What is a duodenal diverticulum?
A duodenal diverticulum (the plural of which is diverticula) is a pouch attached to the duodenum, the second part of the small intestine just past the stomach.
There are two types of duodenal diverticula. The common type which is present in some individuals, sticks out from the duodenum, similar to the more common colonic diverticula. This is referred to as an "extramural" diverticulum. Extramural diverticula may vary in size from a few millimeters to a few centimeters. They usually are located in the area around the Papilla of Vater where the bile and pancreatic ducts enter the duodenum.
A second, rare type of diverticulum is referred to as an "intramural" diverticulum. It does not protrude from the duodenum. Rather, it protrudes into the duodenal lumen (the hollow inside of the duodenum through which digesting food flows). Both types of diverticula, extramural and intramural, communicate with the lumen of the duodenum so that contents of the duodenum can enter the diverticulum.
What causes a duodenal diverticulum?
The cause of extramural diverticula is not definitively 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 is the cause of intramural diverticula?
The cause of intramural diverticula is not clear; however, they are believed to be congenital, that is, present from birth, and may occur as a developmental abnormality of the intestine in the fetus.
Intramural duodenal diverticula most commonly cause obstruction of the duodenum when the diverticulum fills with ingested material. They are commonly diagnosed by barium X-ray studies of the upper gastrointestinal tract but also are seen with upper gastrointestinal endoscopy.
Intramural diverticula are surgically removed through an incision in the wall of the duodenum, although there are reports of treatment using non-surgical, endoscopic means to incise or open up the diverticula so that material does not collect within them.
How do doctors diagnose a duodenal diverticulum?
Extramural duodenal diverticula are most commonly diagnosed by barium X-rays of the upper gastrointestinal tract. They also may be diagnosed at the time of endoscopy or, less frequently, with ultrasonography. Finally, they also may show up by chance in computerized tomographic (CT) scans or magnetic resonance imaging (MRI) studies of the abdomen.
What is the treatment for a duodenal diverticulum?
If treatment is necessary, extramural diverticula can be surgically removed from the outside of the duodenum. The diverticula also may be inverted into the lumen of the duodenum and removed through an incision in the wall of the duodenum. (Sometimes, the diverticulum is inverted but left attached to the wall of the duodenum and protrudes into the duodenum.)
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)
- 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.
MedscapeReference.com. "Small Intestinal Diverticulosis."
Top Duodenal Diverticulum Related Articles
CT Scan (Computerized Tomography)A CT scan is an X-ray procedure that combines many X-ray images with the aid of a computer to generate cross-sectional and three-dimensional images of internal organs and structures of the body. A CT scan is a low-risk procedure. Contrast material may be injected into a vein or the spinal fluid to enhance the scan.
Diverticulitis (Diverticulosis)Most people with diverticulosis have few if any symptoms at all. When people do experience signs and symptoms of diverticulosis (diverticular disease) they may include abdominal pain, abdominal cramps, diarrhea, constipation, and bloating. Diverticulitis is a condition in which diverticula in the colon rupture. The rupture results in infection in the tissues that surround the colon. Treatment methods for diverticulitis include prescription medications, and in some cases, diverticulitis surgery.
Endoscopy (EGD) Procedure
Endoscopy is a broad term used to described examining the inside of the body using an lighted, flexible instrument called an endoscope. Endoscopy procedure is performed on a patient to examine the esophagus, stomach, and duodenum; and look for causes of symptoms such as abdominal pain, nausea, vomiting, difficulty swallowing, or intestinal bleeding.
GallstonesGallstones are stones that form when substances in the bile harden. Gallstones (formed in the gallbladder) can be as small as a grain of sand or as large as a golf ball. There can be just one large stone, hundreds of tiny stones, or any combination. The majority of gallstones do not cause signs or symptoms; however, when they do occur the primary sign is biliary colic. Symptoms of biliary colic are constant pain for 15 minutes to 4-5 hours, and it may vary in intensity; nausea, severe pain that does not worsen with movement; and pain beneath the sternum. Treatment of gallstones depends upon the patient and the clinical situation.
IBS SlideshowWhat is irritable bowel syndrome (IBS)? Learn about symptoms, causes, and foods that trigger IBS. Get lifestyle tips for managing IBS through diet and with IBS medications.
Intestines PictureThe intestines are a long, continuous tube running from the stomach to the anus. See a picture of the Intestines and learn more about the health topic.
Is A Colon Resection A Major Surgery?Colon resection (colectomy) is the surgical removal of part or the entire colon. Colectomy is a major surgery and may take up to four hours for completion. Colectomy is performed under general anesthesia and may require hospitalization for up to a week or more.
MRI (Magnetic Resonance Imaging Scan)MRI (or magnetic resonance imaging) scan is a radiology technique which uses magnetism, radio waves, and a computer to produce images of body structures. MRI scanning is painless and does not involve X-ray radiation. Patients with heart pacemakers, metal implants, or metal chips or clips in or around the eyes cannot be scanned with MRI because of the effect of the magnet.
Acute and Chronic PancreatitisPancreatitis is a rare disease in which the pancreas becomes inflamed. There are two types of pancreatitis: acute and chronic. Symptoms of pancreatitis include abdominal pain, fever, nausea, vomiting, and a rapid pulse. Treatment of pancreatitis often requires hospitalization.
The Digestion Process (Parts, Organs, and Functions)Digestion is the complex process of turning the food you eat into the energy you need to survive. The digestive process also involves creating waste to be eliminated, and is made of a series of muscles that coordinate the movement of food. Learn more about digestion and the body parts that make it possible, including the mouth, pharynx, esophagus, stomach, small intestine, colon, rectum, anus, pancreas, liver, and gallbladder.
UltrasoundUltrasound (and ultrasonography) is imaging of the body used in the medical diagnosis and screening of diseases and conditions such as:
- heart valve irregularities,
- carotid artery disease,
- heart disease,
- kidney stones,
- liver disease,
- diseases of the female reproductive, and
- diseases of the male reproductive organs.
Upper GI Series (Barium Swallow)An upper gastrointestinal GI series, or barium swallow is a test used in assisting in the diagnosis of upper gastrointestinal diseases or conditions such as ulcers, tumors, hiatal hernias, scarring, blockages, and abnormalities of the muscular wall of the GI tract.
What Is A Colon Resection?Colon resection (colectomy) is the surgical removal of part or all of the colon. The surgeon removes the diseased part of the colon and connects the remaining healthy parts (anastomosis).