DUODENAL DIVERTICULUM

TYPES

• Extramural diverticulum – It is the most common type of colonic diverticulum found in patients, one that protrudes out from the duodenum. It may differ in a few mm to cm and can usually be found in the area around the Papilla of Vater.
• Intramural diverticulum – A rare type of diverticulum in most cases, it is present from birth. It protrudes into the hollow insides of the duodenal lumen in which the digested food flows.

SYMPTOMS

Extramural diverticulum generally causes no indications or symptoms. In some instances, they may tear and can lead to inflammation of the adjoining duodenum with or without infection. This may bring about all the signs and indications of intra-abdominal inflammation, including fever, pain, diarrhea, malabsorption due to bacterial overgrowth, and abdominal tenderness.

In the event that the diverticulum is exceptionally near the Ampulla of Vater, patients often develop complications in their gallstones, such as:

• Cholecystitis – It is the swelling or inflammation of the gallbladder.
• Biliary colic – The pain that can be felt by the obstruction in the bile ducts.
• Cholangitis – It is the inflammation of the bile ducts caused by the spread of bacteria into the ducts from the duodenum.
• Recurrent pancreatitis – This complication is due to the interference of the diverticula with the normal function of the pancreatic and bile ducts.

The intramural diverticulum is usually asymptomatic, but in other cases, many patients report nonspecific indications such as an uncertain sensation of bloatedness and dyspepsia. Some also develop incomplete duodenal perforation, obstruction, or bleeding in their colon.

DIAGNOSIS

The extramural and intramural diverticulum is most usually diagnosed with barium X-rays on the upper gastrointestinal tract or ultrasonography and endoscopy. During endoscopy, the diverticulum can be mistaken as the duodenal lumen or a large polyp, but they may also show up on magnetic resonance imaging (MRI) or computerized tomographic (CT) scans with oral contrast.

TREATMENT

Extramural duodenal diverticula can be removed surgically from the exterior of the duodenum; however, the inverted or intramural diverticula is removed through an incision inside the duodenal lumen. Even so, no specific treatment is usually needed for an asymptomatic diverticulum; management may depend on the severity of symptoms.