From the Research
A duodenal diverticulum is an outpouching of all or partial layers of the duodenal wall, typically occurring near the ampulla of Vater where the bile and pancreatic ducts enter the duodenum, and is often acquired rather than congenital 1.
Definition and Characteristics
A duodenal diverticulum is a small pouch or sac that bulges outward from the wall of the duodenum, which is the first part of the small intestine. These pouches form when the inner lining of the duodenum pushes through weak spots in the intestinal wall. Most duodenal diverticula are acquired rather than congenital, becoming more common as people age, particularly after 50 years old.
Location and Symptoms
They typically occur near the ampulla of Vater where the bile and pancreatic ducts enter the duodenum. Most duodenal diverticula are asymptomatic and discovered incidentally during imaging or endoscopic procedures. However, some can cause symptoms like abdominal pain, nausea, vomiting, or complications such as bleeding, inflammation (diverticulitis), perforation, or obstruction of the bile or pancreatic ducts.
Treatment and Management
Treatment is usually not necessary for asymptomatic diverticula. When symptoms occur, they are typically managed with antibiotics for infection, pain management, and sometimes endoscopic or surgical intervention for severe complications, as suggested by recent studies 2. The exact cause of duodenal diverticula is not fully understood, but they likely develop due to increased pressure within the intestine combined with weakening of the intestinal wall over time.
Key Points to Consider
- Duodenal diverticula are the second most common location for diverticula in the digestive tract after the colon 3.
- Surgical management is typically reserved for complicated cases, such as perforation, abscess, or fistula formation 2.
- A systematic approach to guiding management decisions is needed, potentially using the modified Hinchey classification to categorize duodenal diverticulitis and guide treatment choice 2.