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Year : 2002  |  Volume : 12  |  Issue : 1  |  Page : 131-132
Obstructive jaundice due to third part duodenal diverticulum


9, officer's Colony, Pink Avenue, Mogapair, Chennai-50, India

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How to cite this article:
Kumar K S, Singh S, Jagadeesan K. Obstructive jaundice due to third part duodenal diverticulum. Indian J Radiol Imaging 2002;12:131-2

How to cite this URL:
Kumar K S, Singh S, Jagadeesan K. Obstructive jaundice due to third part duodenal diverticulum. Indian J Radiol Imaging [serial online] 2002 [cited 2019 Sep 21];12:131-2. Available from: http://www.ijri.org/text.asp?2002/12/1/131/28431
Sir

Duodenal diverticuli presenting with obstructive jaundice are a clinical rarity. These diverticuli commonly occur in the second part of duodenum and are periampullary in location accounting for 82-90% of duodenal diverticula [1] whereas diverticula of the third part account for less than 10%. The commonest clinical features are pain and anemia although obstruction of the common bile duct and pancreatic duct by these diverticula uncomplicated by malignant change has been reported. Inflammatory changes and duodenal obstruction have been reported following NSAID ingestion [2].

A 59 year old male patient was admitted in our hospital with a history of abdominal pain, generalized pruritis of six weeks duration. For the past one-month he was passing high colored urine and one week back his stool had become clay colored. He had tried Ayurvedic medicine for one month with no relief. No contributing medical, surgical or family history could be elicited. There was no history of NSAID use.

Examination revealed the patient to be anemic, jaundiced with greenish yellow conjunctiva. Vital signs were stable. The principle systems were normal except for hepatomegaly and a distended gall bladder .

Laboratory investigations revealed low hemoglobin (8.8gm%) prolonged prothrombin time (PT) and partial thromboplastin time (PTT). The liver function tests revealed a serum bilirubin of 27mg% and conjugated bilirubin of 17mg%. The liver enzymes were mildly raised. Urine analysis revealed a reddish brown color and presence of bile salts and pigments with normal amount of urobilinogen. The rest of the biochemical parameters including alkaline phosphatase were normal.

Sonogram of the abdomen revealed hepatomegaly, dilated intrahepatic biliary radicles and grossly dilated common bile duct (CBD) traceable up to the retro duodenal portion. The pancreas including the pancreatic duct was normal. There was no evidence of pancreatic or biliary calculi. The rest of the viscera were normal.

Upper Gastrointestinal Endoscopy was then performed which reported a bulky ampulla. The visualized portions of the duodenum were normal. A Computed Tomography was done which showed a distended gall bladder and dilated common bile duct [Figure - 1]. A contrast filled bowel loop was noticed medial to the second part of the duodenum and the CBD [Figure - 2]. For its identification a Barium Meal Series was performed which clinched the diagnosis of a diverticulum of the third part of the duodenum [Figure - 3] Free flow of barium was seen into the diverticulum and the third part of the duodenum.

The CT and the Barium Series did not show any features of malignant change in the diverticulum and the duodenum. Considering the high morbidity and mortality associated with surgical repair of such a diverticula, the uncomplicated nature of the diverticulum and the condition of the patient, the surgical team decided to perform a cholecystectomy and choledochoduodenostomy.

The patient is being followed up regularly and is doing well one month after the surgery. Serum bilirubin was 2 mg% at review, a drastic reduction from the previous high value of 27 mgs% noted at the time of admission.

 
   References Top

1.Venendal RA, Pecters AJ, Krenneg J et al. Department of Gastroenterology-Hepatology; University Hospital, Leiden, The Netherlands. Gastroenterol Clin Bio 1991; 15(4) 355-7, Duodenal Diverticulum complicated by duodenal inflammation and obstruction secondary to the use of NSAID Diclofenac.  Back to cited text no. 1    
2.Sindamore CH, Harrison RL et al; Management of duodenal diverticuli. "Can J Surg 1982 May; 25 (3): 311-4  Back to cited text no. 2    

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Correspondence Address:
K S Kumar
9, officer's Colony, Pink Avenue, Mogapair, Chennai-50
India
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Source of Support: None, Conflict of Interest: None


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[Figure - 1], [Figure - 2], [Figure - 3]



 

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