J Korean Surg Soc.  2009 Feb;76(2):123-126. 10.4174/jkss.2009.76.2.123.

Intraluminal Duodenal Diverticulum Causing Chronic Gastrointestinal Bleeding in Adults

• Kim DH
• Kim HS
• Cho YH

• KMID: 2211272
• DOI: http://doi.org/10.4174/jkss.2009.76.2.123

Abstract

Intraluminal duodenal diverticulum (IDD), 'windsock web', is known to be a rare congenital condition observed in the adult, sometimes causing an obstruction, pancreatitis, and acute/chronic bleeding. We experienced a case of intraluminal duodenal diverticulum associated with a chronic gastrointestinal bleeding in a young adult man. This condition was identified during the examination for an intermittent melena through a gastroduodenoscopy and an upper gastrointestinal series, revealing a lesion between the second and third portion of the duodenum. Laparotomy was planned for its management. A duodenotomy and excision of the diverticulum was performed and showed good results.

Keyword

Intraluminal duodenal diverticulum; Duodenotomy; Excision

MeSH Terms

Adult
Diverticulum
Duodenum
Hemorrhage
Humans
Laparotomy
Melena
Pancreatitis
Young Adult

Figure

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  Fig. 1 Endoscopic findings show two openings in the duodenal lumen, an opening of the lesion (A) and true duodenum (B) at the left side, also showing a cystic mass at the second portion of duodenum at the right. It also shows an ulcerative lesion with minor bleeding.

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  Fig. 2 UGI (upper gastrointestinal) series shows a finding of intraluminal contrast filling with a radiolucent halo.

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  Fig. 3 Abdominal CT (computed tomography) shows an abnormal finding mimicking intussusceptions in the lumen and a sac-like, intraluminal projection.

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  Fig. 4 At the operative field, there are no abnormal findings, grossly.

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  Fig. 5 Two intraluminal diverticulums, sac-like projection were found around the Vater of ampulla, catheterization through its opening.

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  Fig. 6 After excision of diverticulum, the mucosal defect is repaired with interrupted absorbable suture.

Reference

1. D'Alessio MJ, Rana A, Martin JA, Moser AJ. Surgical management of intraluminal duodenal diverticulum and coexisting anomalies. J Am Coll Surg. 2005. 201:143–148.

2. Boyden EA, Cope JG, Bill AH Jr. Anatomy and embryology of congenital intrinsic obstruction of the duodenum. Am J Surg. 1967. 114:190–202.

3. Hajiro K, Yamamoto H, Matsui H, Yamamoto T. Endoscopic diagnosis and excision of intraluminal duodenal diverticulum. Gastrointest Endosc. 1979. 25:151–154.

4. Cheung B, Kelty C, Rickard MJ, Hollinshead J. Intraluminal duodenal diverticulum: a case. ANZ J Surg. 2007. 77:1129–1131.

5. Karoll MP, Ghahremani GG, Port RB, Rosenberg JL. Diagnosis and management of intraluminal duodenal diverticulum. Dig Dis Sci. 1983. 28:411–416.

6. De Castro ML, Hermo JA, Pineda JR, Carreira M, Dominguez F, Clofent J. Acute bleeding and anemia associated with intraluminal duodenal diverticulum: case report and review. Gastrointest Endosc. 2003. 57:976–979.

7. Joshi A, Desai D, Bapat M. Intraluminal duodenal diverticulum presenting as gastrointestinal bleeding after NSAID use. Indian J Gastroenterol. 2004. 23:29–30.

8. De Rai P, Castoldi L, Tiberio G. Intraluminal duodenal diverticulum causing acute pancreatitis: CT scan diagnosis and review of the literature. Dig Surg. 2000. 17:288–292.

9. Fidler JL, Saigh JA, Thompson JS, Habbe TG. Demonstration of intraluminal duodenal diverticulum by computed tomography. Abdom Imaging. 1998. 23:38–39.

10. Park YD, Chung YJ, Jeon SW, Cho CM, Tak WY, Kweon YO, et al. A case of an intraluminal duodenal diverticulum managed with endoscopic incision and ligation using needle-knife and detachable snare. Korean J Gastroenterol. 2007. 49:177–182.