doi: 10.2169/internalmedicine.8514-16 Intern Med 56: 2237-2238, 2017 http://internmed.jp

【 PICTURES IN CLINICAL MEDICINE 】

Chronic Pain Due to True Duodenal Diverticulum Sho Kitagawa, Ai Minoura and Hiroyuki Miyakawa Key words: true duodenal diverticulum, chronic pain

(Intern Med 56: 2237-2238, 2017) (DOI: 10.2169/internalmedicine.8514-16)

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A 50-year-old woman presented with severe chronic postprandial back pain. Upper endoscopy demonstrated that the diverticulum was located at the inferior duodenal angle without signs of ulceration or inflammation (Picture 1). Computed tomography showed no definite abnormalities,

except for those observed in the diverticulum (Picture 2). Based on the symptoms, distention of the diverticulum was presumed to be the cause of her pain. Moreover, the pain was reproducibly induced by injecting Gastrografin into the diverticular cavity (Picture 3) and immediately alleviated by

Department of Gastroenterology, Sapporo Kosei General Hospital, Japan Received: November 6, 2016; Accepted: December 21, 2016; Advance Publication by J-STAGE: August 1, 2017 Correspondence to Dr. Sho Kitagawa, [email protected]

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Intern Med 56: 2237-2238, 2017

DOI: 10.2169/internalmedicine.8514-16

suctioning it. Duodenal diverticulectomy was performed. A histological examination revealed that the wall of the diverticulum contained mucosal, muscular, and serosal layers, consistent with the congenital true diverticulum of the duodenum (Picture 4). The pain ceased completely after surgery. Duodenal diverticula are mostly false diverticula, and true diverticula are rare (1, 2). In our case, the injection of Gastrografin was useful for determining whether duodenal diverticulum was the cause of her pain.

References

We obtained informed consent from the patient.

1. Abdel-Hafiz AA, Birkett DH, Ahmed MS. Congenital duodenal diverticula: a report of three cases and a review of the literature. Surgery 104: 74-78, 1988. 2. Mahajan SK, Kashyap R, Chandel UK, Mokta J, Minhas SS. Duodenal diverticulum: review of literature. Indian J Surg 66: 140145, 2004. The Internal Medicine is an Open Access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. To view the details of this license, please visit (https://creativecommons.org/licenses/ by-nc-nd/4.0/).

The authors state that they have no Conflict of Interest (COI).

Ⓒ 2017 The Japanese Society of Internal Medicine Intern Med 56: 2237-2238, 2017

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Chronic Pain Due to True Duodenal Diverticulum.

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