Resposta ao caso clinico

Duodenal diverticula are out-pouchings from the duodenal wall (intra luminal diverticulum discussed separately). They may result from mucosal prolapse or the prolapse of the entire duodenal wall and can be found at any point in the duodenum.

Demographics and clinical presentation
Duodenal diverticula are very common, found in up to 23% of asymptomatic patients, and in the vast majority remain asymptomatic throughout life. In 10% of patients, some symptoms are attributable to them, with only a minority requiring surgical intervention 2. Potential complications include : duodenal diverticulitis haemorrhage perforation abscess formation Diverticula located at the ampulla of Vater may cause difficulty for endoscopists as they attempt to cannulate the biliary system.

Pathology and classification
There are a two of types of duodenal diverticula: primary diverticulum secondary diverticulum A primary duodenal diverticulum occurs where there is prolapse of mucosa through the muscularis propria. They usually occur within the 2nd part (62%) and less commonly in the 3rd (30%) and 4th (8%) parts. Unlike secondary diverticula they are rarely seen in the 1st part. When they occur in the 2nd part, most (88%) are seen on the medial wall around the ampulla, 8% are seen posteriorly and 4% on the lateral wall. A secondary duodenal diverticulum results from prolapse of the entire duodenal wall and almost invariably occurs in the 1st part of the duodenum. These are true diverticula and are usually secondary to duodenal or peri duodenal inflammation.