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THE BROAD CLINICAL SPECTRUM OF COMPLICATED DUODENAL DIVERTICULA
JJ Williams, MG Swain, R Panaccione, E Raber
Divisions of Gastroenterology and Radiology, Department of Medicine, University of Calgary, Calgary, Alberta
BACKGROUND: The finding of extraluminal duodenal diverticula is not uncommon. They are reported on 6% of all UGI radiographic studies, 27% of ERCP’s, and in up to 23% of autopsies. Despite their frequency, they are rarely symptomatic or require any therapy. Rare cases of intraperitoneal perforation and massive bleeding have been reported. Even though massive bleeding may occur, these acquired abnormalities can be missed with a standard front-viewing endoscope. Similarly, CT and U/S may mistake duodenal diverticula for pancreatic abnormalities.
AIM: To identify a series of duodenal diverticula which highlight the broad clinical spectrum of these abnormalities and emphasize the importance of clinician awareness.
RESULTS: A total of four cases were identified. Two patients presented with massive upper gastrointestinal bleeding. One was treated successfully with hemoclipping. The other required a surgical diverticulectomy. The third patient presented with recurrent episodes of epigastric pain and intermittent jaundice and associated striking elevations in liver enzymes who demonstrated MRCP findings that suggested that compression by the diverticulum was causing recurrent CBD obstruction. Surgical diverticulectomy is being considered. The fourth patient presented with intermittent epigastric pain and iron deficiency anemia and had a duodenal diverticula demonstrated on UGIS.
CONCLUSION: Although duodenal diverticula are common anatomic abnormalities, they rarely cause symptoms or significant complications. However, even when significant complications arise, these diverticula can be missed on standard radiographic and endoscopic evaluation. We describe 4 cases of complicated duodenal diverticula which illustrate the wide spectrum of clinical presentations that can be associated with duodenal diverticula, and highlight the potential importance of this diagnosis in the management of these patients given that surgical intervention is potentially curative.