Duodenal Diverticulum – Types, Causes, Symptoms, Complications, Diagnosis and Treatment
The duodenum is the first part of the small intestine. It is followed by the next two parts of the small intestine, namely, the jejunum and the ileum. It is a hollow tube like structure which connects the stomach to the jejunum. It is the place where the food is acted on by chemicals in the digestive enzymes and the digestion process is initiated. The duodenum is about 10-12 inch long.
is a condition in which the membranous walls of the duodenum bulges out forming pouches. The duodenum is the second most common area to have diverticulum after the colon.
Types of Duodenal Diverticulum
There are two types of duodenal diverticula which are as follows:
: This one is similar to the ones which develop in the colon. It occurs in about 6% of individuals. The lining of the organ bulges out externally and sticks out of the duodenum. The size of the pouch may vary between a few millimeters to a few centimeters. The most common site of the said diverticulum is the ampulla of vater where the bile duct and the pancreatic duct enter the duodenum bringing in the bile and the pancreatic enzymes respectively to act on the food.
: The said type is different from the one above as it bulges inwards from the duodenal wall into the lumen or hollow of the duodenum.
Both the above types are formed such that the contents of the duodenum passing through the lumen could get entry into the diverticulum or inside the pouches.
What Causes Diverticulum in the Duodenum?
The exact cause of duodenal diverticulum is not known.
The extramural ones are definitely not congenital or genetic. They are developed due to the protrusion or bulging out of the said organ through a weak spot in the duodenal wall.
The intramural ones are genetic and occurs as a congenital defect. It is a developmental anomaly of the intestines in the fetus.
Symptoms and Complications of Duodenal Diverticulum
The diverticulum especially the extramural ones can exist without any symptom. The problem arises when there is a rupture in the weak stretched out wall of the diverticula. A rupture may cause localized inflammation and infection in the area. This particular occurrence gives rise to the following symptoms:
- Abdominal pain
- Abdominal tenderness
If the bulged out pocket is close to the ampulla of vater or the entry point of the bile and pancreatic ducts then there are chances of development of gallstones and other correlated complications. Some of the common symptoms in such a situation area as follows:
- Obstruction of bile ducts with a gallstone getting lodged in the ampulla of vater or inside the bile duct causing bile reflux and accumulation. This can cause abdominal pain which is commonly known as Biliary colic.
- Inflammation of the gall bladder or Cholecystitis.
- Inflammation and infection of the bile ducts because of bacteria spreading into the bile and pancreatic ducts from the duodenum.
- Pancreatitis may occur when the diverticula obstructs the flow of the pancreatic juices through the intestine. The pancreatic cells are self destructed by the backward flow and accumulation of the of the pancreatic juices. This process is known as “Autolysis”.
In case of intramular diverticula, the main complication would be the obstruction of the duodenum leading to the accumulation of the food passed down from the stomach. It too is accompanied with the typical symptoms of intestinal obstruction like abdominal pain, nausea, vomiting, loss of appetite etc. It causes an emergency medical situation which requires surgery to be fixed.
Diagnosis of diverticulum in the duodenum
The different diagnostic methods of the same are as follows:
- Barium X-ray of the upper gastrointestinal tract.
- Computed Topography Scans or CT Scans.
- Magnetic Resonance Imaging or MRI.
Treatment of the Diverticulum in the Duodenum
- Other than antibiotics used to treat the accompanying infection, surgery is the only other option. The external or the extramural ones are removed from outside of the duodenum with the aid of the scalpel.
- The diverticuli may be inverted and pushed inside the hollow or the lumen of the duodenum. A small and minimally invasive incision is then made on the duodenal wall and the pocket is removed.