Duodenal Diverticula are bulging pouch-like herniations (diverticula) in the wall of the duodenum (part of the small intestine).
The most common site for diverticula is the sigmoid colon, but they may develop anywhere in the gastrointestinal tract, including the duodenum.
Diverticular disease has two clinical forms. In diverticulosis, diverticula are present but do not cause symptoms. In diverticulitis, diverticula are inflamed and may cause potentially fatal obstruction, infection, or hemorrhage. In diverticulitis, retained undigested food mixed with bacteria accumulates in the diverticular sac, forming a hard mass (fecalith). This substance cuts off the blood supply to the thin walls of the sac, making them more susceptible to attack by colonic bacteria.
Serious complications are bleeding or perforation from inflammation, pancreatitis, and biliary obstruction.
Duodenal diverticula are acquired outpouchings of the mucosa and submucosa, 90 percent of which are on the medial aspect of the duodenum. They are rare before age 40.
There is a high incidence of gallstone disease of the gallbladder in patients with juxtapapillary diverticula. Diverticula are not seen in the first portion of the duodenum, where diverticular configurations are due to scarring by peptic ulceration or cholecystitis (inflammation of the gall bladder).
Symptoms are uncommon. A few patients have chronic postprandial (after eating) abdominal pain or dyspepsia (reflux) caused by a duodenal diverticulum.
Diverticula of the duodenum are found in 20 percent of upper gastrointestinal series (an X-ray study).
Only about 1 percent of duodenal diverticula found by radiologic study warrant surgery. Treatment for those with symptomatic diverticula may include antacids.
Surgical treatment is required for complications and, rarely, for persistent symptoms. Excision and a two-layer closure are usually possible after mobilization of the duodenum and dissection of the diverticulum from the pancreas. Removal of the diverticulum and closure of the defect are often superior to simple drainage in the case of perforation.
Are diverticula present?
Where are they located?
Is there inflammation or infection?
Is surgical intervention necessary?
What are the risks?
Will there be a recurrence?