Duodenal diverticulitis

Case contributed by Dr Derek Smith

Presentation

Two days lower abdominal pain. Tender RIF. CRP 180, WCC 20. ?appendicitis

Patient Data

Age: 65 years
Gender: Female
CT

Right sided retroperitoneal inflammatory change with a 5 cm collection close to the ampulla and second part of duodenum. No free gas in either the retroperitoneal or peritoneal compartments. Fluid extends around the right perirenal space.

The duodenum is displaced anteriorly by the collection, but has an otherwise normal course. The remainder of the small bowel and colon are normal.

Prominent 11 mm common bile duct, with mild intrahepatic ductal dilatation. No intraluminal calculi, normal gallbladder is normal. No focal hepatic lesion. Patent portal vein. Normal pancreas. Both kidneys enhance normally with no calculi or obstruction. There is minor enhancement of the right ureter as it passes the inflammatory phelgmon but is not compromised. Normal adrenals and spleen.

5 cm cyst above the uterus, likely arising from the left ovary, benign appearances. Normal uterus and right ovary.

Dependent lung base changes. No skeletal destruction.

Six month follow up following conservative management

CT

Complete resolution of the retroperitoneal inflammatory changes, with reduction in size of the D2 diverticulum now maximally measuring 3 cm.

Case Discussion

The location of this collection and spread of inflammatory changes in the retroperitoneal compartment was suggestive of duodenal diverticulitis.

This was managed conservatively, with satisfactory appearances on six month follow up imaging.

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