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Diverticula of the Duodenum
Asaccular “true” diverticulum can originate from any part of the duodenum ( Fig. 30.1 ). It is rare in the first part and usually develops in the second part in the region of the ampulla of Vater. Diverticula have been reported in approximately 6% of barium studies but in as many as 27% of endoscopy studies and in 23% of autopsy evaluations. They have been noted close to the ampulla, and in some cases the ampulla enters the diverticulum.
Diverticula of the Duodenum.
Extraluminal Diverticula
Extraluminal duodenal diverticula are common with an interesting etiology, but debate is ongoing concerning congenital weakness in the duodenal wall and increased internal pressure. In rare cases, diverticula may be multiple. They usually develop on the inner or concave border of the duodenal curve and rarely on the outer border.
Clinical Picture
Approximately 10% of patients with extraluminal diverticula have symptoms. Abdominal discomfort may result when the diverticulum becomes inflamed, particularly from prolonged retention of duodenal content. The resultant diverticulitis can cause pain that radiates the epigastrium or back. Pancreatitis may occur when the ampulla is involved. Diverticula on the lateral wall have been reported to perforate (see Section VII ).
Although there is a high incidence of extraluminal diverticula, most patients are asymptomatic. When diverticula are multiple, they can be associated with a malabsorption or bacterial overgrowth syndrome (see Section IV ).
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