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• W2914077718 abstract "The duodenal diverticulum is mucosal outpouching of the duodenum which can lead to pancreaticobiliary disease due to its anatomical location. We are presenting a case where the patient developed acute pancreatitis and duodenal diverticulitis simultaneously. A 67-year-old female with the history of hypothyroidism, hypertension came with severe and epigastric pain associated with fever and vomiting. Labs showed leukocytosis of 15.1 thousand/ microliter, lipase was 23,100 U/L. Liver function tests were normal. CT abdomen showed marked edema surrounding the head of the pancreas as well as an adjacent 3.9 x 2.3 cm2 duodenal diverticulum. The patient was kept NPO, started on piperacillin-tazobactam and aggressive IV hydration was given. Ultrasound showed dilated common bile duct measuring 1.1 cm. No gall stones were noticed. Blood cultures grew staphylococcus lugdunensis, the antibiotic was changed to nafcillin based on sensitivity. MRI confirmed the finding of CT scan. Patient symptoms started improving, diet was advanced as tolerated. Repeat blood culture were negative. The patient refused to undergo an endoscopy. She was discharged on day 7 with 1 more week of antibiotics. Duodenal diverticulum within 2-3 cm radius of the ampulla of Vater is called periampullary diverticula (PAD). Advanced age and increased intraluminal pressure can lead to the diverticulum formation. Duodenal diverticulum usually arises from an area of weak points as perivascular connective tissue sheath and site of entry of pancreaticobiliary ducts. The PAD is associated with biliary stones and pancreatitis. Studies have shown pancreatitis in patients with PAD without evidence of gallstones. Duodenal diverticulitis is a rare event which can predispose to an inflammatory process in adjacent organs as pancreas and liver. MRI gives a multiplaner view and better soft tissue contrast and differentiates PAD from cystic lesions and tumors. Duodenal diverticulitis is usually managed conservatively with IV hydration, bowel rest, and broad spectrum antibiotics. Surgical treatment is recommended in cases with complications as gastrointestinal bleeding, gastrointestinal obstruction, bowel perforation, pancreaticobiliary obstruction. A Duodenal diverticulum is usually a benign condition but can lead to serious complications as acute pancreatitis. In elder population before defining the episode as idiopathic pancreatitis, duodenal diverticulum should be considered as possible etiology.Figure: Axial view CT abdomen showing duodenal diverticulum (red arrow) with inflammation around duodenal wall and head of pancreas.Figure: MRI abdomen showing Duodenal diverticula connected to duodenum (red arrow)." @default.
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• W2914077718 date "2017-10-01" @default.
• W2914077718 modified "2023-09-27" @default.
• W2914077718 title "An Unusual Case of Acute Pancreatitis With Coexisting Duodenal Diverticulitis" @default.
• W2914077718 doi "https://doi.org/10.14309/00000434-201710001-02405" @default.
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