Duodenal Diverticulosis Research Articles

Post Traumatic Perforated Duodenal Diverticulum: A Case Report

Duodenal diverticulosis is second only to the colon as the most common location for diverticula. Despite typically being asymptomatic, it can lead to severe complications such as perforation, hemorrhage, and acute diverticulitis. Diagnosing duodenal diverticulitis is challenging due to its non-distinctive presentation and similarity to other intraabdominal conditions in radiographic images. This paper examines a challenging case of duodenal diverticulitis with post-traumatic perforation in a 63-year-old patient, admitted post-traffic accident with an acute abdominal pain revealing duodenal diverticulum rupture as per abdominal CT scan. Despite the complications and a Grade II compression fracture of the L3 vertebra, the patient showed improvement under observation without necessitating surgery. The study highlights the diagnostic complexities of duodenal diverticulitis and the importance of abdominal CT scans in identifying this rare and often misdiagnosed condition.

Enterolith with underlying duodenal diverticulosis causing acute small bowel obstruction.

Enterolith with underlying duodenal diverticulosis causing acute small bowel obstruction.

Difficult diagnosis of an air-containing, abscess-like, and mass-like pancreatic head lesion.

Duodenal diverticulosis can be a difficult CT diagnosis and should be considered in the differential diagnosis when a periduodenal mass‐like structure that may contain air, air‐fluid level, or oral contrast material is depicted.

«Complex» choledocholithiasis in practice of regional centre of endoscopic surgery

Objective. Estimation of rate of various causes of «complex» choledocholithiasis (CL) in practice of regional centre of endoscopic surgery. Materials and methods. The investigation was conducted on the base of Department of Surgery in Odessa Regional Clinical Hospital in 2019-2021 yrs. Experience of endoscopic operative interventions, performed in 198 patients with clinical signs of CL, was analyzed. Results. In 45 (22.7%) patients while ultrasonographic investigation a solitary calculus was revealed, while in the others –multiple calculi. Average value of the common biliary duct diameter have constituted (10.5 ± 0.8) mm. In all the patients distal localization of calculi was present, which coexisted in 31 (15.7%) with supraduodenal localization. In 1 woman-patient a valve calculus was revealed, which caused several accidents of biliary colic in anamnesis. Thus, multiple CL was present in majority of the patients. In 53 (26.8%) patients “complex” CL was diagnosed. While analyzing the causes rate of «complex” CL there was established its mostly frequent form (71.7%) occurring after previous multiple attempts of endoscopic interventions. Also frequent forms have appeared in technical complexities while approaching duodenal papilla magna (9.2%), cases of periampullar duodenal diverticulosis (5.8%) and tubular stenosis of common biliary duct (5.0%). Complete endoscopic papillosphincterotomy with the calculi extraction by one séance was performed in 27 (13.6%) patients. In 15 (7.6%) patients the procedure of a one-staged extraction of calculi failed as a consequence of the complications occurrence, presence of multiple big calculi. In these patients repeated seances of endoscopic papillosphincterotomy were done with extraction of calculi, which in 5 (2.5%) patients have demonstrated inefficacy, leading to performance of relithoextraction (up to 3 seances). Conclusion. Rate of “complex” CL constitutes 26.8%, its mostly frequent cause is previous multiple attempts of local endoscopic interventions. Rate of perioperative morbidity, while doing endoscopic interventions, do not exceed 15%, and mostly frequent complication is an acute pancreatitis. In part of the patients with “complex” CL it is expedient to apply laparoscopic and combined interventions.

十二指腸後腹膜穿通が疑われ非手術的加療を行った十二指腸水平脚憩室症の1例(A case of duodenal diverticulosis in the horizontal part suspected as duodenal retroperitoneal penetration treated with non–operative management)

要旨十二指腸憩室症自体は結腸憩室に次ぐ頻度で珍しい疾患ではないとされているが，報告例の多くが下行脚または傍乳頭憩室であり，水平脚の報告は限定される。いずれの部位でも無症状で特別な治療を要することは少なく経過観察されることが多いが，有症状時には部位によって鑑別に苦慮することがある。十二指腸後腹膜穿通と誤認した十二指腸水平脚憩室症の1例を経験したため，文献的考察を加えて報告する。症例は50歳代の女性。突然発症した腹痛を主訴に前医に救急搬送され十二指腸後腹膜穿通の診断にて入院となった。しかし，緊急手術となった際に対応が不能とのことで翌日に当院へ転院となった。来院後，消化性潰瘍による十二指腸後腹膜穿通と診断したが，病変は限局していたため非手術的に加療を開始した。臨床経過は順調に経過したが，2週間経過しても消化管造影にて十二指腸壁外への造影剤漏出と考えられる所見が消失せず，十二指腸後腹膜穿通ではない可能性を強く疑った。以前に画像検査を施行した医療機関にCTデータの送付を依頼し確認したところ，その時から十二指腸後面に見える部分にガス像を認めており，十二指腸憩室症と診断できた。十二指腸水平脚部の憩室は比較的稀であるが，有症状時には後腹膜穿通と鑑別が困難で，侵襲的処置が選択されてしまう可能性があり注意を要する。

Spontaneous pneumoperitoneum with duodenal diverticulosis in an elderly patient: a case report

BackgroundPneumoperitoneum commonly occurs as a result of a viscus perforation and usually presents with peritoneal signs requiring emergent laparotomy. Spontaneous pneumoperitoneum is a rare condition characterized by intraperitoneal gas with no clear etiology.Case presentationWe herein report a case in which conservative treatment was achieved for an 83-year-old male patient with spontaneous pneumoperitoneum that probably occurred due to duodenal diverticulosis. He had stable vital signs and slight epigastric discomfort without any other signs of peritonitis. A chest radiograph and computed tomography showed that a large amount of free gas extended into the upper abdominal cavity. Esophagogastroduodenoscopy showed duodenal diverticulosis but no perforation of the upper gastrointestinal tract. He was diagnosed with spontaneous pneumoperitoneum, and conservative treatment was selected. His medical course was uneventful, and pneumoperitoneum disappeared after 6 months.ConclusionIn the management of spontaneous pneumoperitoneum, recognition of this rare condition and an accurate diagnosis based on symptoms and clinical imaging might contribute to reducing the performance of unnecessary laparotomy. However, in uncertain cases with peritoneal signs, spontaneous pneumoperitoneum is difficult to differentiate from free air resulting from gastrointestinal perforation and emergency exploratory laparotomy should be considered for these patients.

Endoscopic rendez-vous after damage control surgery in treatment of retroperitoneal abscess from perforated duodenal diverticulum: a techinal note and literature review

IntroductionThe duodenum is the second seat of onset of diverticula after the colon. Duodenal diverticulosis is usually asymptomatic, but duodenal perforation with abscess may occur.Case presentationWoman, 83 years old, emergency hospitalised for generalized abdominal pain. On the abdominal tomography in the third portion of the duodenum a herniation and a concomitant full-thickness breach of the visceral wall was detected. The patient underwent emergency surgery. A surgical toilette of abscess was performed passing through the perforated diverticula and the Petzer’s tube drainage was placed in the duodenal lumen; the duodenostomic Petzer was endoscopically removed 4 months after the surgery.DiscussionA review of medical literature was performed and our treatment has never been described.ConclusionFor the treatment of perforated duodenal diverticula a sequential two-stage non resective approach is safe and feasible in selected cases.

Perforated Jejunal Diverticulosis: Report of a Case and Review of the Literature

Diverticular disease of the Jejunum is a rare entity. Most patients with small bowel diverticula are asymptomatic. Patients who develop symptoms generally report symptoms that reflect associated complications. The most common are nonspecific epigastric pain or flatulent dyspepsia, mainly post prandial. Complication rates as high as 10-12% for duodenal diverticulosis and 46% for jejunal diverticulosis have been reported. Although there is no consensus on the management of asymptomatic jejunal diverticula disease, some complications are potentially life-threatening and require early surgical intervention. J Med Cases. 2013;4(7):439-442 doi: https://doi.org/10.4021/jmc1276w

Cholangiectasis and Duodenal Diverticulosis in a Farm-Raised Elk (Cervus Elaphus)

A 6-year-old male elk presented in August with a 4-month history of weight loss and a 1-day history of being recumbent and unable to rise. The elk's body condition score was 1.5/5. Hematology and blood chemistry showed an inflammatory leukogram, mild electrolyte abnormalities, and elevated liver enzyme activities. Because of poor prognosis, the owner elected euthanasia. On necropsy, 8 diverticula were in the duodenum distal to the common bile duct, which was dilated and filled with feed material. Many intrahepatic bile ducts were dilated up to 5 cm, were filled with ingesta and gritty material, and had walls thickened up to 1.5 mm. On histologic examination, mural thickening of dilated bile ducts was because of increased fibrous connective tissue with inflammatory cell infiltration and hyperplastic and hypertrophic epithelial lining. Portal tracts diffusely contained hyperplastic bile ducts and had increased amounts of fibrous connective tissue. Abscesses that contained bacteria were scattered throughout the liver. Duodenal diverticula lacked the tunica muscularis, and the muscularis mucosa was hypertrophied. Caudal to some diverticula, the duodenal lumen was narrowed. An additional finding was embolic pneumonia with fungi morphologically and immunohistochemically consistent with Aspergillus spp.

CT Findings in Duodenal Diverticulitis

Duodenal diverticulitis is a rare complication of duodenal diverticulosis. It is often clinically misdiagnosed because it has no pathognomonic signs or symptoms and its CT findings may mimic other intraabdominal processes. We describe two patients with duodenal diverticulitis who presented with abdominal pain, nausea, and leukocytosis. At the time of initial presentation, only one of the two patients was diagnosed correctly. In the first case, which was initially misdiagnosed as acute pancreatitis, the correct diagnosis was evident only after the disease process had become more quiescent and a follow-up CT scan using orally and i.v.-administered contrast agents was performed. In the second case, the coronal reformatted images confirmed the diagnosis suggested by the axial images. Duodenal diverticulitis can be a difficult CT diagnosis to make; however, maintaining it in the differential diagnosis of duodenal and pancreatic inflammatory processes and masses as well as defining the anatomy with nonaxial imaging including coronal images may be helpful in confirming the diagnosis.

The Clinical and Radiological Manifestations That Are Potentially Associated with Duodenal Diverticula

Purpose: Small bowel diverticula are less frequent than the large bowel diverticula, but when they do occur, they occur most frequently in the duodenum where they are usually asymptomatic. The aim of this study is to retrospectively evaluate the potential clinical manifestations and the radiological changes that are associated with duodenal diverticulosis in symptomatic patients. Methods: From March 2003 to March 2006, the Electronic charts of 27 patients with symptomatic duodenal diverticulosis seen at one medical center were reviewed. The mean age of the patients was 64 years (range 43–86 years of age). There were 10 males and 17 females. The clinical and radiological data of those patients were reviewed. Results: Of the 27 patient who were included in this study, 25 patients had upper abdominal pain (93%), 7 patients had acute diverticulitis (26%), 6 patients had acute cholangitis (22%), 5 patients had acute pancreatitis (18%) with no other etiology or explanation for their pancreatitis, 7 patients had sludge and or stones within the biliary system (26%), and 16 patients (59%) had a radiologic abnormality directly related to the duodenal diverticulum such as: pressure effect on the CBD, debris within the diverticulum, air-fluid level within the diverticulum, and or radiological evidence of acute diverticulitis (on MRI there is abnormal enhancement of the duodenal wall with stranding in the adjacent soft tissues on T1 weighted images, and on T2 weighted images we see increased signal intensity relating to edematous changes and diverticular wall thickening, Figures 1 & 2).FigureFigureConclusions: Although diverticulosis of the duodenum is usually asymptomatic, it should be recognized as a potential risk factor for various upper digestive health problems including unexplained upper abdominal pain, and possibly acute pancreatitis. [figure 1][figure 2]

INTESTINAL MALABSORPTION PRESENTING WITH NIGHT BLINDNESS

SUMMARY Night blindness from vitamin A deficiency was observed in a patient with intestinal malabsorption, which in turn was attributable to duodenal diverticulosis and bacterial growth. Monthly supplementation with vitamin A and correction of bacterial overgrowth with tetracycline resulted in a normalisation of plasma retinol levels and resolution of the night blindness.

Differences in gallstone structure in primary common bile duct lithiasis and gallbladder lithiasis

Some differences between gallbladder lithiasis and primary common bile duct lithiasis are described. Microbiological cultures and biochemical analyses were carried out on the bile of two groups of patients: 27 suffering from gallbladder and 5 from primary common duct lithiasis. The microstructure and composition of gallstones were also examined by polarized light microscopy and X-ray diffraction. Women predominated in gallbladder lithiasis but not in primary common duct lithiasis group (P less than 0.05) and body weight was higher in the former group (P less than 0.02). Primary common duct lithiasis patients had a higher, although not significant, incidence of duodenal diverticulosis (P = 0.15), and a higher incidence of E. coli-positive cultures in bile (P less than 0.001). No significant difference in the biochemical composition of the bile was found between the groups. Brown pigment stones predominated in primary common duct lithiasis, while cholesterol stones did in gallbladder and secondary common duct lithiasis (P less than 0.0001). Stones formed in the gallbladder generally show linear, radial growths of cholesterol crystals, while those from the common duct present a polystratified, concentric deposition of microgranules composed mainly of pigmentary salts. These differences should be taken into account as additional criteria in the differential diagnosis between primary and secondary common duct lithiasis, as the classical criteria for diagnosing of the former greatly underestimate its actual incidence. The distinction between primary and secondary common duct lithiasis is of practical significance, since each entity requires different treatment.

The Ageing Gut: A Study of Intestinal Absorption in Relation to Nutrition in the Elderly

This study was designed to assess the functional efficiency of the ageing small intestine and the possible role of malabsorption in old people with nutritional deficiencies. Fifty subjects aged 65 to 92 years were studied, of whom 33 presented with anaemia, chronic diarrhoea or bone pains, and 17 were apparently healthy 'controls' with no relevant symptoms. Tests of intestinal function included blood xylose and iron absorption curves, a double isotope Schilling test, faecal fat, urinary indican and small bowel radiology, with duodenal aspiration and jejunal biopsy in some cases. On the basis either of steatorrhoea or at least two other abnormal parameters of absorption, there were 15 cases of malabsorption. Thirteen of these had symptoms but two were 'controls'. Four of these had duodenal diverticulosis, two had the post-gastrectomy syndrome, and one had calcific pancreatitis. Malabsorption in the remaining eight cases was not fully explained. The age range of this last group was 72--86 years; one of them had a contaminated small bowel and two showed some evidence of pancreatic insufficiency. Malabsorption emerged as a significant cause of low levels of serum iron, haemoglobin and calcium. The blood xylose test is a useful screening procedure for intestinal malabsorption in old age, but full evaluation calls for investigation of pancreatic function.

膵臓結石症のレ線学的考察

The diagnosis of disseminated parapancreatic calculus is relatively easy from its specific roentgenogram, but in those cases with little roentgenographic shadow or with a solitary shadow it becomes quite difficult. Hence in the latter cases it is necessary to distinguish it from bilestone, kidney stone, peritoneal calcified lymph node, splenic venous thrombus, or duodenal diverticulosis. Therefore, for the diagnosis of the parapancreatic calculus it is important to take a single roentgenogram of the entire abdomen as well as lateral views of the abdomen, the combination of which would afford us to identify the parapancreatic calculus from the density of its shadow, its site and its size. We have recently encountered three patients with pancreatic calculus and present our observations of the cases as well as some remarks on them from the aspects of roentgenology.

III. The Radiological Aspects of Diverticula of the Stomach and Small Bowel

Revision of the reports of the radiological findings of some sixteen thousand barium meals undertaken in the last ten years has revealed the fact that diverticulosis is by no means an uncommon occurrence, and is not confined to the elderly and the obese—in fact, one of the very best examples of generalised diverticulosis encountered in this series was in a slim little member of the W.R.N.S. of 23 years. This paper is confined to the radiological aspects of diverticula of the stomach and small bowel. Much has been written on the etiology, the morbid anatomy, and the surgery of this condition, but little on the actual radiology, especially in British journals and the older text-books. Shanks, however, gives an excellent description of the radiological appearances and the significance of duodenal diverticulosis, albeit his reference to gastric diverticulosis is somewhat brief. The pathology and the symptomatology are the province of the surgeons. It is, however, necessary to make one or two points without which the radiological findings and description would be meaningless. The first reliable demonstration radiologically of diverticulosis of the stomach was by Brown in 1916. Since then many other cases have been described, and outstandingly valuable articles have appeared from time to time in the British, American, and Continental literature, such as those by Akerlund (1923); Hurst and Briggs (1924); Bell and Ross Golden (1930); Rivers, Stevens, and Kirklin (1935); Ewart and Cordiner (1936); Martin, who collected the references of ninety-two cases (1936); Boulton Myles; Paul Shiflett (1937); Reich (1941); Telford (1944); and Walters (1946).

A Case of Absence of the Gall Bladder and Duodenal Diverticulosis

A Case of Absence of the Gall Bladder and Duodenal Diverticulosis

A Case of Absence of the Gall Bladder and Duodenal Diverticulosis

A Case of Absence of the Gall Bladder and Duodenal Diverticulosis

On the differential diagnosis of duodenal diverticulosis: Wierig, Alfons. Klin. Wchnscbr., March 26, 1926, v, 562–563

On the differential diagnosis of duodenal diverticulosis: Wierig, Alfons. Klin. Wchnscbr., March 26, 1926, v, 562–563