Duodenal diverticulum
Updates to Article Attributes
Duodenal diverticula are out-pouchings from the duodenal wall (intraluminal diverticulum discussed separately). They may result from mucosal prolapse or the prolapse of prolapse of the entire duodenal wall and can be found at any point in the duodenum.
Diverticula located at theampulla of Vater may cause difficulty for endoscopists as they attempt to to cannulate the biliary system.
Clinical presentation
Duodenal diverticula are very common, found in up to 23% of asymptomatic patients 2, and in the vast majority remain asymptomatic throughout life. In 10% of patients, some symptoms are attributable to them, with only a minority requiring surgical intervention 2.
Pathology
There are a two of types of duodenal diverticula:
- primary diverticulum
- secondary diverticulum
A primary duodenal diverticulum occurs where there is prolapse of mucosa through the muscularis propria. They usually occur within the 2nd part(62%) and less commonly in the 3rd (30%) and 4th (8%) parts. Unlike secondary diverticula they are rarely seen in the 1st part. When they occur in the 2nd part, most (88%) are seen on the medial wall around the ampulla, 8% are seen posteriorly and 4% on the lateral wall.
A secondary duodenal diverticulum results from prolapse of the entire duodenal wall and almost invariably occurs in the 1st part of the duodenum. These aretrue diverticula and are usually secondary to duodenal or peri duodenal inflammation.
Treatment and prognosis
Complications
Potential complications include2:
- duodenal diverticulitis
- haemorrhage
- perforation (see case 7)
- abscess formation
- Lemmel syndrome
-<p><strong>Duodenal diverticula</strong> are out-pouchings from the <a href="/articles/duodenum">duodenal</a> wall (<a href="/articles/duodenal-web">intraluminal diverticulum</a> discussed separately). They may result from mucosal prolapse or the prolapse of the entire duodenal wall and can be found at any point in the duodenum.</p><p>Diverticula located at the <a href="/articles/ampula-of-vater">ampulla of Vater</a> may cause difficulty for endoscopists as they attempt to cannulate the biliary system.</p><h4>Clinical presentation</h4><p>Duodenal diverticula are very common, found in up to 23% of asymptomatic patients <sup>2</sup>, and in the vast majority remain asymptomatic throughout life. In 10% of patients, some symptoms are attributable to them, with only a minority requiring surgical intervention <sup>2</sup>.</p><h4>Pathology</h4><p>There are a two of types of duodenal diverticula:</p><ul>- +<p><strong>Duodenal diverticula</strong> are out-pouchings from the <a href="/articles/duodenum">duodenal</a> wall (<a href="/articles/duodenal-web">intraluminal diverticulum</a> discussed separately). They may result from mucosal prolapse or the prolapse of the entire duodenal wall and can be found at any point in the duodenum.</p><p>Diverticula located at the <a href="/articles/ampula-of-vater">ampulla of Vater</a> may cause difficulty for endoscopists as they attempt to cannulate the biliary system.</p><h4>Clinical presentation</h4><p>Duodenal diverticula are very common, found in up to 23% of asymptomatic patients <sup>2</sup>, and in the vast majority remain asymptomatic throughout life. In 10% of patients, some symptoms are attributable to them, with only a minority requiring surgical intervention <sup>2</sup>.</p><h4>Pathology</h4><p>There are a two of types of duodenal diverticula:</p><ul>
-</ul><p>A <strong>primary duodenal diverticulum</strong> occurs where there is prolapse of mucosa through the muscularis propria. They usually occur within the 2<sup>nd</sup> part (62%) and less commonly in the 3<sup>rd</sup> (30%) and <sup>4th</sup> (8%) parts. Unlike secondary diverticula they are rarely seen in the 1<sup>st</sup> part. When they occur in the 2<sup>nd</sup> part, most (88%) are seen on the medial wall around the ampulla, 8% are seen posteriorly and 4% on the lateral wall.</p><p>A <strong>secondary duodenal diverticulum</strong> results from prolapse of the entire duodenal wall and almost invariably occurs in the 1<sup>st</sup> part of the duodenum. These are <a href="/articles/true-diverticulum">true diverticula</a> and are usually secondary to duodenal or peri duodenal inflammation.</p><h4>Treatment and prognosis</h4><h5>Complications</h5><p>Potential complications include <sup>2 </sup>:</p><ul>- +</ul><p>A <strong>primary duodenal diverticulum</strong> occurs where there is prolapse of mucosa through the muscularis propria. They usually occur within the 2<sup>nd</sup> part (62%) and less commonly in the 3<sup>rd</sup> (30%) and <sup>4th</sup> (8%) parts. Unlike secondary diverticula they are rarely seen in the 1<sup>st</sup> part. When they occur in the 2<sup>nd</sup> part, most (88%) are seen on the medial wall around the ampulla, 8% are seen posteriorly and 4% on the lateral wall.</p><p>A <strong>secondary duodenal diverticulum</strong> results from prolapse of the entire duodenal wall and almost invariably occurs in the 1<sup>st</sup> part of the duodenum. These are <a href="/articles/true-diverticulum">true diverticula</a> and are usually secondary to duodenal or peri duodenal inflammation.</p><h4>Treatment and prognosis</h4><h5>Complications</h5><p>Potential complications include <sup>2 </sup>:</p><ul>
-<li>perforation</li>- +<li>perforation (see case 7)</li>
Image 1 CT (C+ portal venous phase) ( update )
Image 2 Barium (Barium follow through) ( update )
Image 3 CT (CT cholangiography) ( update )
Image 4 CT (CT cholangiography) ( update )
Image 5 Barium ( update )
Image 6 CT (C+ portal venous phase) ( update )
Image 7 CT (C+ portal venous phase) ( update )
Image 8 CT (C+ portal venous phase) ( create )
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