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Current Medical Imaging

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ISSN (Print): 1573-4056
ISSN (Online): 1875-6603

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Research Article

Assessment of Duodenal Diverticula: Computed Tomography Findings

Author(s): Erdem Yilmaz*, Osman Kostek, Savas Hereklioglu, Muhammet Goktas and Nermin Tuncbilek

Volume 15, Issue 10, 2019

Page: [948 - 955] Pages: 8

DOI: 10.2174/1573405614666180904123526

Price: $65

Abstract

Aims: To demonstrate the prevalence, accompanying pathologies, imaging and follow up findings of Duodenal Diverticula (DD) with Multidetector Computed Tomography (MDCT).

Materials and Methods: Consecutive 2910 abdominal MDCTs were retrospectively reviewed on axial, coronal and sagittal planes. DD were evaluated for prevalence, location, number, size, contents, diverticular neck, accompanying pancreaticobiliary pathologies, jejunal and colonic diverticula, respectively.

Results: DD were diagnosed in 157 cases (5.4%) and found mostly in the second part of the duodenum. Juxta-ampullary DD was the most common type (78.3%) and mostly located ventral (n:86, 69.9%) to the ampulla of Vater. DD was solitary in 123 patients (78.3%) and more than one in 34 patients (21.7%). The median diameter of DD was 2.5 cm (range 1.5-3.6 cm) in the long-axis. The lumen of DD contains air and contrast agent (n:96, 61.1%); air, contrast agent and debris (n:42, 26.7%) in most cases. Colonic diverticula (n:36, 22.9%), cholelithiasis (n:32, 20.4%), choledocholithiasis (n:7, 4.4%), and biliary dilatation (n:8, 5.1%) were the most common additional findings. Median follow-up time was 23 months (range 11 to 41 months). In three cases, new findings (cholelithiasis, n:3, choledocholithiasis, n:1) were detected.

Conclusion: Accompanying pathologies with DD diagnosis are valuable for physicians in order to manage the patients. Following clinical and radiological features of well-diagnosed DD might reduce the possible complications.

Keywords: Duodenal diverticula, computed tomography, periampullary diverticula, cholelithiasis, colon diverticula, pathologies.

Graphical Abstract

[1]
Srisajjakul S, Prapaisilp P, Bangchokdee S. Imaging spectrum of nonneoplastic duodenal diseases. Clin Imaging 2016; 40(6): 1173-81.
[http://dx.doi.org/10.1016/j.clinimag.2016.08.007] [PMID: 27572283]
[2]
Jayaraman MV, Mayo-Smith WW, Movson JS, Dupuy DE, Wallach MT. CT of the duodenum: an overlooked segment gets its due. Radiographics 2001; 21(Spec No): S147-60.
[http://dx.doi.org/10.1148/radiographics.21.suppl_1.g01oc01s147] [PMID: 11598254]
[3]
Sakthivel S, Kannaiyan K, Thiagarajan S. Prevalence of duodenal diverticulum in South indians: a cadaveric study. ISRN Anat 2013; 2013767403
[http://dx.doi.org/10.5402/2013/767403] [PMID: 25938103]
[4]
Tamm EP, Balachandran A, Bhosale P, Szklaruk J. Update on 3D and multiplanar MDCT in the assessment of biliary and pancreatic pathology. Abdom Imaging 2009; 34(1): 64-74.
[http://dx.doi.org/10.1007/s00261-008-9416-4] [PMID: 18483805]
[5]
Perdikakis E, Chryssou EG, Karantanas A. Diagnosis of periampullary duodenal diverticula: the value of new imaging techniques. Ann Gastroenterol 2011; 24(3): 192-9.
[PMID: 24713704]
[6]
Snyder MJ. Imaging of colonic diverticular disease. Clin Colon Rectal Surg 2004; 17(3): 155-62.
[http://dx.doi.org/10.1055/s-2004-832696] [PMID: 20011270]
[7]
Telem DA, Buch KE, Nguyen SQ, Chin EH, Weber KJ, Divino CM. Current recommendations on diagnosis and management of right-sided diverticulitis. Gastroenterol Res Pract 2009; 2009359485
[http://dx.doi.org/10.1155/2009/359485] [PMID: 19325923]
[8]
Schroeder TC, Hartman M, Heller M, Klepchick P, Ilkhanipour K. Duodenal diverticula: potential complications and common imaging pitfalls. Clin Radiol 2014; 69(10): 1072-6.
[http://dx.doi.org/10.1016/j.crad.2014.05.103] [PMID: 25110301]
[9]
Rekha BM, Chandramohan A, Chandran BS, Jayaseelan V, Suganthy J. Contrast enhanced computed tomographic study on the prevalence of duodenal diverticulum in Indian population. J Clin Diagn Res 2016; 10(4): AC12-5.
[http://dx.doi.org/10.7860/JCDR/2016/17582.7649] [PMID: 27190786]
[10]
Sakurai Y, Miura H, Matsubara T, Imazu H, Hasegawa S, Ochiai M. Perforated duodenal diverticulum successfully diagnosed preoperatively with abdominal CT scan associated with upper gastrointestinal series. J Gastroenterol 2004; 39(4): 379-83.
[http://dx.doi.org/10.1007/s00535-003-1306-5] [PMID: 15168251]
[11]
Zoepf T, Zoepf DS, Arnold JC, Benz C, Riemann JF. The relationship between juxtapapillary duodenal diverticula and disorders of the biliopancreatic system: analysis of 350 patients. Gastrointest Endosc 2001; 54(1): 56-61.
[http://dx.doi.org/10.1067/mge.2001.115334] [PMID: 11427842]
[12]
Leivonen MK, Halttunen JA, Kivilaakso EO. Duodenal diverticulum at endoscopic retrograde cholangiopancreatography, analysis of 123 patients. Hepatogastroenterology 1996; 43(10): 961-6.
[PMID: 8884321]
[13]
Harford WV. Diverticula of the hypopharynx and esophagus, the stomach and small bowelSleisenger and Fordtran’s gastrointestinal and liver diseases. Philadelphia: WB Saunders 1998; pp. 313-6.
[14]
Boix J, Lorenzo-Zúñiga V, Añaños F, Domènech E, Morillas RM, Gassull MA. Impact of periampullary duodenal diverticula at endoscopic retrograde cholangiopancreatography: a proposed classification of periampullary duodenal diverticula. Surg Laparosc Endosc Percutan Tech 2006; 16(4): 208-11.
[http://dx.doi.org/10.1097/00129689-200608000-00002] [PMID: 16921297]
[15]
Kim CW, Chang JH, Kim JH, Kim TH, Lee IS, Han SW. Size and type of periampullary duodenal diverticula are associated with bile duct diameter and recurrence of bile duct stones. J Gastroenterol Hepatol 2013; 28(5): 893-8.
[http://dx.doi.org/10.1111/jgh.12184] [PMID: 23432035]
[16]
Motta-Ramírez GA, Ortiz-León JL, Urbina De la Vega F, Mejía-Nogales RE, Barinagarrenteria-Aldatz R. Diverticular duodenal disease as incidental finding with computer tomography. Rev Gastroenterol Mex 2010; 75(2): 165-70.
[PMID: 20615784]
[17]
Graur F, Bala O, Bodea R, Geczi-Toth I, Vlad L, Iancu C. Laparoscopic resection of duodenal diverticulum. A case report. Rom J Gastroenterol 2005; 14(4): 405-8.
[PMID: 16400360]
[18]
Twomey M, Moloney F, James K, et al. The small bowel: an imaging guide. Curr Med Imaging 2017; 13: 383-91.
[http://dx.doi.org/10.2174/1573405613666170110103141]
[19]
Comparato G, Pilotto A, Franzè A, Franceschi M, Di Mario F. Diverticular disease in the elderly. Dig Dis 2007; 25(2): 151-9.
[http://dx.doi.org/10.1159/000099480] [PMID: 17468551]
[20]
Li X, Zhu K, Zhang L, et al. Periampullary diverticulum may be an important factor for the occurrence and recurrence of bile duct stones. World J Surg 2012; 36(11): 2666-9.
[http://dx.doi.org/10.1007/s00268-012-1716-8] [PMID: 22911215]
[21]
Pearl MS, Hill MC, Zeman RK. CT findings in duodenal diverticulitis. AJR Am J Roentgenol 2006; 187(4)W392-5
[http://dx.doi.org/10.2214/AJR.06.0215] [PMID: 16985110]
[22]
Boppana V, Adike A, Adike U, Pannala R. An incidental windsock diverticulum. Clin Case Rep 2018; 6(5): 965-6.
[http://dx.doi.org/10.1002/ccr3.1458] [PMID: 29744103]
[23]
Macari M, Lazarus D, Israel G, Megibow A. Duodenal diverticula mimicking cystic neoplasms of the pancreas: CT and MR imaging findings in seven patients. AJR Am J Roentgenol 2003; 180(1): 195-9.
[http://dx.doi.org/10.2214/ajr.180.1.1800195] [PMID: 12490502]
[24]
Naranjo-Chavez J, Schwarz M, Leder G, Beger HG. Ampullary but not periampullary duodenal diverticula are an etiologic factor for chronic pancreatitis. Dig Surg 2000; 17(4): 358-63.
[http://dx.doi.org/10.1159/000018879] [PMID: 11053943]
[25]
Lapin R, Kamath ML, Engler J, Friedman H. Massive gastrointestinal hemorrhage from duodenal diverticula. Am J Gastroenterol 1974; 61(3): 185-9.
[PMID: 4545227]
[26]
Scudamore CH, Harrison RC, White TT. Management of duodenal diverticula. Can J Surg 1982; 25(3): 311-4.
[PMID: 6805932]
[27]
Wiesner W, Beglinger Ch, Oertli D, Steinbrich W. Juxtapapillary duodenal diverticula: MDCT findings in 1010 patients and proposal for a new classification. JBR-BTR 2009; 92(4): 191-4.
[PMID: 19803096]
[28]
Case JT. Diverticula of small intestine, other than meckel’s diverticulum. JAMA 1920; 75: 1463-70.
[http://dx.doi.org/10.1001/jama.1920.02620480001001]
[29]
Ter Horst M, Boer MC, Raber MH, Klaase JM. Giant diverticulum of the duodenum. Gastroenterol Res 2011; 4(6): 289-93.
[PMID: 27957031]
[30]
Bittle MM, Gunn ML, Gross JA, Rohrmann CA. Imaging of duodenal diverticula and their complications. Curr Probl Diagn Radiol 2012; 41(1): 20-9.
[http://dx.doi.org/10.1067/j.cpradiol.2011.07.001] [PMID: 22085659]
[31]
Yang F, Di Y, Jin C, Zhong L, Fu DL. Education and imaging. Gastroenterology: Juxtapapillary diverticulum perforation after endoscopic retrograde cholangiopancreatography. J Gastroenterol Hepatol 2015; 30(4): 651.
[http://dx.doi.org/10.1111/jgh.12854] [PMID: 25776958]
[32]
Wijarnpreecha K, Panjawatanan P, Manatsathit W, et al. Association between juxtapapillary duodenal diverticula and risk of choledocholithiasis: a systematic review and meta-analysis. J Gastrointest Surg 2018; 22(12): 2167-76.
[http://dx.doi.org/10.1007/s11605-018-3865-z] [PMID: 30022443]
[33]
Chen L, Xia L, Lu Y, Bie L, Gong B. Influence of periampullary diverticulum on the occurrence of pancreaticobiliary diseases and outcomes of endoscopic retrograde cholangiopancreatography. Eur J Gastroenterol Hepatol 2017; 29(1): 105-11.
[http://dx.doi.org/10.1097/MEG.0000000000000744] [PMID: 27606949]
[34]
Nishiwaki M, Mizuno C, Yano K, et al. retroperitoneal perforation caused by migration of a pancreatic spontaneous dislodgement stent into periampullary diverticula. Intern Med 2018; 57(3): 351-5.
[http://dx.doi.org/10.2169/internalmedicine.9054-17] [PMID: 29093393]
[35]
Kua JE, Seah A, So JB. Periampullary diverticulum: a case of bleeding from a periampullary diverticulum. Ann Acad Med Singapore 2005; 34(10): 636-8.
[PMID: 16382250]
[36]
Degheili JA, Abdallah MH, Haydar AA, Moukalled A, Hallal AH. Perforated Duodenal diverticulum treated conservatively: another two successful cases. Case Rep Surg 2017.20174045970
[http://dx.doi.org/10.1155/2017/4045970] [PMID: 28555171]
[37]
D’Assuncao MA, Nova da Costa LS, Mota FL, et al. Successful endoscopic treatment of a “windsock” diverticulum: a rare case of duodenal subocclusion. Endoscopy 2018; 50(3): E65-6.
[http://dx.doi.org/10.1055/s-0043-123877] [PMID: 29245161]
[38]
Balci NC, Noone T, Akün E, Akinci A, Klör HU. Juxtapapillary diverticulum: findings on MRI. J Magn Reson Imaging 2003; 17(4): 487-92.
[http://dx.doi.org/10.1002/jmri.10281] [PMID: 12655590]

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