Multiple Diverticula of the First Part of the Duodenum

Abstract

Diverticula of the intestinal tract are well known, those of the colon being encountered most frequently. However, diverticula of the duodenum are comparatively rare. During our careful analysis of the literature we did not find even a single case with more than two diverticula arising from the first part of the duodenum; we assume, therefore, that our findings may prove to be of some interest. Case Report.—K. S., male, aged 56 years, had vague complaints and discomfort in the right upper quadrant of the abdomen for about fifteen years. He suffered from mild heartburn and gas eructation. Occasionally, he experienced a slight feeling of pressure in the epigastrium. His appetite was good. His bowels moved normally. He never had acute pains or cramps. His weight had been stationary for the past few years. He had no nausea or vomiting. The patient was well nourished; heart and lungs normal; blood pressure 140/80; abdomen soft; liver and spleen showed no sign of enlargement, no definite tenderness on palpation. On very hard pressure on the right side of the epigastrium he complained of slight discomfort. Stomach contents after alcohol test meal showed slight amount of mucus, free HCl 18, total HCl 32. The stomach contents showed no blood. Examination of the stools, following a meat-free diet of three days, showed no evidence of occult blood. The blood count was normal. X-ray Examination.—Esophagus normal. Stomach filled without delay, in hook form. The lower pole of the larger curvature situated in the interspinous line. The mucosal pattern of the stomach normal. Curvatures normal. Peristalsis increased. The pylorus opened immediately after the peristalsis reached it. The cap was filled readily. From the top of the cap, three small ducts leading into three diverticula, were visualized. The x-ray plates in the upright position showed these diverticula with horizontal fluid level and gas bubbles on top. The second portion of the duodenum was situated behind the antrum; the other part of the duodenum was normal and free from the presence of diverticula. The best view of the diverticula was furnished by the left oblique position. After two hours, a slight residue was observed in the stomach. The diverticula had not emptied, and the remainder of the barium was in the small intestines. After six hours the stomach was empty, and the diverticula were well filled, showing the same grape-like aspect. The remaining barium was in the ileo-cecal portion of the intestines. After 24 hours, the diverticula were empty, and there was only a filling of the colon. The treatment of the patient was limited to diet and alkali. The patient's condition improved to a certain extent, but all the complaints were not eliminated. An operation was suggested, but it met with the patient's opposition. A control examination six months later showed findings analogous to those already reported.