Imaging of Duodenal Diverticula and Their Complications

A 58-year-old woman presenting with dysphagia. Abdominal radiograph from an upper gastrointestinal barium study demonstrates an incidental duodenal diverticulum (arrow) in the third portion of duodenum.

Diagram demonstrating an intraluminal diverticulum. Intraluminal diverticulum results from failed embryonic recanalization of the duodenum. A web or flap usually arises in the second portion of the duodenum near the ampulla of Vater and forms a diaphragm that may contain variable fenestrations (arrow). Due to chronic antegrade enteric propulsive pressure, a diverticulum (arrowhead) within the duodenal lumen may develop. The white asterisk indicates the dilated stomach.

A 44-year-old-male with epigastric pain. Spot radiograph from an upper gastrointestinal barium study demonstrates four duodenal diverticula (arrows). In addition, there were multiple jejunal diverticula, one of which is marked (arrowhead).

A 65-year-old-man with abdominal pain and bloating. (A) Spot radiograph from an upper gastrointestinal barium study demonstrates a large duodenal diverticulum with a small neck (arrow) arising from the third part of the duodenum. (B) Contrast-enhanced CT shows an air-fluid level in the duodenal diverticulum (asterisk), with mild compression of the second part of the duodenum (arrows). Subsequent endoscopy demonstrated extrinsic mass effect on the duodenum and gastric antrum without obstruction.

A 64-year-old woman presenting with nonspecific abdominal pain. (A) Axial and (B) coronal contrast-enhanced CT images demonstrate a large debris-filled duodenal diverticulum (asterisks) arising from the third portion of the duodenum.

A 42-year-old-woman presenting with right upper quadrant pain. (A) Axial contrast-enhanced CT demonstrates a cystic area in the region of head of the pancreas (arrow) that was initially reported as suspicious for a cystic pancreatic neoplasm. (B) Subsequent thin-section contrast-enhanced CT ordered 2 days later to characterize the mass demonstrates air within the “cystic pancreatic mass” (arrow), typical of a duodenal diverticulum. CT of the abdomen a week later showed stability in the duodenal diverticulum.

A 63-year-old-woman presenting with right lower quadrant abdominal pain. (A) Axial and (B) coronal contrast-enhanced CT images demonstrate an incidental pancreatic head region duodenal diverticulum containing impacted debris and gas (arrows), mimicking a necrotic pancreatic head mass. Reactive thickening of the cecum from cecal diverticulitis is seen.

A 66-year-old woman presenting with abdominal pain. Spot radiograph from an upper gastrointestinal barium study demonstrates an intraluminal diverticulum. The classic “wind sock” filling defect (arrow) is present in the second portion of the duodenum.

A 52 year-old man presenting with abdominal pain. (A) Spot radiograph from an upper gastrointestinal barium study demonstrates the “wind sock” filling defect (arrow) in the second portion of the duodenum. A few minutes later during the same examination (B), the filling defect has disappeared. Endoscopy (C) was normal. (Color version of figure is available online.)

A 64-year-old woman with fever, vomiting, and right upper quadrant pain. (A) Axial and (B) coronal contrast-enhanced CT images demonstrate acute duodenal diverticulitis with extensive periduodenal and retroperitoneal inflammation (asterisks). There is relative nonenhancement of the diverticulum wall, which is lateral to the second portion of the duodenum (arrowheads).

A 65-year-old woman with a bleeding duodenal diverticulum resulting in massive upper gastrointestinal bleeding requiring 19 units of blood before surgery. (A) Axial and (B) coronal CT angiography images of the upper abdomen show active contrast extravasation within the duodenum (arrow) from a duodenal diverticulum (white arrow). (C) Catheter angiography demonstrates a contrast blush in the region of active hemorrhage (black arrow).

A 55-year-old man with 3 days of fever and abdominal and back pain. (A) Axial and (B) coronal contrast-enhanced CT images demonstrate a perforated duodenal diverticulum (arrow) with extraluminal fluid (arrowheads) and gas (asterisks) in the retroperitoneum.

A 81-year-old man with 1 day of abdominal and back pain and fever. (A) Axial and (B) coronal contrast-enhanced CT images show communication (arrow) between the duodenal lumen, a duodenal diverticulum, and extraluminal gas in the retroperitoneum (arrowhead) with standing in the retroperitoneum, indicating a perforated duodenal diverticulum. Due to comorbidities, the patient was treated conservatively.

A 63-year-old man with recent acute pancreatitis and a dilated distal common bile duct due to a juxtapapillary duodenal diverticulum. (A) Coronal fast imaging with steady-state precession (true FISP) and (B) axial half Fourier acquisition single-shot turbo spin-echo (HASTE) MRCP demonstrates low signal gas (arrows) in a duodenal diverticulum without evidence of a neoplasm or calculus.

A 56-year-old man with right upper quadrant pain. (A) Sagittal and (B) coronal thick-slab HASTE MRCP demonstrates a large periampullary diverticulum containing an air-fluid level (asterisks) with displacement and dilation of the common bile duct (black arrow). Filling defect distally in the CBD is a calculus (white arrow).