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Duodenal Diverticulum


Presentation

  • In this challenging presentation, the presence of the coin led to the correct diagnosis. Patients with congenital duodenal anomalies may present a number of associated abnormalities.[ncbi.nlm.nih.gov]
  • They usually present with obstruction; presentation with GI bleeding is very rare. We report a 51-year-old man who presented with melena after NSAID intake; the diverticulum was excised surgically.[ncbi.nlm.nih.gov]
  • Type A patients presented with papillae near the diverticulum or in its margin. In this type, 36 patients (25%) presented with diverticulitis, bleeding, perforation or cholelithiasis, and were treated surgically.[ncbi.nlm.nih.gov]
  • We also present a review of the literature.[ncbi.nlm.nih.gov]
  • The patient presented to the emergency department due to melenic depositions of a one day evolution and dietary vomiting.[ncbi.nlm.nih.gov]
Dyspepsia
  • Gemelli Medical School, Largo Gemelli, 8-00168 Rome, Italy. gclemente@rm.unicatt.it Abstract A 34-year-old woman presented with epigastric pain, nausea, and dyspepsia.[ncbi.nlm.nih.gov]
  • Case report A 65 year old man was admitted with a two-month history of right upper quadrant abdominal pain and a six week history of dyspepsia and itching. Physical examination was positive for icteric sclera, and a pruritic rash.[revistagastroenterologiamexico.org]
  • Be cautious about recommending surgery for patients who have a diverticulum and vague GI symptoms (eg, dyspepsia). Click here for Patient Education[merckmanuals.com]
  • A few patients have chronic postprandial (after eating) abdominal pain or dyspepsia (reflux) caused by a duodenal diverticulum. Diagnosis Diverticula of the duodenum are found in 20 percent of upper gastrointestinal series (an X-ray study).[healthcentral.com]
Right Upper Quadrant Pain
  • Majority of patients present with acute onset epigastric or right upper quadrant pain associated with nausea and vomiting. As in our case a provisional diagnosis of acute cholecystitis was made based on clinical scenario of the patient.[casereports.in]
  • However, on the floor, the patient developed right upper quadrant pain and leukocytosis (peaked at 16.4 k / μl).[onlinejets.org]
Periumbilical Pain
  • We report a 45-year-old woman, with a five days history of high fever along with epigastric and periumbilical pain. Physical examination revealed right upper and lower quadrant tenderness with peritoneal signs.[ncbi.nlm.nih.gov]
Behavior Problem
  • Because of a history of behavioral problems associated with intellectual impairment, including a compulsion to swallow coins during childhood, an abdominal radiograph was performed.[ncbi.nlm.nih.gov]

Workup

  • ., duplication cyst, intraluminal diverticulum) during the diagnostic workup of recurrent pancreatitis in children.[ncbi.nlm.nih.gov]
  • The patient was given nil per mouth while workup for abdominal pain was started. His pancreatic enzymes were found to be elevated and a subsequent CT scan showed an irregular pancreatic outline consistent with pancreatitis.[wjgnet.com]
  • Initial workup suggested leucocytosis (WBC 11000 K/uL), elevate lipase level (204 U/L) with normal total bilirubin (0.4 mg/dL) and LFTs. An abdominal ultrasound showed dilated CBD (9 mm) without evidence of gallstone.[shmabstracts.com]
  • Diagnostic workup is usually completed in the intensive care setting. Most patients stop bleeding, allowing elective surgery. Mesenteric angiography with infusion of vasoconstrictors can be used in persistent hemorrhage.[emedicine.medscape.com]
  • Diagnostic workup, including laboratory data, was unremarkable. A stress test was normal.[acgcasereports.gi.org]
Pneumoperitoneum
  • Under general anesthesia, a pneumoperitoneum was created. Four trocars were inserted into the peritoneal cavity for this intervention.[ncbi.nlm.nih.gov]
  • A rare case involving massive pneumoretroperitoneum and pneumoperitoneum following argon plasma coagulation treatment for DDB is presented. A short discussion of the optimal endoscopic therapy for this rare disease is provided.[ncbi.nlm.nih.gov]

Treatment

  • Herein, we report two cases of perforated duodenal diverticulum, one case managed with surgical treatment and one with conservative treatment.[ncbi.nlm.nih.gov]
  • A case of this association is presented, in which the surgical treatment was a biliary-enteric bypass.[ncbi.nlm.nih.gov]
  • DATA EXTRACTION: Patient demographics, clinical characteristics, radiologic findings, treatment, and outcomes were obtained.[ncbi.nlm.nih.gov]
  • In combination with conservative treatment, this technique can be a challenging alternative to surgery.[ncbi.nlm.nih.gov]
  • Surgical treatment is the most frequently performed approach.[ncbi.nlm.nih.gov]

Prognosis

  • However, it remains unclear whether excision of the diverticulum is preferred to biliodigestive anastomosis from the point of view of long-term prognosis. Subsequent surveillance is necessary.[ncbi.nlm.nih.gov]
  • This accounts for earlier diagnosis, more favorable prognosis and the possibility of treatment by minimally invasive techniques in ampullary tumors.[revistagastroenterologiamexico.org]
  • Treatment and prognosis Complications Potential complications include 2, 3 : duodenal diverticulitis hemorrhage perforation abscess formation biliary duct obstruction - Lemmel syndrome The major consideration and mimic of a duodenal diverticulum is that[radiopaedia.org]
  • The prognosis is better than for patients with adenocarcinomas, with overall 5-year survival rates 50 to 75 per cent.[ots1.narod.ru]
  • Mortality/Morbidity The prognosis is good even with complications.[emedicine.medscape.com]

Etiology

  • Diagnosis is not easily made on ultrasonography, however, as our case illustrates, it should be suspected in the abscence of more common etiologies.[sages.org]
  • Duodenal diverticuli are acquired false diverticuli; the etiology is unknown. Most are periampullary.[onlinejets.org]
  • The exact etiology is not clear; however, it might be the end result of disordered duodenal motility.[wjgnet.com]
  • Naranjo-Chavez J, Schwarz M, Leder G, Beger HG: Ampullary but not periampullary duodenal diverticula are an etiologic factor for chronic pancreatitis. Dig Surg 2000;17:358–363.[karger.com]
  • An underestimated etiological association. Am J Gastroenterlogy; 1996; 91: 1186-8. 6.[ispub.com]

Epidemiology

  • Epidemiology Frequency United States Duodenal diverticula are approximately 5 times more common than jejunoileal diverticula. The actual incidence of both types of diverticula is not known because these lesions are usually asymptomatic.[emedicine.medscape.com]
  • Epidemiology Although extraluminal duodenal diverticula are rare in young patients, their frequency increases with age. There is no sex predilection.[ots1.narod.ru]
Sex distribution
Age distribution

Pathophysiology

  • Pathophysiology The cause of this condition is not known. It is believed to develop as the result of abnormalities in peristalsis, intestinal dyskinesis, and high segmental intraluminal pressures.[emedicine.medscape.com]
  • Pathophysiology of Pancreatobiliary Disease Associated with JPD Bile duct dilatation is significantly more common in patients with JPD than in those without JPD [ 4 ].[karger.com]
  • […] anatomic curiosity until 1913 when the radiological demonstration was done by Case. [3] Duodenal diverticula are pouches of the mucosa, submucosa, and scattered muscle cells that extend through the intestinal wall. [4] It is a common finding, and the pathophysiological[jdeonline.in]

Prevention

  • He had hypertension and dyslipidemia for several years, and was taking aspirin to prevent heart disease. CT and colonoscopy revealed a diverticulum in the third portion of the duodenum, rectal polyps, and internal hemorrhoids.[ncbi.nlm.nih.gov]
  • After resection of the tumor, a stent is placed in the pancreatic duct, which will prevent obstruction of the outlet of pancreatic juice that leads to acute pancreatitis, but before that we injected around 2-3 mL of methylen blue solution to facilitate[revistagastroenterologiamexico.org]
  • Recognition of the entity and its anatomic relationships to the ampulla of Vater is essential to the prevention of iatrogenic complications.[academic.oup.com]
  • There are a few case reports of successful endoscopic treatment where the diverticulum is unroofed to prevent food from collecting.[merckmanuals.com]
  • A bulky stool helps prevent this. Plant fiber, especially the insoluble fiber, is the best. These are the fibers that do not produce colon gas. The easiest to take are wheat bran, amaranth, barley and others as listed in Fiber Content of Foods .[gicare.com]

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