21:19,21,Aug,2006 | (2367/0/0) | Original

periampullary duodenal diverticulum

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periampullary duodenal diverticulum

Wu Jiang, Chang-Sheng Deng, Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
Project Leader: Wujiang, 430071, Wuchang District, Wuhan City, Hubei Province, 169 East Lake Road, Wuhan University Zhongnan Hospital of Internal Medicine. No-river@163.net
Phone :027 -87,877,459
Received date :2003-03-08 Accepted :2003-04-05
Objective: To investigate the clinical manifestations of duodenal diverticulum, diagnosis, and treatment characteristics.
Methods: Near 20 a Wuhan University Zhongnan Hospital patients by X-ray barium meal, duodenal endoscopy and surgery of 120 cases found in patients with duodenal diverticula, were retrospectively reviewed.
Results: no special clinical features, and more confirmed by the X-ray examination, the majority of medical treatment.
Conclusion: Duodenal diverticulum no specific clinical features, diagnosis mainly relies on X-gastrointestinal barium meal and the stomach, duodenum, endoscopy identified. Asymptomatic no special treatment. Patients have gastrointestinal symptoms, and diverticula and other diseases coexist, should first consider the treatment of other diseases.
Wu Jiang, Chang-Sheng Deng. Duodenal diverticulum in 120 patients. World Journal of Gastroenterology 2003; 11 (11) :1824-1825
0 Introduction duodenal diverticulum is due to different causes local pathological duodenal bulging pouch-like. This collection of Wuhan University Zhongnan Hospital 1983-01/2002-12 hospitalized patients after gastrointestinal barium meal X- duodenal endoscopy and surgery duodenal diverticulum
found in 120 patients were studied retrospectively.
1 Materials and methods
1.1 The material in this group of 120 patients, male 65 cases, female 55 cases. Aged 18-86 years, of which less than 1 case of 20-year-old ,20-29 ,30-39 years in 8 cases of 10 cases 13 cases 40-49 50-60-59 years 69 years 30 cases 34 cases 19 cases ,70-79 years, greater than or equal to 80 years in 5 cases. descending diverticulum in 91 cases, 7 cases the level of the Ministry or the Ministry of 9 patients with descending l Department of 5 cases, descending and empty, ileum in 2 cases, descending 1 patient with esophageal, bulb diverticulum in 5 cases. diverticulum number ranging from 1-4, a single in 105 cases. sizes, 4 × greatest 5cm, smallest grain size only.
1.2 Methods and Statistics in patients with duodenal diverticula and treatment of clinical manifestations and outcome of the situation.
2 Results
2.1 Clinical manifestations of 120 cases, 69 cases with digestive tract of other diseases: cholangitis, cholecystitis, cholelithiasis, 12 cases of acute pancreatitis in 3 cases, 10 cases of chronic gastritis, acute gastric mucosal lesion in 4 cases, duodenal inflammation , bulbar ulcer in 16 cases, 12 cases of hepatitis and fatty liver, liver cyst in 4 cases, esophagitis, intestinal heterotopic pancreas, liver cavernous lymphangioma, liver schistosomiasis, intestinal obstruction, jejunal leiomyosarcoma, colon polyps, ascending colon in 1. only 6 cases diagnosed as duodenal diverticulum admission. Its main symptoms are abdominal pain, digestive / discomfort (72.73%), nausea and vomiting (40.91%), vomiting blood and (or) melena (34.91%) and jaundice (6.82%). There were 16 cases of diverticulitis. The group, 50 patients with other systems associated with disease: 24 cases of cardiovascular system, respiratory system in 11 cases, 7 cases of urinary system, endocrine system, 5 cases (all diabetes), the nervous system in 3 cases.
2.2 Treatment and prognosis of this group, 10 patients underwent surgery: gastrectomy in 8 cases, 2 cases of duodenal diverticulum embedded operation. I are medical therapy, 1 patient died due to congestive cardiomyopathy.
3 Discussion diverticulum is a tubular organ originated in the pocket and the cystic structure. "Authenticity" diverticulum containing layers of the intestinal wall, "false" diverticulum is leaving the muscularis mucosa and submucosa defects outstanding due to [1] . duodenal diverticulum in a variety of upper gastrointestinal examination in the detection rate of about 2.50% [2]. The middle-aged patients were more common (greater than or equal to 40 years 101 patients, 84.16%). male and female incidence were similar, male slightly higher (65/120, 54.17%), but some scholars [3] that women more common.
Duodenal diverticula occur in the descending part [4], and more in the descending medial from the ampulla Vater range of about 2.50cm [1]. This group also down are more than the Ministry (91/120, 75.83%) Another 7 cases the level of the Ministry or the Ministry of 9 cases; bulb diverticulum in 5 cases there were associated with duodenal ulcer, the duodenal diverticulum may be caused by scar contraction of "pseudo" diverticulum. duodenal diverticulum in this group are mostly single (105/120, 87.50%), large and small, greatest 4 × 5cm, smallest grain size only.
Most patients with this disease without clinical symptoms and signs can be [2]. This group is not associated with other digestive diseases in 51 cases, including 10 cases manifested as abdominal pain / discomfort, nausea, vomiting, vomiting blood and (or) black stools, I have no gastrointestinal symptoms. The group, admission diagnosis was only 6 cases of duodenal diverticulum, duodenal diverticulum shows no specific clinical features.
The group had 16 cases of diverticulitis, and peptic ulcer in similar clinical manifestations: upper abdominal pain, nausea, belching, acid reflux and bloating. There are 12 cases with biliary disease, 3 patients with acute pancreatitis, possibly due to pressure diverticulum common bile duct and pancreatic duct or papillary edema, causing bile duct obstruction, biliary and pancreatic symptoms appear.
The diagnosis of duodenal diverticulum gastrointestinal barium meal X-reliance and stomach, duodenum, endoscopy identified, can also be found in surgery. Most of this group confirmed by the X-ray examination (103/120, 85.83% ), X-ray showed extraluminal duodenal diverticulum is protruding, round or oval-shaped pouch pocket shadow, outline clearly visible stretching diverticulum duodenal mucosa. If the common bile duct and pancreatic duct openings in the diverticulum , endoscopy and retrograde cholangiopancreatography help to determine the relationship between its anatomy. In addition, CT of duodenal diverticulum causing complications such as acute pancreatitis, which are certain diagnostic value [5].
If asymptomatic duodenal diverticulum without special treatment. If gastrointestinal symptoms in patients, and coexistence of other diseases, treatment of other diseases should be considered first. Medical treatment to take a more integrated approach: The acid antispasmodic drugs, prokinetic drugs and antibiotics. no improvement after medical treatment or have symptoms of complications, surgery may be considered (in this group, only 10 cases), indications for the diverticulum perforation, bleeding, a recreation room cancer, fistula, bowel obstruction, bile induced by repeated pancreatic complications and recurrent diverticulitis or diverticular bleeding, the medical treatment ineffective [6]. surgical resection of a diverticulum, duodenal exclusion surgery, duodenal anastomosis [1].
Duodenal diverticulum prognosis is usually good, even if the occurrence of complications, if handled properly, can have a better prognosis.
4 References 1 Chang-Sheng Deng. Duodenal diverticulum. 1st edition. Beijing: People's Medical Publishing House, 2002; 172-173
2 Yin WY, Chen HT, Huang SM, Lin HH, Chang TM. Clinical analysis andliterature review of massive duodenal diverticular
bleeding. World J Surg 2001; 25:848-855
3 Gulotta G, Agosta G, Romano G. Perforated duodenal diverticulum: report of a case. Chir Ital 2001; 53:255-258
4 Mehrotra P, Chandra M, Mitra MK, Misra R. Massive bleeding fromduodenal diverticulum. Indian J Gastroenterol
2002; 21:32
5 De Rai P, Castoldi L, Tiberio G. Intraluminal duodenal diverticulumcausing acute pancreatitis: CT scan diagnosis and
review of the literature. Dig Surg 2000; 17:288-292
6 Shu-Dong Xiao. Jiangshao Ji Gastroenterology. 1st edition. Shanghai: Shanghai Science and Technology Press ,2001:839-841
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