A Rare Case of Extraluminal Duodenal Diverticula Complicated with Duodenal Obstruction and Cholangitis

Ikuya Fujiwara, Hiroshi Konosu, Yasunori Sawabe, Tomoya Inoue and Shuji Shirakata

Department of Surgery, Ayabe Municipal Hospital

We report a case of duodenal obstruction caused by a large extraluminal duodenal diverticulum. A 76-year-old woman was admitted for epigastric pain, appetite loss and vomiting. Abdominal computed tomography (CT) showed marked dilatation of the duodenum and a large diverticulum filled with undigested food at the third portion of the duodenum. It also demonstrated cholangitis with fluid collection surrounding the gall bladder. It was considered that elevation of the intraluminal pressure of the duodenum had caused cholangitis, and an ileus tube was inserted into the duodenum to reduce the intraluminal pressure. The cholangitis improved immediately, however obstruction of the duodenum persisted, so we performed surgery. A laparotomy showed that the diverticulum, 7 cm in diameter, was filled with undigested vegetable matter and had caused extraluminal compression of the duodenum leading to duodenal obstruction. We resected the diverticulum. The patient's postoperative course was uneventful.

Key words
duodenal diverticulum, duodenal obstruction, cholangitis

Reprint requests
Ikuya Fujiwara Department of Surgery, Ayabe Municipal Hospital 20-1 Otsuka Aono town Ayabe city, 623-0011 JAPAN

Accepted
May 27, 2003

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