Intraluminal duodenal diverticulum

Case contributed by Ammar Haouimi
Diagnosis almost certain

Presentation

Two weeks history of postprandial vomiting and obstructive jaundice. Past history of recurrent episodes of acute pancreatitis before, and after cholecystectomy. An ultrasound exam was inconclusive.

Patient Data

Age: 45 years
Gender: Male

Distended esophagus, stomach, and duodenum up to 3rd part with an intraluminal diverticulum within the duodeno-jejunal junction seen as a double duodenal lumen, obstructing the digestive lumen. The diverticular neck seems to be at the ampullary region.

Dilatation of the intra and extrahepatic biliary tree, down to the ampulla, for example 20 mm CBD. Pancreatic duct (5 mm) with stretching to the left. No biliary ductal stone or pancreatic head tumor seen.

Barium meal performed 12 days later, showing moderate dilatation of the esophagus, stomach, and proximal duodenum (no much as seen on CT) with an intraluminal diverticulum within the duodeno-jejunal junction with smooth and regular wall, seen as a barium coated pouch within the barium filled duodenal lumen. giving the appearance of a "thumb of a glove". the diverticular neck seems to be at the ampullary region, as seen on CT. Beyond the proximal jejunal loops show normal appearance.

Case Discussion

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

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.