Management of complicated duodenal diverticula

Abstract

The duodenum is the second most common location of intestinal diverticula after the colon. Duodenal diverticulum (DD) is usually located in the second portion of the duodenum (D2), close to the papilla. Most duodenal diverticula are extraluminal and acquired rather than congenital; more rare is the congenital, intraluminal diverticulum. DD is usually asymptomatic and discovered incidentally, but can become symptomatic in 1% to 5% of cases when complicated by gastroduodenal, biliary and/or pancreatic obstruction, by perforation or by hemorrhage. Endoscopic treatment is the most common first-line treatment for biliopancreatic complications caused by juxtapapillary diverticula and also for bleeding. Conservative treatment of perforated DD based on fasting and broad-spectrum antibiotics may be offered in some selected cases when diagnosis is made early in stable patients, or in elderly patients with comorbidities who are poor operative candidates. Surgical treatment is currently reserved for failure of endoscopic or conservative treatment. The main postoperative complication of diverticulectomy is duodenal leak or fistula, which carries up to a 30% mortality rate.

Naujas perforavusio dvylikapirštės žarnos divertikulo gydymas atliekant Roux-en-Y duodenojejunostomiją

“…When the acute abdomen pain passed and after the same consevative treatment the patient was transfered to a third level hospital for a more accurate diagnosis and treatment. After the reevaluation of CT scans duodenum cancer was denyed and patient was diagnosed with diverticulitis -one diverticulum with perforation in 4,5]. The most difcult complication is perforation -0.03%.…”

“…The most frequent location is the second (62%) and third (30%) portions of the duodenum [4,5]. Symptomatic duodenal diverticulum are from 1% to 5%, which present with pain, bleeding, inflammation, cholestasis, cholangitis, obstruction, perforation, pancreatitis, or malignant transformation [2, forates into the retroperitoneum adjacent to the second portion of the duodenum [4].…”

“…Usually perforation of duodenal diverticulitis is treated by simple diverticulectomy and two layer closure of the duodenum with drainage of the retroperitoneum [3,4]. Unfortunately this operation has high postoperative morbidity and mortality.…”

“…Unfortunately this operation has high postoperative morbidity and mortality. The main postoperative complication of diverticulectomy is duodenal leak or fistula, which carries up to a 13% to 30% mortality rate [3,4].…”

“…Conservative treatment of perforated duodenal diverticulum based on fasting with bowel rest with or without nasogastric suction, intravenous fluid hydration or total parenteral nutrition, and broad-spectrum antibiotics [4,7,10].…”