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

  • case report
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Introduction

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.

Methods

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

Results

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.

Conclusions

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.

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Authors and Affiliations

  1. Department of Visceral and Transplantation Surgery, University Hospital Bern, CH-3010, Bern, Switzerland

    Beat Schnueriger, Stephan A. Vorburger, Vanessa M. Banz & Daniel Candinas

  2. Department of Gastroenterology, Bern University Hospital, Bern, Switzerland

    Alain M. Schoepfer

Authors
  1. Beat Schnueriger
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  2. Stephan A. Vorburger
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  3. Vanessa M. Banz
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  4. Alain M. Schoepfer
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  5. Daniel Candinas
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Correspondence to Beat Schnueriger.

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Schnueriger, B., Vorburger, S.A., Banz, V.M. et al. Diagnosis and Management of the Symptomatic Duodenal Diverticulum: a Case Series and a Short Review of the Literature. J Gastrointest Surg 12, 1571–1576 (2008). https://doi.org/10.1007/s11605-008-0549-0

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  • DOI: https://doi.org/10.1007/s11605-008-0549-0

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