Giant duodenal diverticulum—an incidental finding
A 72-year-old female presented to the Emergency Department (ED) with sharp, non-radiating epigastric pain for less than 12 hours duration without aggravating factors or other associated symptoms.

She had an extensive past medical history including Wegener’s granulomatosis, chronic renal failure, primary biliary cirrhosis, chronic obstructive airways disease, ischaemic heart disease, liver haemangiomas undergoing surveillance and a hiatus hernia seen on esophagogastroduodenoscopy (OGD). She was an active smoker and rarely drank alcohol.

On examination she was afebrile, with observations within the normal parameters. Her abdomen was tender with voluntary guarding in the epigastrium. Her initial blood tests were all normal other than mildly increased inflammatory markers. She underwent a non-contrast (due to chronic kidney disease) Computed Tomography (CT) scan that revealed no evidence of acute biliary/gallbladder disease, however there was the appearance of a large duodenal diverticulum. The patient was recalled for an oral contrast study that confirmed a giant duodenal diverticulum arising from the second/third part of the duodenum measuring 9.5 × 5.7 × 7.3 cm. There were no signs of surrounding inflammation or pending rupture and this was thought to be an incidental finding. Upper abdominal ultrasound revealed no acute biliary tract disease. Her pain settled and she was discharged home.

On retrospective analysis of prior scans (CT and Magnetic Resonance Imaging (MRI)) of this woman there was evidence of this duodenal diverticulum for over five years and previous OGD three years prior had noted two duodenal diverticula; one small and one large. The patient denied previous knowledge of these findings.

Source: Journal of Surgical Case Reports, Volume 2019, Issue 4, April 2019, rjz120

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