gastrointestinal disorders
Diverticular Disease of the Stomach and Small Bowel
Duodenal diverticula
Duodenal diverticula can be Extraluminal (which protrude outside the duodenal wall) Intraluminal (which protrude into the duodenal lumen) of the duodenum are common and are seen in about 25% of patients > 50 years of age who are undergoing Endoscopic retrograde cholangiopancreatography (ERCP) ; they are periampullary in 75% of these patients. A diverticulum that arises within 2- to 3-cm of the ampulla is called a juxtapapillary diverticulum. Patients are asymptomatic or complain of nonspecific abdominal symptoms. Complications of extraluminal diverticula include Overview of Gastrointestinal Bleeding , Intraluminal diverticula or windsock diverticulaare diverticula that occur entirely within the lumen. They are rare and are due to a developmental anomaly that results in a diaphragm or web across the lumen. Over time, peristalsis can pull the web and the bowel wall to which it is attached into the lumen. The invaginated bowel wall then is in effect an intraluminal pouch or diverticulum. Intraluminal diverticula typically occur in the second portion of the duodenum, the majority occurring near the ampulla of Vater. They may involve the entire circumference or only a part of the wall of the duodenum and may project as far distally as the fourth part of the duodenum. There is often a second opening located eccentrically in the diverticulum. They are usually asymptomatic, but some patients develop incomplete duodenal obstruction, perforation, or bleeding. These diverticula can be diagnosed with upper GI barium studies, but CT with oral contrast and upper endoscopy can also be used. During upper endoscopy, a diverticulum may be incorrectly interpreted as the duodenal lumen or a large polyp. Treatment options include surgical resection when obstruction or bleeding occurs. There are a few case reports of successful endoscopic treatment where the diverticulum is unroofed to prevent food from collecting. 