Duodenal Diverticulum (cont.)

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What causes a duodenal diverticulum?

The cause of extramural diverticula is not definitely known; however, they are believed to be acquired (not present from birth) due to a herniation (protrusion) of the duodenum through a defect in the muscle of the wall of the duodenum, perhaps in an area where arteries pass through the intestinal muscle to nourish the lining of the intestine.

What complications are caused by a duodenal diverticulum?

Extramural diverticula usually cause no symptoms. Occasionally, they may rupture (just like colonic diverticula) and lead to a pocket of inflammation adjacent to the duodenum with or without infection. This may result in all the signs and symptoms of intra-abdominal inflammation including pain, fever, and abdominal tenderness.

If the diverticulum is very close to the Ampulla of Vater, patients more frequently develop gallstones, particularly in the bile duct, and may develop all of the complications of gallstones:

  • biliary colic (the typical pain of obstruction of the bile ducts),
  • cholecystitis (inflammation of the gallbladder), and
  • cholangitis (inflammation of the bile ducts due to the spread of bacteria into the ducts from the duodenum).

Pancreatitis also may occur. These complications are believed to be due to interference by the diverticula with the normal function of the bile and pancreatic ducts.

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