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eISSN 2951-0805
    J Korean Soc Radiol. 2013 Nov;69(5):373-376. Korean.
    Published online Nov 08, 2013.
    https://doi.org/10.3348/jksr.2013.69.5.373
    Copyright © 2013 The Korean Society of Radiology
    Case Report

    Perforated Duodenal Diverticulum Caused by Bezoar: A Case Report

    Jung Eun Lee, MD, Sung Kyoung Moon, MD, Seong Jin Park, MD, Joo Won Lim, MD, Dong Ho Lee, MD and Young Tae Ko, MD
      • Department of Radiology, College of Medicine, Kyung Hee University, Seoul, Korea.
    • Corresponding author: Sung Kyoung Moon, MD. Department of Radiology, College of Medicine, Kyung Hee University, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul 130-702, Korea. Tel. 82-2-958-8622, Fax. 82-2-968-0787, Email: aquamsk@naver.com
    Received July 05, 2013; Accepted August 05, 2013.

    This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

    Abstract

    Duodenal diverticulum is common, but its perforation is a rare complication. Duodenal diverticulum perforation requires prompt treatments because of its high mortality rate. However, an accurate diagnosis is difficult to make due to nonspecific symptoms and signs. It can be misdiagnosed as pancreatitis, cholecystitis, or peptic ulcer. Herein, we report a case of perforated duodenal diverticulum caused by bezoar in a 33-year-old woman whom was diagnosed by abdomen computed tomography and ultrasonography.

    Keywords
    Duodenal Diverticulum; Perforation; Bezoar; CT

    Figures

    Fig. 1
    A 33-year-old woman with perforated duodenal diverticulum with epigastric pain.

    A. On an axial CT image, an irregular fluid collection (asterisk) containing air-bubbles is shown at the posterior aspect of the pancreas uncinate process. It displaces the pancreas head (black arrow) and duodenum (white arrow) anteriorly.

    B. An abdomen ultrasonography shows a hard material (white arrow) with posterior acoustic shadow in the duodenal diverticulum. The pancreas parenchyma (asterisk) shows normal appearance.

    C. A coronal CT image shows the discontinuity of the superior wall of duodenal diverticulum (white arrow) and communication (black arrows) with complicated fluid collection (asterisk) around the pancreas head.

    Note.-D = duodenum

    Fig. 2
    The follow-up abdomen CT and endoscopy.

    A. An axial CT image shows the decrease in size of duodenal diverticulum (white arrow). There is no more fluid collection near the pancreas head and uncinate process (black arrow = duodenum).

    B. An endoscopy shows the opening of the duodenal diverticulum at the periampullary region.

    References

      1. Duarte B, Nagy KK, Cintron J. Perforated duodenal diverticulum. Br J Surg 1992;79:877–881.
      1. Thorson CM, Paz Ruiz PS, Roeder RA, Sleeman D, Casillas VJ. The perforated duodenal diverticulum. Arch Surg 2012;147:81–88.
      1. Rossetti A, Christian BN, Pascal B, Stephane D, Philippe M. Perforated duodenal diverticulum, a rare complication of a common pathology: a seven-patient case series. World J Gastrointest Surg 2013;5:47–50.
      1. Graur F, Bala O, Bodea R, Geczi-Toth I, Vlad L, Iancu C. Laparoscopic resection of duodenal diverticulum. A case report. Rom J Gastroenterol 2005;14:405–408.
      1. López Zárraga F, Saenz De Ormijana J, Diez Orive M, Añorbe E, Aisa P, Aguirre X, et al. Abdominal pain in a young woman (2009: 8b). Eur Radiol 2009;19:2783–2786.
      1. Cattell RB, Mudge TJ. The surgical significance of duodenal diverticula. N Engl J Med 1952;246:317–324.
      1. Jones TW, Merendino KA. The perplexing duodenal diverticulum. Surgery 1960;48:1068–1084.
      1. Ames JT, Federle MP, Pealer KM. Perforated duodenal diverticulum: clinical and imaging findings in eight patients. Abdom Imaging 2009;34:135–139.
      1. de Perrot T, Poletti PA, Becker CD, Platon A. The complicated duodenal diverticulum: retrospective analysis of 11 cases. Clin Imaging 2012;36:287–294.
      1. Huang RY, Romano AE, Stone ME, Nathanson N. Diagnosis and treatment of a perforated duodenal diverticulum. Emerg Radiol 2007;13:285–287.
    MeSH Terms
    Abdomen
    Adult
    Bezoars*
    Cholecystitis
    Diverticulum*
    Female
    Humans
    Pancreatitis
    Peptic Ulcer
    Ultrasonography
    Metrics
    Share
    Figures
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