Diagnosis and Management of the Symptomatic Duodenal Diverticulum: a Case Series and a Short Review of the Literature

Schnueriger, Beat; Vorburger, Stephan A.; Banz, Vanessa; Schoepfer, Alain; Candinas, Daniel

doi:10.1007/s11605-008-0549-0

Cited by 72 publications

(68 citation statements)

References 19 publications

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“…Perforation represents the rarest but most serious complication, with mortality of upto 13% [5]. Perforated duodenal diverticulum poses a diagnostic challenge as there are no pathognomonic clinical features.…”

Section: Discussionmentioning

confidence: 99%

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Perforated Duodenal Diverticulum

Sattibabu¹,

Dalal²,

Ms³

et al. 2017

JCR

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Background: Duodenum is the second most frequent location for a diverticulum in the digestive tract next to the colon. Duodenal diverticulum occurs in 20% of the general population and is generally asymptomatic. Complications such as perforation are exceedingly rare, with only few cases reported in the literature. Case Report: Here, we present a case of a 70 year old, male patient who was admitted with acute abdomen and intra-operatively diagnosed as perforated duodenal diverticulum. Conclusion: Early diagnosis of perforated duodenal diverticulum is a challenge and clear guidelines for the management of this rare entity is still lacking.

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Section: Discussionmentioning

confidence: 99%

“…It can even demonstrate the presence of a diverticulum in some cases. Typical radiological findings include thickened bowel wall, fat stranding and extra-luminal air or fluid [5,7]. In patients with no evidence of impending sepsis, non-operative treatment for perforated diverticula is safe and a practical alternative to surgery.…”

Section: Discussionmentioning

confidence: 99%

Perforated Duodenal Diverticulum

Sattibabu¹,

Dalal²,

Ms³

et al. 2017

JCR

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“…In terms of surgical approach, several technical options are available, ranging from local excision to the Whipple procedure, depending on the location of the DD and the inflammatory status [18] . Moreover, laparoscopic diverticulectomy has also been reported to give good results [19] .…”

Section: Discussionmentioning

confidence: 99%

Perforated duodenal diverticulum, a rare complication of a common pathology: A seven-patient case series

Rossetti

Buchs²,

Bucher³

et al. 2013

WJGS

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Duodenal diverticula (DD) are frequently encountered and are usually asymptomatic, with an incidence at autopsy of 22%. Perforation of DD is a rare complication (around 160 cases reported) with potentially dramatic consequences. However, little evidence regarding its treatment is available in the literature. The aim of this study was to review our experience of perforated DD, with a focus on surgical management. Between January 2001 and June 2011, all perforated DD were retrospectively reviewed at a single centre. Seven cases (5 women and 2 men; median age: 72.4 years old, rang: 48-91 years) were found. The median American Society of Anesthesiologists' score in this population was 3 (range: 3-4). The perforation was located in the second portion of duodenum (D2) in six patients and in the third portion (D3) in one patient. Six of these patients were treated surgically: five patients underwent DD resection with direct closure and one was treated by surgical drainage and laparostomy. One patient was treated conservatively. One patient died and one patient presented a leak that was successfully treated conservatively. The median hospital stay was 21.1 d (range: 15-30 d). Perforated DD is an uncommon presentation of a common pathology. Diverticular excision with direct closure seems to offer the best chance of survival and was associated with a low morbidity, even in fragile patients.

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“…It may be caused by the diverticulitis, enterolithiasis, ulceration, foreign body or trauma (5). Only 1-2% of patients with duodenal diverticula require surgical treatment for complications (4).…”

Section: Discussionmentioning

confidence: 99%

Clinical challenge: diverticulitis of third and fourth portion of the duodenum with perforation

Ming¹,

Feng

Cherng³

et al. 2012

Rev. esp. enferm. dig.

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Duodenal diverticulum is not rare, and it represents the second most frequent place in the digestive tract. Localization of diverticula in the third or fourth portions of the duodenum is rare and the symptoms are often non-specific. Computed tomography may be helpful to make a diagnosis. We present a rare case of diverticulitis of third and fourth portion of the duodenum with perforation and it was treated successfully by duodenal-jejunostomy and abscess drainage. Case reportA 77-year-old man presented with vomiting and abdominal pain for 1 day prior to the emergency department. On arrival, his vital signs showed temperature of 37.8 ºC, heart rate of 86/min, and blood pressure of 110/68 mmHg. Physical examination revealed tender in the epigastric area with signs of peritoneal irritation. Blood tests were: white blood cells 23,300/mm 3 , hemoglobin, 13.9 g/dL, and platelets, 230,000/mm 3 . The differential count of white blood cell was: neutrophils, 96%; monocytes, 3%; and lymphocytes, 1%. Creactive protein (CRP) was 32.6 ng/dL. The liver and renal function tests and amylase concentrations were normal. Abdominal X-ray showed no intraperitoneal free air. Computed tomography (CT) of abdomen showed extraluminal retroperitoneal air around 3 rd and 4 th portion of the duodenum with fatty stranding. Perforated diverticulitis of the duodenum and a retroperitoneal abscess were considered.The emergency laparotomy was performed. After mobilization (Kocher maneuver), pus was found around retroperitoneal duodenum. Further examination showed a perforated diverticulum in the 3 rd and 4 th portion of the duodenum. We performed the procedure of duodeno-jejunostomy bypass. The abscess cavity was irrigated and multiple drainages were placed. The post-operative course was uneventful. The patient was discharged without complication. DiscussionWe report the patient with perforated diverticulitis in the third and fouth portion of the duodenum. It is uncommon and fewer cases have been reported in the literature. The prevalence of duodenal diverticula is higher in the people with over than 50-year-old year (1). Diverticulum in duodenum is the second common site to the colon in the alimentary tract (2). The typical location is in the second portion of the duodenum (3). Most patients with duodenal diverticula are asymptomatic and they are discovered incidental during upper gastrointestinal image studies. There are only 5% of patients with symptoms resulting from the hemorrhage, inflammation, or perforation (4). Perforation is rare, but the most serious complication. It may be caused by the diverticulitis, enterolithiasis, ulceration, foreign body or trauma (5). Only 1-2% of patients with duodenal diverticula require surgical treatment for complications (4).Abdominal CT is the useful diagnostic tool for duodenal diverticula because it is powerful to demonstrate adjacent anatomy and helpful to find complications such as perforation (3). CT findings may show the mesenteric fat stranding, thickened bowel wall, and an extraluminal, retroperito...

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Diagnosis and Management of the Symptomatic Duodenal Diverticulum: a Case Series and a Short Review of the Literature

Cited by 72 publications

References 19 publications

Perforated Duodenal Diverticulum

Perforated Duodenal Diverticulum

Perforated duodenal diverticulum, a rare complication of a common pathology: A seven-patient case series

Clinical challenge: diverticulitis of third and fourth portion of the duodenum with perforation

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