Duodenal Diverticulum

 

General Considerations

• Relatively common (up to 6% of upper GI examinations) in adults
• Usually arise in 2^nd portion of the duodenum (85%) within 1-2 cm of the ampulla of Vater
• Like almost all GI diverticula, they are false diverticula with herniation of the mucosa and submucosa through the muscular layer
• Usually single but may be multiple
• Peak incidence in 5^th-6^th decade
• Usually asymptomatic
• Duodenum is second most common site of diverticula formation in GI tract after colon

Clinical Findings

• 90-95% are asymptomatic
• Symptoms are usually from associated complications – pain and bleeding

Imaging Findings

• Vary in size from mm to several centimeters
• Arise from medial wall (mesenteric side) of duodenal sweep most commonly
• Most are juxta-ampullary
• Mushroom shape with narrow neck and broad base
• May have an air-fluid level if large enough on upright studies

Differential Diagnosis

• Intraluminal diverticulum – are congenital, have a “wind sock”-like structure filled with barium and are surrounded by a radiolucent halo

Treatment

• No treatment unless causing complications
• Surgery may be indicated in cases of hemorrhage or perforation

Complications

• GI bleed
• Perforation
• Pancreatobiliary disease, e.g., cholelithiasis and pancreatitis