Intraluminal duodenal diverticulum. A rare cause of recurrent acute pancreatitis

Chambenois, Edouard; Derhy, Sarah; Arrivé, Lionel

doi:10.1016/j.clinre.2014.08.010

Cited by 3 publications

(3 citation statements)

References 3 publications

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“…The duodenum is the second most common site of diverticula in the small bowel following the jejunum [2]. Intraluminal duodenal diverticulum is thought to be part of the spectrum of congenital abnormalities, which includes duodenal atresia [3].…”

Section: Discussionmentioning

confidence: 99%

Acute Pancreatitis with Duodenal Diverticulum

Asma¹,

Narjis²,

Ridouan³

2017

UCMS

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Abstract:Intraluminal duodenal diverticulum is a recognised but rare cause of acute pancreatitis. CASE REPORT: we recently encountered this lesion in a 65 year old woman. She had no history of gallstones with no any medications or alcohol consomation. She presented to our hospital because of worsening abdominal pain for three days. The pain was initially in the upper abdomen but later radiated to the back. Epigastric tenderness was evident on physical examination. She had a history of similar painful episodes occurring infrequently for a few years but the pain had never been so severe. She had never previously sought medical attention for this pain. Her pancreatic enzymes were found to be elevated. Interestingly, a subsequent CT scan showed an irregular pancreatic outline consistent with pancreatitis and parapapillary diverticulum (15 mm). No intervention was needed since the patient's condition started to improve with conservative management and the patient was found to be doing well at his one year follow-up visit with medical treatment. The majority of duodenal diverticula are asymptomatic. Clinical presentation may be characterized by non-specific abdominal symptoms. However, complications are responsible for presentation in most cases.

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Section: Discussionmentioning

confidence: 99%

Acute Pancreatitis with Duodenal Diverticulum

Asma¹,

Narjis²,

Ridouan³

2017

UCMS

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“…Duodenal diverticulum can be acquired or congenital, the last contains all intestinal layers, with an extraluminal (EDD) and intraluminal (IDD) type [10,12,15]. The origin of IDD seems to be caused by the presence of a luminal membrane due to recanalization failure of the foregut lumen during fetal stages, later peristaltic and feeding pressure extends it, leading to an intraluminal duodenal diverticulum [1,5,6,11]. The acquired EDD is more frequent and characterized by herniation of the submucosa and mucosa, through a muscularis defect or a weak spot of the wall, such as an artery entry; it's also named as pseudodiverticulum [8,10,12].…”

Section: Introductionmentioning

confidence: 99%

“…The ID is a common finding in gastrointestinal imaging studies, and the most usual location is in the colon, followed by duodenum. Most of the duodenal diverticulum remain asymptomatic, but serious complications as biliary obstruction, recurrent acute pancreatitis, hemorrhagic ulcer, proximal intestinal obstruction and perforation may occur [2,5,7,14].…”

Section: Introductionmentioning

confidence: 99%

Partial Obstruction and Intestinal Bleeding Secondary to a Congenital Duodenal Diverticulum in a Dog

Lorigados

Zoppa

Schiller

et al. 2021

Acta Scientiae. Vet.

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Background: Intestinal diverticulum is an abnormality resulting in the formation of a blind-ended saccular pouch that can be acquired either congenital, true (involving all intestinal layers) or false (involving the mucosa and submucosa), with extraluminal and intraluminal type. In humans, the acquired is more frequent, being the colon is the most affected segment followed by duodenum; most of duodenal diverticulum remains asymptomatic, but biliary obstruction, recurrent acute pancreatitis, hemorrhagic ulcer, proximal intestinal obstruction and perforation may occur. The aim of this report is to present a case of a congenital disease in dogs, prone to misdiagnosis due to non-specific clinical signs.Case: An 8-month-old male Boxer was evaluated due to recurrent hyporexia, vomiting, melena and syncope over three months with signs of a possible intestinal obstruction. Physical examination showed no abnormalities except for pale mucous membranes. Complete blood count revealed anemia and leukocytosis. Platelets and biochemical profiles were normal. Abdominal ultrasound examination indicated a dilated duodenum, measuring approximately 3.36 cm in diameter, with heterogeneous fluid content and hyperechogenic structures with acoustic shadow, peristalsis appeared decreased and non-progressive. The gastrointestinal positive contrast study was performed to better evaluate abnormalities detected at ultrasonography. Images after 30 m of contrast administration demonstrated a marked distension of the duodenum, filled with contrast and a mildly filled stomach displaced to the left. Sixty min after contrast administration a marked distension of the entire duodenum, with tortuous aspect and filled with contrast was seen. The caudal duodenal flexure was connected to a large barium filled saccular structure that measured approximately 7 cm in diameter, consistent with a duodenal diverticulum. A blood transfusion was performed and surgical treatment indicated. The diverticulum and a small portion of the caudal duodenal segment were resected, an end-side enteroanastomosis was made due to the difference in diameter between intestinal segments. The patient was medicated with sucralfate (12.5 mg/kg), ranitidine (2 mg/kg), metronidazole (25 mg/kg), dipyrone (25 mg/kg) and, tramadol (2 mg/kg) and recovered quickly from surgery. Histopathological examination characterized the diverticular tissue as a true diverticulum by the presence of all intestinal layers. Post-operative and follow-up evaluations showed no recurrence of clinical signs.Discussion: In veterinary practice, congenital duodenal diverticulum is a rare condition documented in dogs, curiously all Boxers None of the reported cases in literature had the diagnostic of duodenal diverticulum made exclusively by ultrasonography. Other diagnostic imaging modalities, such as gastrointestinal barium study or endoscopy, were necessary. In one case a diagnostic was made during exploratory laparotomy. The marked dilatation of the duodenal segment impaired ultrasound evaluation, allowing recognition of an obstructive pattern, not the diverticulum itself. At histopathological examination, the diverticular tissue was characterized by a thickened wall with a hypertrophied muscle layer, characterizing a true duodenal diverticulum. The location, breed and age of the dogs affected with duodenal diverticulum was similar in all veterinary cases reported. Dogs presenting signs of gastrointestinal disease and abdominal pain are common in patients referred to ultrasound examination. However, despite the rare reports described, we must consider this affection as a differential diagnosis, whenever boxer puppies present these clinical signs associated with gastrointestinal bleeding and syncope.

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Mass-forming lesions of the duodenum: A pictorial review

Barat

Dohan

Dautry

et al. 2017

Diagnostic and Interventional Imaging

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Recent advances in imaging have resulted in marked changes in the investigation of the duodenum, which still remains primarily evaluated with videoendoscopy. However, improvements in computed tomography (CT) and magnetic resonance (MR) imaging have made detection and characterization of duodenal mass-forming abnormalities easier. The goal of this pictorial review was to illustrate the most common conditions of the duodenum that present as mass-forming lesions with a specific emphasis on CT and MR imaging. MR imaging used in conjunction with duodenal distension appears as a second line imaging modality for the characterization of duodenal mass-forming lesions. CT remains the first line imaging modality for the detection and characterization of a wide range of duodenal mass-forming lesions.

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Intraluminal duodenal diverticulum. A rare cause of recurrent acute pancreatitis

Cited by 3 publications

References 3 publications

Acute Pancreatitis with Duodenal Diverticulum

Acute Pancreatitis with Duodenal Diverticulum

Partial Obstruction and Intestinal Bleeding Secondary to a Congenital Duodenal Diverticulum in a Dog

Mass-forming lesions of the duodenum: A pictorial review

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