Background. Duodenum is the second most common site of diverticula after the colon. Diagnosis of duodenal diverticula is incidental and found during other therapeutic procedures. In 90% of cases, they are asymptomatic, and less than 10% develop clinical symptoms. The difficulty to ascertain the true incidence of duodenal diverticula demanded for the present study to elucidate the prevalence of the duodenal diverticulum in South Indians. Materials and Methods. One hundred and twenty specimens of duodenum were utilized for the study. The prevalence, anatomical location, and dimension of duodenal diverticulum were studied. Results. Among the 120 specimens of duodenum, five specimens had solitary, extraluminal, and globular-shaped diverticula in the medial wall of the duodenum. In three (60%) cases, it was found in the second part of duodenum and in two (40%) cases in the third part. The mean size of the diverticula was 1.4？cm. Conclusion. In the present study in South Indian people, the prevalence (4.2%) of duodenal diverticula is low comparable to other studies in the literature. Even though most of the duodenal diverticula are asymptomatic, the knowledge about its frequency and location is of great importance to prevent complications like diverticulitis, hemorrhage, obstructive jaundice, and perforation. 1. Introduction Duodenal diverticulum was first reported by a French pathologist Chomel in 1710 [1] and was diagnosed radiologically by Case [2] in 1913. Duodenum is the second most common site of diverticula in alimentary tract after colon, followed by jejunum, ileum, and stomach [3, 4]. Although associated with complications like diverticulitis, perforation, obstruction, or haemorrhage, the majority of duodenal diverticula are asymptomatic [5, 6], more often coming as a surprise on gastrointestinal series. Duodenal diverticula are found in 0.16 to 6% of upper gastrointestinal barium series and up to 23% of endoscopic retrograde cholangiopancreaticographies [6, 7]. However, reported incidence from cadaveric studies could be as high as 31.8% [8]. In recent review of the literature, there were a few cadaveric studies on the incidence of duodenal diverticulum throughout the world, and none from South India. To the best of our knowledge, the present study should be the first to highlight the prevalence and anatomical location of duodenal diverticula in South Indians. 2. Materials and Methods One hundred and twenty specimens of duodenum from 108 male and 12 female subjects, in the age group of 25 to 63 years, procured from the Department of Anatomy,
References
[1]
R. Maingot, “Gastric and duodenal diverticula,” in Abdominal Operations, R. Maingot, Ed., pp. 141–156, Appleton-Century-Crofts, New York, NY, USA, 1980.
[2]
J. T. Case, “Diverticula of small intestine, other than meckel's diverticulum,” Journal of the American Medical Association, vol. 75, pp. 1463–I470, 1920.
[3]
R. M. Gore, G. G. Ghahremani, M. D. Kirsch, A. A. Nemcek Jr., and M. P. Karoll, “Diverticulitis of the duodenum: clinical and radiological manifestations of seven cases,” American Journal of Gastroenterology, vol. 86, no. 8, pp. 981–985, 1991.
[4]
W. T. Knoefel and D. W. Ratttner, “Duodenal diverticula and duodenal tumours,” in Oxford Text Book of Surgery, P. J. Morris and R. A. Malt, Eds., vol. 1, pp. 943–946, Oxford University Press, New York, NY, USA, 1994.
[5]
B. D. Pimparkar, “Diverticulosis of the small intestine,” in Gastroenterology, L. Bockus Henry, Ed., pp. 437–435, WB Saunders, Philadelphia, Pa, USA, 3rd edition, 1976.
[6]
W. V. Harford, “Diverticula of the hypopharynx and esophagus, the stomach and small bowel,” in Sleisenger and Fordtran's Gastrointe Stinal and Liver Diseases, M. Feldman, B. F. Scharschmidt, and M. H. Sleisenger, Eds., vol. 1, pp. 313–316, WB Saunders, Philadelphia, Pa, USA, 6th edition, 1998.
[7]
W.-Y. Yin, H.-T. Chen, S.-M. Huang, H.-H. Lin, and T.-M. Chang, “Clinical analysis and literature review of massive duodenal diverticular bleeding,” World Journal of Surgery, vol. 25, no. 7, pp. 848–855, 2001.
[8]
M. Minoru and K. Atsuyoshi, “Symposium (III): clinical aspects of the duodenal diverticula,” Gastroenterologia Japonica, vol. 8, no. 3, pp. 263–269, 1973, Proceedings of the 14th Autumnal Meeting september 1972—Niigata Part 1.
[9]
E. A. Boyden, J. G. Cope, and A. H. Bill Jr., “Anatomy and embryology of congenital intrinsic obstruction of the duodenum,” The American Journal of Surgery, vol. 114, no. 2, pp. 190–202, 1967.
[10]
W. R. Richardson and L. W. Martin, “Pitfalls in the surgical management of the incomplete duodenal diaphragm,” Journal of Pediatric Surgery, vol. 4, no. 3, pp. 303–312, 1969.
[11]
N. Hamada, N. Ishizaki, K. Shirahama et al., “Multiple duodeno-jejunal diverticula causing massive intestinal bleeding,” Journal of Gastroenterology, vol. 35, no. 2, pp. 159–162, 2000.
[12]
F. Graur, O. Bala, R. Bodea, I. Geczi-Toth, L. Vlad, and C. Iancu, “Laparoscopic resection of duodenal diverticulum. A case report,” Romanian Journal of Gastroenterology, vol. 14, no. 4, pp. 405–408, 2005.
[13]
J. E. Lane, M. Ajjan, and S. Sedghi, “GI bleeding from duodenal diverticula,” American Journal of Gastroenterology, vol. 96, no. 9, pp. 2799–2800, 2001.
[14]
J. C. Grant Boileau, “On the frequency and age incidence of duodenal diverticula,” The Canadian Medical Association Journal, vol. 33, no. 3, pp. 258–262, 1935.
[15]
M. E. Mackenzie, W. T. Davies, M. B. Farnell, A. L. Weaver, and D. M. Ilstrup, “Risk of recurrent biliary tract disease after cholecystectomy in patients with duodenal diverticula,” Archives of Surgery, vol. 131, no. 10, pp. 1083–1085, 1996.
[16]
P. R. Acu？a, C. M. A. Guadarrama, M. G. Leal, et al., “Incidencia del divertículo duodenal en la colangiografía endoscópica,” Cirujano General, vol. 27, pp. 144–147, 2005.
[17]
R. Akhrass, M. B. Yaffe, C. Fischer, J. Ponsky, and J. M. Shuck, “Small-bowel diverticulosis: perceptions and reality,” Journal of the American College of Surgeons, vol. 184, no. 4, pp. 383–388, 1997.
[18]
W. M. Baldwin, “Duodenal diverticulum in man,” The Anatomical Record, vol. 5, pp. 121–140, 1911.
[19]
W. Ackermann, “Diverticula and variations of the Duodenum,” Annals of Surgery, vol. 117, pp. 403–412, 1943.
[20]
A. Eggert, W. Teichmann, and D. H. Wittmann, “The pathologic implications of duodenal diverticula,” Surgery Gynecology and Obstetrics, vol. 154, no. 1, pp. 62–64, 1982.
[21]
M. V. Jayaraman, W. W. Mayo-Smith, J. S. Movson, D. E. Dupuy, and M. T. Wallach, “CT of the duodenum: an overlooked segment gets its due,” Radiographics, vol. 21, pp. S147–S160, 2001.
[22]
R. Lapin, M. L. Kamath, J. Engler, and H. Friedman, “Massive gastrointestinal hemorrhage from duodenal diverticula,” American Journal of Gastroenterology, vol. 61, no. 3, pp. 185–189, 1974.
[23]
C. H. Scudamore, R. C. Harrison, and T. T. White, “Management of duodenal diverticula,” Canadian Journal of Surgery, vol. 25, no. 3, pp. 311–314, 1982.
[24]
S. A. Afridi, C. J. Fichtenbaum, and H. Taubin, “Review of duodenal diverticula,” American Journal of Gastroenterology, vol. 86, no. 8, pp. 935–938, 1991.
[25]
W. Wiesner, C. Beglinger, D. Oertli, and W. Steinbrich, “Juxtapapillary duodenal diverticula: MDCT findings in 1010 patients and proposal for a new classification,” JBR-BTR, vol. 92, no. 4, pp. 191–194, 2009.
[26]
E. I. Spriggs and O. A. Marxer, “An address on intestinal diverticula,” British Medical Journal, vol. 1, no. 3395, pp. 130–134, 1926.
[27]
R. E. Miller, R. E. McCabe, P. F. Salomon, and W. G. Knox, “Surgical complications of small bowel diverticula exclusive of Meckel's,” Annals of Surgery, vol. 171, no. 2, pp. 202–210, 1970.
[28]
P. M. Rao, “Perforated duodenal diverticulitis,” Radiology, vol. 211, no. 3, pp. 711–713, 1999.
[29]
M. S. Pearl, M. C. Hill, and R. K. Zeman, “CT findings in duodenal diverticulitis,” American Journal of Roentgenology, vol. 187, no. 4, pp. W392–W395, 2006.
[30]
F. L. Crowe, P. N. Appleby, N. E. Allen, and T. J. Key, “Diet and risk of diverticular disease in Oxford cohort of European Prospective Investigation into Cancer and Nutrition (EPIC): prospective study of British vegetarians and non-vegetarians,” British Medical Journal, vol. 343, p. d4131, 2011.
[31]
J. S. S. Gear, A. J. M. Brodribb, A. Ware, and J. I. Mann, “Fibre and bowel transit times,” British Journal of Nutrition, vol. 45, no. 1, pp. 77–82, 1981.
[32]
M. A. Sanjoaquin, P. N. Appleby, E. A. Spencer, and T. J. Key, “Nutrition and lifestyle in relation to bowel movement frequency: a cross-sectional study of 20 630 men and women in EPIC-Oxford,” Public Health Nutrition, vol. 7, no. 1, pp. 77–83, 2004.
[33]
S. Krisnamurthy, M. M. Kelly, C. A. Rohrmann, and M. D. Schuffler, “Jejunal diverticulosis. A heterogenous disorder caused by a variety of abnormalities of smooth muscle or myenteric plexus,” Gastroenterology, vol. 85, no. 3, pp. 538–547, 1983.
