This is an interesting, and rare case of an intraluminal duodenal diverticulum (confirmed at surgery) illustrating two major complications:

• intermittent upper GIT obstruction with postprandial vomiting due to the progressive filling of the intraduodenal diverticulum, obstructing the duodenal lumen.
• dilated intra-and extrahepatic biliary tree, including the CBD as well as the pancreatic duct, indicating a biliary obstruction at the level of the ampulla of Vater (presumed origin of the duodenal diverticulum)

The Meticulous analysis of the CT (and multiplanar reformats) shows that the diverticular neck arises from the 2nd part of the duodenum, as evidenced by the leftward displacement of the ampulla of Vater as well as the clinical history (repeated episodes of acute pancreatitis).

Additional contributors: R Bouguelaa MD and Z E Boudiaf MD / O. Bafdal surgeon