Duodenal Diverticula

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Although duodenal diverticula are not uncommon and are discovered in up to 20 % of autopsies, they are rarely seen at endos-copy. They are detected more frequently by radiography (Fig. 3.155). The frequency of endoscopic detection increases when a side-viewing duodenoscope is used.

■ Clinical Aspects

Duodenal diverticula usually cause no complaints, although some cases present with biliary tract obstruction or symptoms due to impacted food residues.

Duodenal diverticula are found predominantly in the medial wall of the descending duodenum, usually at the Vater papilla or at the opening of an accessory pancreatic duct (Fig. 3.153).

Fig. 3.153 Sites of occurrence of duodenal diverticula

1 Juxtapapillary

2 At an accessory papilla

3 Medial wall of the inferior flexure

4 Lateral wall of the inferior flexure

Endoscopic diagnostic criteria (Fig. 3.154)

► Outpouching of the duodenal wall

► Pouch may contain food residues

Differential diagnosis

► Typical appearance

Checklist for endoscopic evaluation

Additional Studies

► Upper GI contrast series for accurate size determination (Fig. 3.155)

Comments

Treatment is usually unnecessary. With obstruction of the biliary tract or duodenum, operative treatment is required.

Fig. 3.153 Sites of occurrence of duodenal diverticula

1 Juxtapapillary

2 At an accessory papilla

3 Medial wall of the inferior flexure

4 Lateral wall of the inferior flexure

b Diverticulum next to the papilla

Fig. 3.154 Duodenal diverticulum a Bulbar diverticulum b Diverticulum next to the papilla

Fig. 3.154 Duodenal diverticulum a Bulbar diverticulum

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