A Case of Duodenal Diverticulitis

십이지장 게실염 1예

  • Seock, Chang-Hyeon (Department of Internal Medicine, Kwangmyung Sungae Hospital) ;
  • Kim, Hae-Kyung (Department of Internal Medicine, Kwangmyung Sungae Hospital) ;
  • Park, Tae-Il (Department of Internal Medicine, Kwangmyung Sungae Hospital) ;
  • John, Byung-Min (Department of Internal Medicine, Kwangmyung Sungae Hospital) ;
  • Jo, Hyeon-U (Department of Internal Medicine, Kwangmyung Sungae Hospital) ;
  • Kim, Jae-Seung (Department of Internal Medicine, Kwangmyung Sungae Hospital) ;
  • Kim, Kee-Bum (Department of Internal Medicine, Sungae Hospital) ;
  • Na, Byung-Soo (Department of Internal Medicine, Sungae Hospital)
  • Received : 2010.04.14
  • Accepted : 2010.10.12
  • Published : 2010.11.30

Abstract

Duodenal diverticulitis is difficult to diagnose because it can mimic other common diseases such as cholecystitis and perforated ulcer. Recently, we experienced a rare case of duodenal diverticulitis that was initially suspected on abdominal computed tomography as focal pancreatitis. Although duodenal diverticulitis has been increasingly recognizable before surgery, with the advent of multi-detector computed tomography, misdiagnosis remains problematic since duodenal diverticulitis is commonly not considered in the differential diagnosis of acute abdominal pain. We have to consider this rare disease entity because delayed diagnosis might be a cause of substantial morbidity and mortality.

십이지장 게실염은 임상증상이 비특이적으로 종종 췌장염이나 담관염으로 오인되기도 한다. 최근 저자들은 복부 CT 후 급성 담관염, 췌장염을 의심했던 환자에서 MRCP와 ERCP 후 십이지장 게실염을 진단하여 이를 보고한다. 십이지장 게실염은 진단이 용이하지 않지만 천공 등 합병증 동반 시 사망률이 높아 급성 복통 환자에서 반드시 감별해야 할 질환으로 생각한다.

Keywords

References

  1. Ames JT, Federle MP, Pealer KM. Perforating duodenal diverticulum: clinical and imaging finding in eight patients. Abdom Imaging 2009;34:135-139. https://doi.org/10.1007/s00261-008-9374-x
  2. Luz LP, Eloubeidi MA. Duodenal diverticulitis mimicking cholangitis: endoscopic and EUS appearance. Am J Gastroentrol 2009;104:2125-2126. https://doi.org/10.1038/ajg.2009.244
  3. Miller G, Mueller C, Yim D, et al. Perforated duodenal diverticulitis: a report of three cases. Dig surg 2005;22:198-202. https://doi.org/10.1159/000087974
  4. Coulier B, Maldague P, Bourgeos A, Broze B. Diverticulitis of the small bowel: CT diagnosis. Abdom Imaging 2007;32:228-233. https://doi.org/10.1007/s00261-006-9045-8
  5. Dennesen PJ, Rijken J. Duodenal diverticulitis. Neth J Med 1997;50:250-253. https://doi.org/10.1016/S0300-2977(97)00009-0
  6. Gore RM, Ghahremani GG, Kirsch MD, Nemcek AA Jr, Karoll MP. Diverticulitis of the duodenum: clinical and radiological manifestations of seven cases. Am J Gastroenterol 1991;86:981-985.
  7. Park H, Song J, Lee B, Yoon D, Lee D. Perforated duodenal diverticulitis caused by retained common bile duct stone in the diverticulum. Am J Gastroenterol 2009;104:248-249. https://doi.org/10.1038/ajg.2008.30
  8. Verbeeck N, Mazy V, Hoebeke Y. Duodenal diverticulitis. CT diagnosis and conservative management. JBR-BTR 1999;82:99-100.
  9. Kwon SO, Baik SK, Kim JM, et al. Clinical charateristics of periampullary diverticulum. Korean J Gastrointest Endosc 1996;16:937-944.
  10. Vandenbroucke F, Op de Beeck B, de Mey J. Duodenal diverticulitis: CT and MR findings. Emerg Radiol 2006;13:95-97. https://doi.org/10.1007/s10140-006-0526-4
  11. Pearl MS, Hill MC, Zeman RK. CT findings in duodenal diverticulitis. AJR Am J Roentgenol 2006;187:W392-W395. https://doi.org/10.2214/AJR.06.0215