Clinics and Research in Hepatology and Gastroenterology (2015) 39, 278—279

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Intraluminal duodenal diverticulum. A rare cause of recurrent acute pancreatitis E. Chambenois , S. Derhy , L. Arrivé ∗ Sorbonne universités, UPMC université Paris 06, faculté de médecine Pierre-et-Marie-Curie, Department of Radiology, Saint-Antoine Hospital, Assistance publique—Hôpitaux de Paris, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France Available online 26 September 2014

A 29-year-old woman presented for abdominal pain radiating to the back with vomiting. She had three episodes of acute pancreatitis in the past four months. She had no alcohol abuse or lithiasic history. Physical examination was unremarkable. Laboratory investigations confirmed a new episode of acute pancreatitis (lipase 900 U/L, ASAT 197 U/L, ALAT 106 U/L, Gamma-GT 169 U/L). Enhanced abdominal CT demonstrated an oblong blindended tube with thick wall and hydroaeric content, localized within the second duodenum reaching the duodenojejunal flexure (Fig. 1). This mass was implanted near the major duodenal papillar, stretching the common bile duct and the Wirsung duct (Fig. 2). The patient underwent surgery and histopathologic analysis revealed an intraluminal duodenal diverticulum measuring 6.5 × 5.5 cm with moderate inflammatory reaction. The patient recovered quickly and remained healthy after a one-year follow-up. Intraluminal duodenal diverticulum is a rare congenital disease. It is a sac-like structure that develops in the second duodenum near the major duodenal papillar [1]. This anomaly is related to the failure of recanalization of the occluded foregut lumen in the duodenum during



Corresponding author. E-mail address: [email protected] (L. Arrivé).

http://dx.doi.org/10.1016/j.clinre.2014.08.010 2210-7401/© 2014 Elsevier Masson SAS. All rights reserved.

Figure 1 Intraluminal duodenal mass with hydroaeric content and thick wall (arrows), reaching the duodenojejunal flexure.

embryonic development, resulting in persistence of a complete or partial transverse diaphragm. Peristalsis and the pressure caused by feeding progressively stretch the diaphragm and lead to an intraluminal diverticulum [1,2]. This anomaly commonly remains asymptomatic. Sometimes diverticulum becomes symptomatic with epigastric pain, nausea and vomiting after meal. In 1% to 5%, complications occur such as hemorragic ulcer (25%), acute pancreatitis

Intraluminal duodenal diverticulum. A rare cause of recurrent acute pancreatitis

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sometimes associated with other congenital anomalies such as annular pancreas, intestinal malrotation, hernias, situs inversus and Down’s syndrome [1]. Intraluminal duodenal diverticulum is sometimes a difficult diagnosis, especially when he is empty, and then should be kept in mind for the diagnosis of recurrent acute pancreatitis without obvious cause.

Disclosure of interest The authors declare that they have no conflicts of interest concerning this article.

References Figure 2 Intraluminal duodenal blind-ended tube (D), stretching the common bile duct (arrow) and the Wirsung duct (arrow heads). (S: stomach).

(20%) by stretching the major papillar with Oddi’s sphincter dysfunction, and proximal digestive obstruction [3]. In the present case, CT scan nicely demonstrates the mechanism of pancreatitis. Intraluminal duodenal diverticulum is

[1] Karoll MP, Ghahremani GG, Port RB, Rosenber JL. Diagnosis and management of intraluminal duodenal diverticulum. Dig Dis Sci 1983;28:411—6. [2] Rowe MI, Buckner D, Clatworthy Jr HW. Wind sock web of the duodenum. Am J Surg 1968;116:444—9. [3] De Rai P, Castoldi L, Tiberio G. Intraluminal duodenal diverticulum causing acute pancreatitis: CT scan diagnosis and review of the literature. Dig Surg 2000;17:288—92.

Intraluminal duodenal diverticulum. A rare cause of recurrent acute pancreatitis.

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