Intraluminal duodenal “windsock” diverticulum; Case Report and discussion

Intraluminal duodenal diverticulum (IDD) is a rare developmental anomaly usually found in the second portion of the duodenum. The cause appears to be a failure of recanalization of the occluded foregut lumen of the human embryo, resulting in a fenestrated mucosal membrane [1]. A small aperture in this diaphragm will gradually cause it to elongate caudally in response to duodenal peristalsis to form the so called “wind-sock” configuration. Symptoms are nonspecific and generally depend on the degree of duodenal obstruction; 25% of cases are associated with GI bleeding. In most documented cases, IDD was diagnosed radiologically, but the value of endoscopy for diagnosis and treatment has been amply demonstrated.

Clinical Impacts of Juxtapapillary Duodenal Diverticulum Detected on Computed Tomography

Background: : Diverticula are commonly observed in the duodenum. Duodenal diverticulum (DD) usually does not give symptoms throughout life and is diagnosed by coincidence. However, it may present with different symptoms in patients. Objective:: This study aims to evaluate the prevalence of DD and juxtapapillary duodenal diverticulum (JDD) and its association with other possible pathologies and to determine its clinical impact by using Computed Tomography (CT). Methods: This retrospective observational study, which was taken consecutively between the years of 2013-2020, was evaluated in the Radiology Department. The total number of cases was 4850 (male-2440; female-2410). CT images were evaluated by two experienced radiologists at the workstation. DD and JDD prevalence and clinical findings in the hospital registry system were examined. Results: The age of the patients included in the study ranged from 17 to 92 years (mean age 46.94±16.42). In patients with DD (female-130; male-101), mean age was 62.24 ± 12.69 (21-92). The prevalence of DD was 4.76% (n=231). The prevalence of JDD was 4.02% (n=195) and increased with age (p<0.01). The average diameter of the JDD was measured as 23.29±8.22(9.5-55.3) mm. A significant positive correlation was found between age and DD diameter (p=0.039). DDs were found most commonly 84.42% (n=195) in the second segment of the duodenum as JDD. In patients with JDD, the mean diameter of choledochus and wirsung canal were 6.7 ± 2.4 (3-15.3) mm and 0.31 ± 0.1 (0.1-6.5) mm respectively. The choledochal diameter was correlated with the JDD size (p = 0.004). Cholelithiasis (n=56), choledocholithiasis (n=20), cholecystitis (n=52), diverticulitis (n=15), duodenitis (n=37), pancreatitis (n=5) and hiatal hernia (n=60) with JDD were observed. Periampullary carcinoma was detected in one patient.

Endoscopic negative pressure therapy as stand-alone treatment for perforated duodenal diverticulum: presentation of two cases

Background Endoscopic negative pressure therapy is a novel and successful treatment method for a variety of gastrointestinal leaks. This therapy mode has been frequently described for rectal and esophageal leakages. Duodenal diverticular perforations are rare but life-threatening events. The early diagnosis of duodenal diverticular perforation is often complicated by inconclusive symptoms. This is the first report about endoscopic negative pressure therapy in patients with perforated duodenal diverticula. Case presentation We present two cases of duodenal diverticula perforations treated with endoscopic negative pressure therapy as stand-alone treatment. Start of symptoms varied from one to three days before hospital admission. Early sectional imaging led to the diagnosis of duodenal diverticular perforation. Both patients were treated with endoluminal endoscopic negative pressure therapy with simultaneous feeding option. Three respective changes of the suction device were performed. Both patients were treated with antibiotics and antimycotics during their hospital stay and be discharged from hospital after 20 days. Conclusions This is the first description of successful stand-alone treatment by endoscopic negative pressure therapy in two patients with perforated duodenal diverticulum. We thus strongly recommend to attempt interventional therapy with endoluminal endoscopic negative pressure therapy in patients with duodenal diverticular perforations upfront to surgery.

Largest sized enterolith ileus due to a duodenal diverticulum in a virgin abdomen causing small bowel obstruction

We describe the case of a 73-year-old woman with a high body mass index and a virgin abdomen who presented with a 5-day history of abdominal pain, emesis and confusion on admission. Inflammatory markers and renal function were significantly deranged. CT of the abdomen and pelvis demonstrated a clear transition point and faecalisation of the small bowel proximal to the obstruction. It was suggested that the patient may have ingested a foreign object. A collateral history was obtained, making this less likely and confirmed an acute cognitive impairment. She was optimised following multidisciplinary discussion preoperatively. Thereafter, the patient underwent a laparotomy, where a hard, mobile mass was identified in the jejunum. This was diagnosed as an enterolith of dimensions 62×38×32 mm secondary to a duodenal diverticulum. She improved postoperatively with complete resolution of her confusion and renal function. She was discharged on day 14 of admission.

Retro-pneumoperitoneum and pneumomediastinum as a consequence of perforation of a duodenal diverticulum after upper digestive endoscopy

Resumen La enfermedad diverticular del duodeno es una entidad poco frecuente. Suele ser asintomática y descubrirse de manera incidental pero, cuando existe sintomatología, se relaciona con alguna complicación, encontrándose entre éstas la perforación iatrogénica por endoscopia digestiva alta. El diagnóstico precoz es fundamental para reducir la morbimortalidad, siendo la prueba de imagen de elección la TC abdominal, con visualización de gas extraluminal. Igualmente, el tratamiento debe ser precoz, y puede ser tanto conservador como endoscópico o quirúrgico, en función de la etiología y de la gravedad del paciente. Es importante que no se demore más allá de las 24 horas, debido a que el pronóstico dependerá directamente del intervalo de tiempo entre la perforación y el tratamiento.