Laparobotic duodenal diverticulectomy and choledochoduodenostomy: a case study and review of the literature.

Abstract

The duodenum is the second most common site for diverticulae, after the colon. They are common after the fifth decade and usually asymptomatic. Ten percent of patients present with symptoms, which include abdominal pain, hemorrhage, duodenal obstruction, diverticulitis, perforation, pancreatitis, and obstructive jaundice. After a thorough search of medline we present, for the first time, a case of obstructive jaundice secondary to duodenal diverticulum compressing the common bile duct. It was managed by laparobotic duodenal diverticulectomy with choledocho-duodenostomy. The operative technique is discussed. A 78-year-old female was found to have an abnormal cholestatic liver function profile and dilated common bile duct during workup for upper abdominal pain. CT scan showed dilated common bile duct measuring 2.7cm with suspected ampullary mass. Endoscopic ultrasound showed a large diverticulum next to the ampulla. Upper GI endoscopy confirmed duodenal diverticulum, arising from the second part of the duodenum. Laparobotic duodenal diverticulectomy and choledochoduodenostomy were performed. Her post-operative course was complicated by Clostridium difficile diarrhea, treated with metronidazole and she was discharged home on the 6th postoperative day. Follow-up at 18 months demonstrated that she was well. Obstructive jaundice due to compression by a duodenal diverticulum is rare. It poses a diagnostic challenge and requires technically demanding surgical and endoscopic intervention. Robotic surgery has revolutionized the field of minimally invasive surgery by improving vision and motion control. Robotic duodenal diverticulectomy and choledocho-duodenostomy are safe and feasible.