Diverticulum of the duodenum

Diverticulum of the duodenum is the second most frequent after diverticulum of the colon, mostly congenital. Only A-5% of diverticula are accompanied by clinical manifestations. They are localized mainly on the inner surface of the intestine. Diverticula can be single and multiple (each 3-4 diverticulum).

Symptoms. Clinical manifestations arise only in case of complications. The diverticula of the upper horizontal section is manifested by the clinical symptoms of peptic ulcer, which is associated with the entry of acid contents into the diverticulum and the occurrence of erosion and ulceration in it. Diverticulum of the descending part of the intestine in the event of inflammation in it can cause compression of the large papilla of the duodenum (fater nipple) followed by the development of hopangitis, pancreatitis, mechanical jaundice. Possible and direct transition of inflammation to the pancreas with the development of chronic pancreatitis.

Clinical picture: pain in the right side of the abdomen, a feeling of heaviness, nausea, vomiting, bleeding, jaundice is possible. Diverticulum of the lower horizontal division in the development of the inflammatory periprocess may cause compression of the duodenum and lead to its obstruction.

The diagnosis is based on a clinical picture, contrast radiographic examination of the stomach and duodenum, gastroduodenoscopy.

Treatment is mostly conservative. It is aimed at the treatment and prevention of diverticulitis. With persistent recurrence of complications, large sizes of diverticulum, surgical treatment is indicated. During the operation it is sometimes difficult to find a diverticulum, the search is facilitated by insufflation of air through a probe inserted into the duodenum. After the detection of the diverticulum, it is immersed and sutured with a defect in the muscular membrane of the intestine. With large paraphatral and intrapancreatic diverticula, stomach resection is sometimes performed by the method of Bilrot-II, turning off the duodenum from digestion.

The prognosis is favorable.