Endoscopic diagnosis of intraluminal duodenal diverticulum

Management of the intraluminal duodenal diverticulum: endoscopy or duodenotomy?

The intraluminal duodenal diverticulum is an uncommon congenital anomaly which is associated with obstructive symptoms. Treatment of the symptomatic intraluminal duodenal diverticulum can be undertaken either endoscopically with excision by snare cautery or with duodenotomy and excision of the diverticulum. An understanding of the embryologic and anatomic characteristics of the intraluminal duodenal diverticulum is essential in order to select the best treatment and avoid the pitfall of inadvertent pancreatic or bile duct injury.

Diagnosis and management of intraluminal duodenal diverticulum

The descending part of duodenum is the principal site for an intraluminally projecting mucosal pouch or diverticulum, but this unusual lesion may also occur elsewhere in the upper gastrointestinal tract. We report three patients in whom a large intraluminal duodenal diverticulum (IDD) was diagnosed radiographically at the ages of 15, 27, and 68 years, respectively. Fiberoptic duodenoscopy was performed in the two symptomatic cases for the removal of impacted food from IDD or dilatation of its outflow aperture. Guidelines for the diagnosis and treatment of IDD are provided based on our experience and review of the pertinent literature.