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Diagnosis of periampullary duodenal diverticula: the value of new imaging techniques.

Perdikakis E, Chryssou EG, Karantanas A - Ann Gastroenterol (2011)

Bottom Line: Acute abdominal symptomatology resulting from duodenal diverticula was as follows: one patient presented with perforation-diverticulitis, two patients with pancreatitis, one patient with acute acalculous cholecystitis, four patients with biliary dilation and two patients with acute postprandial discomfort-pain.The mean maximal diameter of the diverticula examined was 2.67 cm (range 0.96-4.98 cm).Further image analysis of the MDCT exams revealed that both the axial and the coronal plane demonstrated the presence of the diverticula but the depiction of the diverticular neck was demonstrated in five cases in the axial plane and in all cases in the coronal plane.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, University of Crete, Stavrakia, Heraklion, Crete, Greece.

ABSTRACT

Objective: The purpose of this study was to evaluate and demonstrate the clinical and imaging features of symptomatic duodenal diverticula presenting as or mimicking acute abdomen.

Methods: The imaging studies of 10 patients, all presenting with acute abdomen and diagnosed with duodenal diverticula as the possible underlying cause, over a time period of 20 months were retrospectively analyzed.

Results: Eleven duodenal diverticula were depicted in 8 Multidetector Computed Tomography (MDCT) exams, 2 MRI-MRCP exams and in one intraoperative cholangiography. Acute abdominal symptomatology resulting from duodenal diverticula was as follows: one patient presented with perforation-diverticulitis, two patients with pancreatitis, one patient with acute acalculous cholecystitis, four patients with biliary dilation and two patients with acute postprandial discomfort-pain. The mean maximal diameter of the diverticula examined was 2.67 cm (range 0.96-4.98 cm). Further image analysis of the MDCT exams revealed that both the axial and the coronal plane demonstrated the presence of the diverticula but the depiction of the diverticular neck was demonstrated in five cases in the axial plane and in all cases in the coronal plane.

Conclusion: Although duodenal diverticula constitute a rare cause of acute abdomen, careful analysis of imaging studies can aid to the identification of this uncommon factor of abdominal symptomatology.

No MeSH data available.


Related in: MedlinePlus

(a to c) An 80-year-old male patient presenting with acute right upper quadrant colic pain. The axial (a) and coronal (b) true FISP MR images and the coronal c) MIP image from the 3D respiratory-triggered, thin slice T2-w fast spin-echo MRCP sequence demonstrate the presence of a periampullary divericulum (thick white arrows) exerting compression upon the common bile duct outlet. Note associated biliary dilation (open arrow in b, c). The communication of the diverticular false lumen with the true duodenal lumen is also demonstrated (black curved arrows).
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Figure 2: (a to c) An 80-year-old male patient presenting with acute right upper quadrant colic pain. The axial (a) and coronal (b) true FISP MR images and the coronal c) MIP image from the 3D respiratory-triggered, thin slice T2-w fast spin-echo MRCP sequence demonstrate the presence of a periampullary divericulum (thick white arrows) exerting compression upon the common bile duct outlet. Note associated biliary dilation (open arrow in b, c). The communication of the diverticular false lumen with the true duodenal lumen is also demonstrated (black curved arrows).

Mentions: Eleven duodenal juxtapapillary diverticula were depicted in our population study group (ten patients). One patient demonstrated two diverticula. In all cases acute abdominal symptomatology was possibly or definitely attributed to complications resulting from the presence of duodenal diverticulosis. There were two patients with pancreatitis attributed to the presence of a diverticulum that exerted pressure on the main pancreatic duct (Fig. 1), one patient with acute acalculous cholecystitis as a result of the common bile duct outlet into a diverticulum, four patients with biliary dilation due to duodenal compression (Fig. 2), one patient with diverticular perforation-diverticulitis (Fig. 3), and two patients with acute colic postprandial discomfort-pain due to the presence of a duodenal diverticulum. The mean diameter of the long axis of periampullary diverticula was 2.67 cm (range 0.96-4.98 cm). Measurement of the diameter of the diverticula detected on intraoperative cholangiography was considered subjective (calculated in magnification views in the operating room) and thus omitted from the mean diameter calculation. The detailed analysis of our population study is shown in Table 1.


Diagnosis of periampullary duodenal diverticula: the value of new imaging techniques.

Perdikakis E, Chryssou EG, Karantanas A - Ann Gastroenterol (2011)

(a to c) An 80-year-old male patient presenting with acute right upper quadrant colic pain. The axial (a) and coronal (b) true FISP MR images and the coronal c) MIP image from the 3D respiratory-triggered, thin slice T2-w fast spin-echo MRCP sequence demonstrate the presence of a periampullary divericulum (thick white arrows) exerting compression upon the common bile duct outlet. Note associated biliary dilation (open arrow in b, c). The communication of the diverticular false lumen with the true duodenal lumen is also demonstrated (black curved arrows).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3959313&req=5

Figure 2: (a to c) An 80-year-old male patient presenting with acute right upper quadrant colic pain. The axial (a) and coronal (b) true FISP MR images and the coronal c) MIP image from the 3D respiratory-triggered, thin slice T2-w fast spin-echo MRCP sequence demonstrate the presence of a periampullary divericulum (thick white arrows) exerting compression upon the common bile duct outlet. Note associated biliary dilation (open arrow in b, c). The communication of the diverticular false lumen with the true duodenal lumen is also demonstrated (black curved arrows).
Mentions: Eleven duodenal juxtapapillary diverticula were depicted in our population study group (ten patients). One patient demonstrated two diverticula. In all cases acute abdominal symptomatology was possibly or definitely attributed to complications resulting from the presence of duodenal diverticulosis. There were two patients with pancreatitis attributed to the presence of a diverticulum that exerted pressure on the main pancreatic duct (Fig. 1), one patient with acute acalculous cholecystitis as a result of the common bile duct outlet into a diverticulum, four patients with biliary dilation due to duodenal compression (Fig. 2), one patient with diverticular perforation-diverticulitis (Fig. 3), and two patients with acute colic postprandial discomfort-pain due to the presence of a duodenal diverticulum. The mean diameter of the long axis of periampullary diverticula was 2.67 cm (range 0.96-4.98 cm). Measurement of the diameter of the diverticula detected on intraoperative cholangiography was considered subjective (calculated in magnification views in the operating room) and thus omitted from the mean diameter calculation. The detailed analysis of our population study is shown in Table 1.

Bottom Line: Acute abdominal symptomatology resulting from duodenal diverticula was as follows: one patient presented with perforation-diverticulitis, two patients with pancreatitis, one patient with acute acalculous cholecystitis, four patients with biliary dilation and two patients with acute postprandial discomfort-pain.The mean maximal diameter of the diverticula examined was 2.67 cm (range 0.96-4.98 cm).Further image analysis of the MDCT exams revealed that both the axial and the coronal plane demonstrated the presence of the diverticula but the depiction of the diverticular neck was demonstrated in five cases in the axial plane and in all cases in the coronal plane.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, University of Crete, Stavrakia, Heraklion, Crete, Greece.

ABSTRACT

Objective: The purpose of this study was to evaluate and demonstrate the clinical and imaging features of symptomatic duodenal diverticula presenting as or mimicking acute abdomen.

Methods: The imaging studies of 10 patients, all presenting with acute abdomen and diagnosed with duodenal diverticula as the possible underlying cause, over a time period of 20 months were retrospectively analyzed.

Results: Eleven duodenal diverticula were depicted in 8 Multidetector Computed Tomography (MDCT) exams, 2 MRI-MRCP exams and in one intraoperative cholangiography. Acute abdominal symptomatology resulting from duodenal diverticula was as follows: one patient presented with perforation-diverticulitis, two patients with pancreatitis, one patient with acute acalculous cholecystitis, four patients with biliary dilation and two patients with acute postprandial discomfort-pain. The mean maximal diameter of the diverticula examined was 2.67 cm (range 0.96-4.98 cm). Further image analysis of the MDCT exams revealed that both the axial and the coronal plane demonstrated the presence of the diverticula but the depiction of the diverticular neck was demonstrated in five cases in the axial plane and in all cases in the coronal plane.

Conclusion: Although duodenal diverticula constitute a rare cause of acute abdomen, careful analysis of imaging studies can aid to the identification of this uncommon factor of abdominal symptomatology.

No MeSH data available.


Related in: MedlinePlus