Duodenal diverticulae

Case contributed by Dr Mostafa Mahmoud El Feky

Presentation

Obstructive jaundice.

Patient Data

Age: 75
Gender: Female
CT

CT abdomen with contrast

Moderate dilatation of CBD reaching 22 mm till its end with moderate intrahepatic biliary radical dilatation. A small biliary stone is seen impacted at the ampulla of vater measuring 2 x 3 mm.

Bilateral proximal renal artery stenosis by atherosclerotic plaques is also noted.

CT

Annotated images

The featured images show the two duodenal diverticulae and the ampullary stone.

Case Discussion

Duodenal diverticula are by far most commonly located along the medial wall of the second or third part of the duodenum. They are usually asymptomatic. Rarely they can cause compression on the intrapancreatic part of common bile duct with resultant upstream dilatation of the extra- and intrahepatic bile ducts; known as "Lemmel syndrome". However, in this case, the ampullary obstruction is caused by a small stone with moderate intrahepatic biliary radical dilatation as well as the common bile duct. Diverticula located at the ampulla of Vater may cause difficulty to cannulate the biliary system during endoscopy.

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Case information

rID: 54177
Case created: 25th Jun 2017
Last edited: 2nd Jul 2017
Inclusion in quiz mode: Included

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