Diagnosis and Management of the Symptomatic Duodenal Diverticulum: a Case Series and a Short Review of the Literature

  • Beat SchnuerigerEmail author
  • Stephan A. Vorburger
  • Vanessa M. Banz
  • Alain M. Schoepfer
  • Daniel Candinas
case report



The incidence of duodenal diverticula (DD) found at autopsy may be as high as 22%. Perforation is the least frequent but also the most serious complication. This case series gives an overview of the management of this rare entity.


This study is a case series of eight patients treated for symptomatic DD.


Two patients had a perforated DD. One perforation was in segments III–IV, which to our knowledge is the first published case; the other perforation was in segment II. A segmental duodenectomy was performed in the first patient and a pylorus-preserving duodeno-pancreatectomy (pp-Whipple) in the second. A third patient with chronic complaints and recurring episodes of fever required an excision of the DD. In a fourth patient with biliary and pancreatic obstruction, a pp-Whipple was carried out, and a DD was discovered as the underlying cause. Four patients (one small perforation, one hemorrhage, and two recurrent cholangitis/pancreatitis caused by a DD) were treated conservatively.


Symptomatic DD and, in particular, perforations are rare, encompass diagnostic challenges, and may require technically demanding surgical or endoscopic interventions. The diagnostic value of forward-looking gastroduodenoscopy in this setting seems limited. If duodenoscopy is performed at all, the use of a side-viewing endoscope is mandatory.


Duodenal diverticulum Perforation Operative management 


  1. 1.
    Chomel J. Report of a case of duodenal diverticulum containing gallstones. Acad R Sci Paris 1710:48–50.Google Scholar
  2. 2.
    Ackermann W. Diverticula and variations of the duodenum. Ann Surg 1943;117:403–413.PubMedCrossRefGoogle Scholar
  3. 3.
    Leivonen MK, Halttunen JA, Kivilaakso EO. Duodenal diverticulum at endoscopic retrograde cholangiopancreatography, analysis of 123 patients. Hepatogastroenterology 1996;43:961–966.PubMedGoogle Scholar
  4. 4.
    Jin T, Ho G, Eun Y, Joong G, Chang H, Young S et al. Incidence of juxtapapillary duodenal diverticula is higher in brown pigment stone but not in black pigment or cholesterol stone. Gastroint Endosc 2006;63:297.Google Scholar
  5. 5.
    Oddo F, Chevallier P, Souci J, Baque J, Buckley MJ, Fabiani P et al. Radiologic aspects of the complications of duodenal diverticula. J Radiol 1999;80(2):134–140.PubMedGoogle Scholar
  6. 6.
    Suda K, Mizuguchi K, Matsumoto M. A histopathological study on the etiology of duodenal diverticulum related to the fusion of the pancreatic anlage. Am J Gastroenterol 1983;78(6):335–338.PubMedGoogle Scholar
  7. 7.
    Yang HK, Fondacaro PF. Enterolith ileus: a rare complication of duodenal diverticula. Am J Gastroenterol 1992;87(12):1846–1848.PubMedGoogle Scholar
  8. 8.
    Chitambar IA, Springs C. Duodenal diverticula. Surgery 1953;33(5):768–791.PubMedGoogle Scholar
  9. 9.
    Umbricht-Sprungli RE, Hollinger A, Meier L, Largiader F. Complications of diverticuli of the proximal small intestine. 3 case reports and review of the literature. Chirurg 1992;63(7):568–571.PubMedGoogle Scholar
  10. 10.
    Papalambros E, Felekouras E, Sigala F, Kiriakopoulos A, Giannopoulos A, Aessopos A et al. Retroperitoneal perforation of a duodenal diverticulum with colonic necrosis—report of a case. Zentralbl Chir 2005;130(3):270–273.PubMedCrossRefGoogle Scholar
  11. 11.
    Jones TW, Merendino KA. The perplexing duodenal diverticulum. Surgery 1960;48:1068–1084.PubMedGoogle Scholar
  12. 12.
    Duarte B, Nagy KK, Cintron J. Perforated duodenal diverticulum. Br J Surg 1992;79(9):877–881.PubMedCrossRefGoogle Scholar
  13. 13.
    Franzen D, Gurtler T, Metzger U. Solitary duodenal diverticulum with enterolith as a rare cause of acute abdomen. Swiss Surg 2002;8(6):277–279.PubMedCrossRefGoogle Scholar
  14. 14.
    Poostizadeh A, Gow KW, Al-Mahmeed T, Allardyce DB. Traumatic perforation of duodenal diverticulum. J Trauma 1997;43(2):370–371.PubMedCrossRefGoogle Scholar
  15. 15.
    Elder J, Stevenson G. Delayed perforation of a duodenal diverticulum by a biliary endoprosthesis. Can Assoc Radiol J 1993;44(1):45–48.PubMedGoogle Scholar
  16. 16.
    Tissot E, Ayoun CL, Maisonnier M. Preoperative diagnosis of a subacute perforation of a duodenal diverticulum. J Chir (Paris) 1988;125(5):346–349.Google Scholar
  17. 17.
    Van Beers B, Trigaux JP, De Ronde T, Melange M. CT findings of perforated duodenal diverticulitis. J Comput Assist Tomogr 1989;13(3):528–530.PubMedCrossRefGoogle Scholar
  18. 18.
    Cavanagh JE Jr. Iatrogenic perforation of perivaterian duodenal diverticulum: report of a case. Can J Surg 1996;39(4):336–338.PubMedGoogle Scholar
  19. 19.
    Juler GL, List JW, Stemmer EA, Connolly JE. Perforating duodenal diverticulitis. Arch Surg 1969;99(5):572–578.PubMedGoogle Scholar
  20. 20.
    Eeckhout G, Vanstiphout J, Van Pottelbergh I, Leyman P, Vandervoort J, De Man M et al. Endoscopic treatment of a perforated duodenal diverticulum. Endoscopy 2000;32(12):991–993.PubMedCrossRefGoogle Scholar
  21. 21.
    Yoshino S et al. Endoscopic management of a dieulafoy-like lesion in a duodenal diverticulum. Dig Endosc 2006;18:59–61.CrossRefGoogle Scholar
  22. 22.
    Lee SH, Park SH, Lee JH, Park DH, Chung IK, Kim SJ et al. Endoscopic diverticulotomy with an isolated-tip papillotome (Iso-Tome) in a patient with intraluminal duodenal diverticulum. Gastrointest Endosc 2005;62(5):817–819.PubMedCrossRefGoogle Scholar
  23. 23.
    Pothamsetty S, Attar B, Abrahamian F, Behara S, Rahim T. Bezoar in a periampullary extraluminal duodenal diverticulum causing acute pancreatitis. Am J Gastroenterol 2000;95:728.Google Scholar
  24. 24.
    Plath F, Brock P, Hasse N, Liebe S, Arendt T. Vegetable stalk as a nidus for gallstone formation in a patient with a juxtapapillary duodenal diverticulum. Gastrointest Endosc 2002;56(6):944–946.PubMedCrossRefGoogle Scholar
  25. 25.
    Lobo DN, Balfour TW, Iftikhar SY, Rowlands BJ. Periampullary diverticula and pancreaticobiliary disease. Br J Surg 1999;86(5):588–597.PubMedCrossRefGoogle Scholar
  26. 26.
    Harthun NL, Morse JH, Shaffer HA Jr, Minasi JS. Duodenal obstruction caused by intraluminal duodenal diverticulum and annular pancreas in an adult. Gastrointest Endosc 2002;55(7):940–943.PubMedCrossRefGoogle Scholar
  27. 27.
    Yokomuro S, Uchida E, Arima Y, Mizuguchi Y, Shimizu T, Kawahigashi Y et al. Simple closure of a perforated duodenal diverticulum: “a case report”. J Nippon Med Sch 2004;71(5):337–339.PubMedCrossRefGoogle Scholar
  28. 28.
    Willox GL, Costopoulos LB. Entry of common bile and pancreatic ducts into a duodenal diverticulum. Cause of pancreaticobiliary disease. Arch Surg 1969;98(4):447–450.PubMedGoogle Scholar
  29. 29.
    Vassilakis JS, Tzovaras G, Chrysos E, Mouzas I, Manousos O, Xynos E. Roux-Y choledochojejunostomy and duodenojejunostomy for the complicated duodenal diverticulum. Am J Surg 1997;174(1):45–48.PubMedCrossRefGoogle Scholar
  30. 30.
    Critchlow JF, Shapiro ME, Silen W. Duodenojejunostomy for the pancreaticobiliary complications of duodenal diverticulum. Ann Surg 1985;202(1):56–58.PubMedCrossRefGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2008

Authors and Affiliations

  • Beat Schnueriger
    • 1
    Email author
  • Stephan A. Vorburger
    • 1
  • Vanessa M. Banz
    • 1
  • Alain M. Schoepfer
    • 2
  • Daniel Candinas
    • 1
  1. 1.Department of Visceral and Transplantation SurgeryUniversity Hospital BernBernSwitzerland
  2. 2.Department of GastroenterologyBern University HospitalBernSwitzerland

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