Symptomatic Periampullary Duodenal Diverticulum

Shivani Shah, BS, Christian W Ertl, MD, FACS, Leandra H Burke, BS, CCRP

Michigan State University College of Human Medicine; Western Michigan University School of Medicine

Inroduction: Duodenal diverticula in themselves are not uncommon findings. Studies have reported that 5 – 22% of patients undergoing endoscopic evaluations are found to have asymptomatic duodenal diverticula. However, rarely do these diverticula result in emergent complcations, such as bleeding, biliary obstruction, perforation, or acute diverticulitis.

Case Presentation: A 46 year-old woman presented to our care with RUQ pain, nausea, and vomiting lasting 3-4 weeks. An ultrasound revealed dilation of the common bile duct to 12 mm, suggesting the presence of choledocholithiasis. The patient subsequently underwent laparascopic cholecystectomy with common bile duct exploration and intraoperative choleangiogram. Exploration of the CBD was attempted but the cholendoscope could not be passed. There was evidence of obstruction at the ampulla of Vater. ERCP was performed POD number 1, findings revealed a periampullary duodenal diverticulum with unidentifiable debris, resembling a white pill.

Discussion: Symptomatic duodenal diverticulum should be included in the differential diagnosis of patients presenting with RUQ pain and obstructive jaundice. Diagnosis is not easily made on ultrasonography, however, as our case illustrates, it should be suspected in the abscence of more common etiologies.

Session: Poster Presentation

Program Number: P313

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