S3574 Duodenal Diverticula: An Unusual Cause of Dyspepsia

Abstract

INTRODUCTION: Duodenal diverticula are a rare entity. They frequently remain undiagnosed owing to their asymptomatic presentation. Here we report a case of a middle-aged female who presented to us with episodic abdominal pain and her endoscopy revealed multiple diverticula in the duodenum. CASE DESCRIPTION/METHODS: A 45-year-old woman presented to the clinic with complaints of 3 months history of episodic upper abdominal discomfort and vomiting. These episodes were worsened after a heavy meal and sometimes when she lies down immediately after a meal. She denies any heartburn. Her appetite had decreased during the past 3 months and she reported a 3 kg weight loss during this period. Her examination was normal. Initial laboratory investigations (including amylase and lipase levels) were normal. Her stool for H. Pylori was negative. An endoscopy was performed which showed hyperemic mucosa in the gastric antrum and multiple duodenal diverticula (Figure 1). Biopsy from the antrum and diverticula showed non-specific inflammation. She was started on high dose proton pump inhibitors, prokinetics, and was advised to take multiple small meals instead of two large meals. She was advised to get regular followup as well. DISCUSSION: Duodenal diverticula can be classified as extramural or intramural with the latter commonly attributed to a developmental abnormality. They are mostly asymptomatic but can present with abdominal discomfort, nausea, and bloating. The complications, although rare, can include perforation, diverticulitis, and other pathologies arising due to mechanical compression. The diagnosis can be made on endoscopy and barium studies, with most of them discovered as incidental findings. Treatment is mainly conservative. Surgery is reserved for complications and symptoms refractory to medical treatment.Figure 1.: Endoscopy showing multiple diverticula in the duodenum.