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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

Clinical Impacts of Juxtapapillary Duodenal Diverticulum Detected on Computed Tomography

Author(s): İlyas Dündar*, Cemil Göya, Salih Hattapoğlu, Sercan Özkaçmaz, Mesut Özgökçe, Saim Türkoğlu and Ensar Türko

Volume 18, Issue 3, 2022

Published on: 06 January, 2022

Article ID: e261121198343 Pages: 7

DOI: 10.2174/1573405617666211126153042

Price: $65

Abstract

Background: Diverticula are commonly observed in the duodenum. Duodenal Diverticulum (DD) usually does not give symptoms throughout life and is diagnosed by coincidence. However, it may present with different symptoms in patients.

Objective: This study aims to evaluate the prevalence of DD and Juxtapapillary Duodenal Diverticulum (JDD) and its association with other possible pathologies and to determine its clinical impact by using Computed Tomography (CT).

Methods: This retrospective observational study, which was taken consecutively between the years of 2013-2020, was evaluated in the Radiology Department. The total number of cases was 4850 (male-2440; female-2410). CT images were evaluated by two experienced radiologists at the workstation. DD and JDD prevalence and clinical findings in the hospital registry system were examined.

Results: The age of the patients included in the study ranged from 17 to 92 years (mean age 46.94±16.42). In patients with DD (female-130; male-101), mean age was 62.24 ± 12.69 (21-92). The prevalence of DD was 4.76% (n=231). The prevalence of JDD was 4.02% (n=195) and increased with age (p<0.01). The average diameter of the JDD was measured as 23.29±8.22 (9.5-55.3) mm. A significant positive correlation was found between age and DD diameter (p=0.039). DDs were found most commonly 84.42% (n=195) in the second segment of the duodenum as JDD. In patients with JDD, the mean diameter of choledochus and wirsung canal were 6.7 ± 2.4 (3-15.3) mm and 0.31 ± 0.1 (0.1-6.5) mm respectively. The choledochal diameter was correlated with the JDD size (p = 0.004). Cholelithiasis (n=56), choledocholithiasis (n=20), cholecystitis (n=52), diverticulitis (n=15), duodenitis (n=37), pancreatitis (n=5) and hiatal hernia (n=60) with JDD were observed. Periampullary carcinoma was detected in one patient.

Conclusion: Our study shows that cholelithiasis, choledocholithiasis, cholecystitis, diverticulitis, duodenitis, pancreatitis may be associated with JDD. Therefore, in contrast-enhanced abdominal CT scans taken for various reasons, investigation of the presence and characteristics of JDD and detection of pathologies that may be associated with JDD are important for patients to benefit from early diagnosis and treatment opportunities and to take precautions against possible complications.

Keywords: Computed tomography, juxtapapillary duodenal diverticulum, diverticulitis, cholelithiasis, cholecystitis, pancreatitis.

Graphical Abstract

[1]
Mahajan SK, Rajesh K, Chandel UK, Jatinder M. Duodenal diverticulum: Review of literature. Indian J Surg 2004; 66(3): 140-5.
[2]
Ersan Y, Yavuz N, Çiçek Y, et al. Clinical analysis and review of related literature in cases of duodenal diverticulosis. Cerrahpaşa J Med 2005; 36: 120-7.
[3]
Lane JE, Ajjan M, Sedghi S. GI bleeding from duodenal diverticula. Am J Gastroenterol 2001; 96(9): 2799-800.
[http://dx.doi.org/10.1111/j.1572-0241.2001.04146.x] [PMID: 11569722]
[4]
Lobo DN, Balfour TW, Iftikhar SY, Rowlands BJ. Periampullary diverticula and pancreaticobiliary disease. Br J Surg 1999; 86(5): 588-97.
[http://dx.doi.org/10.1046/j.1365-2168.1999.01121.x] [PMID: 10361174]
[5]
Yin WY, Chen HT, Huang SM, Lin HH, Chang TM. Clinical analysis and literature review of massive duodenal diverticular bleeding. World J Surg 2001; 25(7): 848-55.
[http://dx.doi.org/10.1007/s00268-001-0039-y] [PMID: 11572022]
[6]
Jayaraj M, Mohan BP, Dhindsa BS, et al. Periampullary diverticula and ERCP outcomes: A systematic review and meta-analysis. Dig Dis Sci 2019; 64(5): 1364-76.
[http://dx.doi.org/10.1007/s10620-018-5314-y] [PMID: 30293190]
[7]
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]
[8]
Khan K, Saeed S, Maria H, et al. Duodenal diverticular perforation after small bowel obstruction: A case report. Case Rep Surg 2018; 2018: 6197828.
[http://dx.doi.org/10.1155/2018/6197828] [PMID: 30159194]
[9]
Cavanagh JE Jr. Iatrogenic perforation of perivaterian duodenal diverticulum: Report of a case. Can J Surg 1996; 39(4): 336-8.
[PMID: 8697327]
[10]
Kim KH, Park SH. Conservative treatment of duodenal diverticulitis perforation: A case report and literature review. Open Access Emerg Med 2018; 10: 101-4.
[http://dx.doi.org/10.2147/OAEM.S168487] [PMID: 30214324]
[11]
Chen Q, Li Z, Li S, et al. Diagnosis and treatment of juxta-ampullary duodenal diverticulum. Clin Invest Med 2010; 33(5): E298-303.
[http://dx.doi.org/10.25011/cim.v33i5.14355] [PMID: 20926036]
[12]
Cuschieri A, Hanna GB. Disorders of the stomach and duodenum. Essential surgical practice: Higher surgical training in general surgery.Boca Raton: CRC Press Taylor & Francis Group 2015; pp. 558-616.
[http://dx.doi.org/10.1201/b17820-28]
[13]
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]
[14]
Mohammad Alizadeh AH, Afzali ES, Shahnazi A, et al. ERCP features and outcome in patients with periampullary duodenal diverticulum. ISRN Gastroenterol 2013; 2013: 217261.
[http://dx.doi.org/10.1155/2013/217261] [PMID: 23984079]
[15]
Rizwan MM, Singh H, Chandar V, Zulfiqar M, Singh V. Duodenal diverticulum and associated pancreatitis: Case report with brief review of literature. World J Gastrointest Endosc 2011; 3(3): 62-3.
[http://dx.doi.org/10.4253/wjge.v3.i3.62] [PMID: 21455344]
[16]
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]
[17]
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; 2009: 359485.
[http://dx.doi.org/10.1155/2009/359485] [PMID: 19325923]
[18]
Destigter KK, Keating DP. Imaging update: Acute colonic diverticulitis. Clin Colon Rectal Surg 2009; 22(3): 147-55.
[http://dx.doi.org/10.1055/s-0029-1236158] [PMID: 20676257]
[19]
Franzen D, Gürtler T, Metzger U. Solitary duodenal diverticulum with enterolith as a rare cause of acute abdomen. Swiss Surg 2002; 8(6): 277-9.
[http://dx.doi.org/10.1024/1023-9332.8.6.277] [PMID: 12520848]
[20]
Sakthivel S, Kannaiyan K, Thiagarajan S. Prevalence of duodenal diverticulum in South indians: A cadaveric study. ISRN Anat 2013; 2013: 767403.
[http://dx.doi.org/10.5402/2013/767403] [PMID: 25938103]
[21]
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]
[22]
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]
[23]
Ko KS, Kim SH, Kim HC, Kim IH, Lee SO. Juxtapapillary duodenal diverticula risk development and recurrence of biliary stone. J Korean Med Sci 2012; 27(7): 772-6.
[http://dx.doi.org/10.3346/jkms.2012.27.7.772] [PMID: 22787373]
[24]
Mackenzie ME, Davies WT, Farnell MB, Weaver AL, Ilstrup DM. Risk of recurrent biliary tract disease after cholecystectomy in patients with duodenal diverticula. Arch Surg 1996; 131(10): 1083-5.
[http://dx.doi.org/10.1001/archsurg.1996.01430220077017] [PMID: 8857907]
[25]
Psathakis D, Utschakowski A, Müller G, Broll R, Bruch HP. Clinical significance of duodenal diverticula. J Am Coll Surg 1994; 178(3): 257-60.
[PMID: 8149017]
[26]
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]
[27]
Martinez-Cecilia D, Arjona-Sanchez A, Gomez-Alvarez M, et al. Conservative management of perforated duodenal diverticulum: A case report and review of the literature. World J Gastroenterol 2008; 14(12): 1949-51.
[http://dx.doi.org/10.3748/wjg.14.1949] [PMID: 18350639]
[28]
Ferreira-Aparicio FE, Gutiérrez-Vega R, Gálvez-Molina Y, Ontiveros-Nevares P, Athie-Gútierrez C, Montalvo-Javé EE. Diverticular disease of the small bowel. Case Rep Gastroenterol 2012; 6(3): 668-76.
[http://dx.doi.org/10.1159/000343598] [PMID: 23185148]
[29]
Shocket E, Simon SA. Small bowel obstruction due to enterolith (bezoar) formed in a duodenal diverticulum: A case report and review of the literature. Am J Gastroenterol 1982; 77(9): 621-4.
[PMID: 6810693]
[30]
Frauenfelder G, Maraziti A, Ciccone V, et al. Computed tomography imaging in lemmel syndrome: A report of two cases. J Clin Imaging Sci 2019; 9: 23.
[http://dx.doi.org/10.25259/JCIS-17-2019] [PMID: 31448174]
[31]
Venkatanarasimha N, Yong YR, Gogna A, Tan BS. Case 265: Lemmel syndrome or biliary obstruction due to a periampullary duodenal diverticulum. Radiology 2019; 291(2): 542-5.
[http://dx.doi.org/10.1148/radiol.2019162375] [PMID: 30998446]
[32]
Christoforidis E, Goulimaris I, Kanellos I, Tsalis K, Dadoukis I. The role of juxtapapillary duodenal diverticula in biliary stone disease. Gastrointest Endosc 2002; 55(4): 543-7.
[http://dx.doi.org/10.1067/mge.2002.122615] [PMID: 11923769]
[33]
Khan A, Karanth V, Khan A, Rodrigues G. Duodenal diverticulitis masquerading as acute cholecystitis: A lesson learnt. Surg Pract 2019; 23(4): 167-9.
[http://dx.doi.org/10.1111/1744-1633.12394]
[34]
De Koster E, Mante M, Denis P, et al. Juxtapapillary duodenal diverticula and diverticula of the colon: Is there a general “gastrointestinal diverticular disease”? Acta Gastroenterol Belg 1991; 54(2): 191-4.
[PMID: 1755272]
[35]
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]
[36]
Hariri A, Siegelman SS, Hruban RH. Duodenal diverticulum mimicking a cystic pancreatic neoplasm. Br J Radiol 2005; 78(930): 562-4.
[http://dx.doi.org/10.1259/bjr/52543195] [PMID: 15900065]
[37]
Furukawa M, Izumi S, Tsukuda K, Tokumo M, Sakurai J, Mano S. Duodenal carcinoma from a duodenal diverticulum mimicking pancreatic carcinoma. Acta Med Okayama 2012; 66(5): 423-7.
[PMID: 23093061]
[38]
Kaise M, Nagata N, Ishii N, et al. Epidemiology of colonic diverticula and recent advances in the management of colonic diverticular bleeding. Dig Endosc 2020; 32(2): 240-50.
[http://dx.doi.org/10.1111/den.13547]
[39]
Oma E, Jorgensen LN, Meisner S, Henriksen NA. Colonic diverticulosis is associated with abdominal wall hernia. Hernia 2017; 21(4): 525-9.
[http://dx.doi.org/10.1007/s10029-017-1598-7] [PMID: 28349226]
[40]
Palmer ED. Saint’s triad: Hiatus hernia, diverticulosis coli and gall stones. Am J Dig Dis 1951; 18(8): 240-1.
[http://dx.doi.org/10.1007/BF02891987] [PMID: 14856960]
[41]
Foster JJ, Knutson DL. Association of cholelithiasis, hiatus hernia, and diverticulosis coli. J Am Med Assoc 1958; 168(3): 257-61.
[http://dx.doi.org/10.1001/jama.1958.03000030029007] [PMID: 13575149]

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