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Yi GY, Lee JK, Lee H, Yi SY, Park S. Imaging Findings of an Intraluminal Duodenal Diverticulum Associated with Adult Duodeno-Duodenal Intussusception and Recurrent Pancreatitis: A Case Report. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2022; 83:680-686. [PMID: 36238501 PMCID: PMC9514536 DOI: 10.3348/jksr.2021.0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/22/2021] [Accepted: 07/17/2021] [Indexed: 02/05/2023]
Abstract
Intraluminal duodenal diverticulum (IDD) is a rare congenital abnormality, consisting of a sac-like mucosal lesion in the duodenum. Cases of IDD can present with gastrointestinal bleeding, duodenal obstruction, or pancreatitis. Here, we report a rare case of a 25-year-old female presenting with IDD complicated by duodeno-duodenal intussusception and recurrent pancreatitis. The diagnosis was based on findings from radiologic examinations (CT and MRI), upper gastrointestinal series (barium swallow), and gastroduodenofiberscopy. Laparoscopic excision of the presumed duodenal duplication was performed. The subsequent histopathologic evaluation of the excised sac revealed normal mucosa on both sides, but the absence of a proper muscle layer confirmed the diagnosis of IDD. Radiologic detection of a saccular structure in the second portion of the duodenum can indicate IDD with duodeno-duodenal intussusception as the lead point.
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Affiliation(s)
- Ga Young Yi
- Department of Radiology, College of Medicine, Ewha Womans University, Mokdong Hospital, Seoul, Korea
| | - Jeong Kyong Lee
- Department of Radiology, College of Medicine, Ewha Womans University, Mokdong Hospital, Seoul, Korea
| | - Huisong Lee
- Department of Surgery, College of Medicine, Ewha Womans University, Mokdong Hospital, Seoul, Korea
| | - Sun Young Yi
- Department of Gastroenterology, College of Medicine, Ewha Womans University, Mokdong Hospital, Seoul, Korea
| | - SangHui Park
- Department of Pathology, College of Medicine, Ewha Womans University, Mokdong Hospital, Seoul, Korea
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Eghbali E, Tarzamni MK, Shirmohammadi M, Javadrashid R, Fouladi DF. Diagnostic performance of 64-MDCT in detecting ERCP-proven periampullary duodenal diverticula. Radiol Med 2020; 125:339-347. [PMID: 31893332 DOI: 10.1007/s11547-019-01121-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 11/28/2019] [Indexed: 11/29/2022]
Abstract
AIM To determine the diagnostic performance of 64-slice multidetector computed tomography (64-MDCT) in detecting periampullary duodenal diverticula. MATERIALS AND METHODS Medical profiles of 120 endoscopic retrograde cholangiopancreatography (ERCP)-proven patients with (n = 100) and without (n = 20) periampullary duodenal diverticula who had undergone 64-MDCT were retrospectively reviewed. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 64-MDCT in detecting periampullary duodenal diverticula were calculated. Potential factors that might influence the diagnostic performance of 64-MDCT in such patients were also examined. RESULTS Patients were 60 males and 60 females with the mean age of 68.8 ± 12.7 (27-93) years. Indications of ERCP were common bile duct stricture (n = 62) or stone (n = 41), biliary cholestasis (n = 16) and acute cholangitis (n = 1). The sensitivity, specificity, PPV, and NPV of 64-MDCT in detecting periampullary duodenal diverticula were 76%, 100%, 100%, and 45.5%, respectively. The size of diverticula was the only predictor of 64-MDCT performance, with better results observed in larger (> 20 mm) diverticula. CONCLUSION 64-MDCT is a highly specific imaging modality in detecting periampullary duodenal diverticula. The diagnostic performance of 64-MDCT increases for larger diverticula.
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Affiliation(s)
- Elham Eghbali
- Medical Radiation Sciences Research Group, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Kazem Tarzamni
- Medical Radiation Sciences Research Group, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Masoud Shirmohammadi
- Department of Gastroenterology, Imam Reza Teaching Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Reza Javadrashid
- Medical Radiation Sciences Research Group, Tabriz University of Medical Sciences, Tabriz, Iran
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Chambenois E, Derhy S, Arrivé L. Intraluminal duodenal diverticulum. A rare cause of recurrent acute pancreatitis. Clin Res Hepatol Gastroenterol 2015; 39:278-9. [PMID: 25260567 DOI: 10.1016/j.clinre.2014.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 08/20/2014] [Indexed: 02/04/2023]
Affiliation(s)
- E Chambenois
- Sorbonne universités, UPMC université Paris 06, faculté de médecine Pierre-et-Marie-Curie, Department of Radiology, Saint-Antoine Hospital, Assistance publique-Hôpitaux de Paris, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France
| | - S Derhy
- Sorbonne universités, UPMC université Paris 06, faculté de médecine Pierre-et-Marie-Curie, Department of Radiology, Saint-Antoine Hospital, Assistance publique-Hôpitaux de Paris, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France
| | - L Arrivé
- Sorbonne universités, UPMC université Paris 06, faculté de médecine Pierre-et-Marie-Curie, Department of Radiology, Saint-Antoine Hospital, Assistance publique-Hôpitaux de Paris, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France.
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Peng HL, Su CT, Chang CY, Lau BH. Intraluminal duodenal diverticulum in a child concomitant with an entrapped coin and a duodenal polyp. FORMOSAN JOURNAL OF SURGERY 2014. [DOI: 10.1016/j.fjs.2014.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Bittle MM, Gunn ML, Gross JA, Rohrmann CA. Imaging of Duodenal Diverticula and Their Complications. Curr Probl Diagn Radiol 2012; 41:20-9. [DOI: 10.1067/j.cpradiol.2011.07.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Sathyanarayana SA, Agaba E, Kamath V, Mishra N, Gunabushanam V, Friedman B, Alhindawi R. Duodenal Diverticulum: An Unusual Cause of High-Grade Duodenal Obstruction. Am Surg 2011. [DOI: 10.1177/000313481107700704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Emmanuel Agaba
- Department of Surgery North Shore University Hospital Manhasset, New York
| | - Vijay Kamath
- Department of Surgery North Shore University Hospital Manhasset, New York
| | - Nitin Mishra
- Department of Surgery North Shore University Hospital Manhasset, New York
| | | | - Barak Friedman
- Department of Surgery North Shore University Hospital Manhasset, New York
| | - Ritha Alhindawi
- Department of Surgery North Shore University Hospital Manhasset, New York
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Kim DH, Kim HS, Cho YH. Intraluminal Duodenal Diverticulum Causing Chronic Gastrointestinal Bleeding in Adults. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2009. [DOI: 10.4174/jkss.2009.76.2.123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Dae Hwan Kim
- Department of Surgery, Pusan National University Hospital, School of Medicine, Pusan National University, Busan, Korea
| | - Hyun Seong Kim
- Department of Surgery, Pusan National University Hospital, School of Medicine, Pusan National University, Busan, Korea
| | - Yong Hoon Cho
- Department of Surgery, Pusan National University Yangsan Hospital, School of Medicine, Pusan National University, Busan, Korea
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Kwak SW, Kim S, Lee JW, Lee NK, Kim CW, Yi MS, Kim GH, Kang DH. Evaluation of unusual causes of pancreatitis: role of cross-sectional imaging. Eur J Radiol 2008; 71:296-312. [PMID: 18538971 DOI: 10.1016/j.ejrad.2008.04.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2008] [Revised: 03/26/2008] [Accepted: 04/08/2008] [Indexed: 12/20/2022]
Abstract
There are widely diverse causes of pancreatitis. Gallstone and alcohol have been recognized as the most common causes of pancreatitis accounting for 90% of cases. However, acute and chronic pancreatitis may also result from a variety of uncommon causes. The determination of the etiology is important for patient management and prevention of recurrence. Sludge is the most common cause of idiopathic or recurrent acute pancreatitis. Endoscopic ultrasonography is considered as the most accurate diagnostic test for this abnormality. Computed tomography (CT) and magnetic resonance imaging (MRI) have only a limited role in the diagnosis of sludge. However, papillitis observed on the contrast-enhanced CT and MR may provide clues to the detection of pancreatitis secondary to sludge, a small stone or a recently passed stone. Radiological studies, clinical presentation and laboratory data can be helpful in determining the etiology of unusual causes of pancreatitis such as anatomic anomalies, autoimmune pancreatitis, groove pancreatitis, and traumatic pancreatitis.
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Affiliation(s)
- Sang Wook Kwak
- Department of Diagnostic Radiology, Pusan National University Hospital, Pusan National College of Medicine and the Medical Research Institute, Pusan National University, Busan 602-739, Republic of Korea
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Martins PNA, Benckert C, Vetzke-Schlieker W, Pratschke J, Tullius SG, Neuhaus P. Intraduodenal diverticulum associated with a double common bile duct causing recurrent pancreatitis and cholangitis: report of a case. Surg Today 2007; 37:320-4. [PMID: 17387566 DOI: 10.1007/s00595-006-3401-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2005] [Accepted: 01/17/2006] [Indexed: 11/26/2022]
Abstract
Intraduodenal diverticulum (IDD) is a rare congenital anomaly, arising at or near the papilla of Vater. Double common bile duct (DCBD) is another rare congenital anomaly of the biliary system. Recognition of these abnormalities is essential to prevent the development of lesions in the biliary system, as well as to avoid unnecessary surgical intervention. Although both conditions are often asymptomatic, severe clinical conditions may develop. Intraduodenal diverticulum should always be considered as a possible cause of pancreatitis of unknown etiology. We report a rare case of IDD with DCBD in a patient with Lemmel's syndrome, which consists of obstructive jaundice, acute pancreatitis, and suppurative cholangitis. The patient was treated successfully with a Roux-en-Y hepaticojejunostomy.
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Affiliation(s)
- Paulo Ney Aguiar Martins
- Division of Transplant Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
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Lee SH, Park SH, Lee JH, Park DH, Chung IK, Kim SJ, Kim HC. Endoscopic diverticulotomy with an isolated-tip papillotome (Iso-Tome) in a patient with intraluminal duodenal diverticulum. Gastrointest Endosc 2005; 62:817-9. [PMID: 16246711 DOI: 10.1016/j.gie.2005.07.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2005] [Accepted: 07/08/2005] [Indexed: 12/10/2022]
Affiliation(s)
- Suck-Ho Lee
- Division of Gastroenterology, Department of Internal Medicine, Soon Chun Hyang University Cheonan Hospital, Cheonan, Choongnam, Reoublic of Korea
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Takamatsu S, Gabata T, Matsui O, Noto M, Ninomiya I, Nonomura A. Intraluminal duodenal diverticulum: MR findings. ACTA ACUST UNITED AC 2005; 31:39-42. [PMID: 16252140 DOI: 10.1007/s00261-005-0344-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2005] [Accepted: 03/02/2005] [Indexed: 11/27/2022]
Abstract
We report a case of intraluminal duodenal diverticulum with special reference to its magnetic resonance imaging findings. An intraluminal duodenal fluid collection surrounded by a hypointense rim on T2-weighted or magnetic resonance cholangiopancreatographic images, the shape of which is changed by peristalsis, is considered to be almost diagnostic for intraluminal duodenal diverticulum.
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Affiliation(s)
- S Takamatsu
- Department of Radiology, Kanazawa University, School of Medicine, 13-1 Takara-machi, Kanazawa City, Ishikawa, 920-8641, Japan.
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Mazziotti S, Costa C, Ascenti G, Gaeta M, Pandolfo A, Blandino A. MR cholangiopancreatography diagnosis of juxtapapillary duodenal diverticulum simulating a cystic lesion of the pancreas: usefulness of an oral negative contrast agent. AJR Am J Roentgenol 2005; 185:432-5. [PMID: 16037516 DOI: 10.2214/ajr.185.2.01850432] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Silvio Mazziotti
- Department of Radiological Sciences, University of Messina, via Consolare Valeria, Gazzi, Messina, Italy 98100.
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N/A. N/A. Shijie Huaren Xiaohua Zazhi 2003; 11:1824-1825. [DOI: 10.11569/wcjd.v11.i11.1824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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15
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Balci NC, Noone T, Akün E, Akinci A, Klör HU. Juxtapapillary diverticulum: findings on MRI. J Magn Reson Imaging 2003; 17:487-92. [PMID: 12655590 DOI: 10.1002/jmri.10281] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The purpose of our study was to describe the imaging findings of juxtapapillary diverticulum on magnetic resonance imaging (MRI). The MRI and magnetic resonance cholangiopancreatography (MRCP) examinations of 14 patients with juxtapapillary diverticula that were diagnosed on endoscopic retrograde cholangiopancreatography (ERCP) (N = 8) or endoscopy (N = 6) were retrospectively evaluated. T1-weighted spoiled gradient-echo, T2-weighted half Fourier single shot fast spin-echo (HASTE), and T2-weighted True FISP (fast imaging with steady state precession) images and thin-slice MRCP images were obtained on all patients. In five patients, diluted gadolinium DPTA (1/100) was used as an oral contrast. T2-weighted True FISP and HASTE images demonstrated air-fluid levels within all diverticula. Hyperintense oral contrast on T1-weighted spoiled gradient-echo images aided detection of the smaller diverticula. MRCP images obtained in the coronal plane best demonstrated the relationship of the diverticula to the papilla. MRI with the use of HASTE, True FISP, and oral contrast-enhanced T1-weighted sequences was able to depict juxtapapillary diverticula in our series.
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Affiliation(s)
- N Cem Balci
- Department of Radiology, Florence Nightingale Hospital, Istanbul, Turkey.
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Abstract
The purpose of this study was to evaluate the computed tomography (CT) and magnetic resonance imaging (MRI) features of juxtapapillary diverticulum. CT and/or MRI examinations of 12 patients were evaluated. The size, location of the diverticula and imaging findings of associated pancreaticobiliary disease were assessed. On CT, oral contrast air level was the characteristic imaging feature. On MRI, T2-weighted images demonstrated the air fluid level with hyperintense fluid and signal void air level above. Associated imaging findings were dilated common bile duct (CBD), cholecystitis, cholecystolithiasis and chronic pancreatitis.
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Affiliation(s)
- N Cem Balci
- Department of Radiology of the Florence Nightingale Hospitals, Istanbul, Turkey.
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