IS Case 393: Duodenal diverticula
2009 URMC Imaging Sciences
Publication Date: 2010-03-09
History
Patient is a 48-year-old male, with a history of colitis and perirectal fistula, presenting with persistent abdominal pain. Evaluation for stricture, fistula, inflammatory disease or other abnormality was requested.
Diagnosis
Duodenal diverticula
Discussion
Duodenal diverticula are often discovered as an incidental finding on UGI barium studies. They are present in approximately 10-15% of the population. These are acquired lesions, and form as a result of herniation of the mucosal and submucosal layers of the duodenum through a muscular defect.
Most duodenal diverticula are found on the medial aspect of the proximal duodenum. However, they can occur in the third and fourth parts of the duodenum as well.
They generally appear on barium studies as smooth, rounded outpouchings with a discrete neck and can change appearance during the course of the study as they fill and empty with contrast and air. Occasionally, a filling defect can be observed within a duodenal diverticula if food particles become trapped within it. Some duodenal diverticula can be seen on CT if there is intradiverticular gas.
Most are asymptomatic, however complications including upper GI bleeding, gastric outlet obstruction and pancreaticobiliary disease can develop. As with colonic diverticula, duodenal diverticula can perforate (leading to retroperitoneal air). These complications are often a diagnosis of exclusion as symptoms mimic more common abdominal conditions.
References
- Brant WE, Helms CA (Eds.). Brant and Helms: Fundamentals of Diagnostic Radiology, 3rd edition. Lippincott Williams & Wilkins, 2006: 828-9
- Gore RM, Levine MC. Textbook of GastroIntestinal Radiology, 3rd edition. Saunders, 2007: 684-6.
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