum is rare, and to the best of our knowledge, this is the first such case due to altered anatomy after gastrectomy reported in the English literature.
authors.affiliation: Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan. tsutomun@kochi-u.ac.jp.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Namikawa
authors.affiliation: Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Kawanishi
authors.affiliation: Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan.
authors.forename: Kazune
authors.initials: K
authors.lastname: Fujisawa
authors.affiliation: Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan.
authors.forename: Eri
authors.initials: E
authors.lastname: Munekage
authors.affiliation: Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan.
authors.forename: Masaya
authors.initials: M
authors.lastname: Munekage
authors.affiliation: Cancer Treatment Center, Kochi Medical School Hospital, Kochi, Japan.
authors.forename: Hiromichi
authors.initials: H
authors.lastname: Maeda
authors.affiliation: Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kitagawa
authors.affiliation: Department of Gastroenterology and Hepatology, Kochi Medical School, Kochi, Japan.
authors.forename: Takuhiro
authors.initials: T
authors.lastname: Kohsaki
authors.affiliation: Cancer Treatment Center, Kochi Medical School Hospital, Kochi, Japan.|Department of Human Health and Medical Sciences, Kochi Medical School, Kochi, Japan.
authors.forename: Michiya
authors.initials: M
authors.lastname: Kobayashi
authors.affiliation: Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Hanazaki
mesh_terms: D002137:Calculi / Q000000981:diagnostic imaging / Q000601:surgery*; D004240:Diverticulum / Q000601:surgery*; D004378:Duodenal Diseases / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery*; D004386:Duodenum / Q000000981:diagnostic imaging / Q000601:surgery; D005743:Gastrectomy; D018530:Gastric Stump / Q000000981:diagnostic imaging / Q000601:surgery; D005763:Gastroenterostomy; D006801:Humans; D018442:Lymphoma, B-Cell, Marginal Zone / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D013274:Stomach Neoplasms / Q000601:surgery*; D014057:Tomography, X-Ray Computed
keywords: Enterolith; Juxtapapillary duodenal diverticulum; Surgically altered anatomy