Intraluminal duodenal diverticulum
The noncontrastenhanced computed tomography (CT)
image demonstrates dilation of the second and third portions of the duodenum
with internal fluid density. After administration of oral contrast material, a
thin soft-tissue structure is seen circumferentially within the lumen of the
duodenum, outlined by oral contrast material on both sides. A frontal view of
the stomach from an upper gastrointestinal (GI) series demonstrates a thin, smooth-walled,
saccular structure within the second and third portions of the duodenum. The
majority of the contrast material is located within the saccular structure with
a small amount of surrounding intraduodenal contrast material.
Intraluminal duodenal diverticula (IDD) represent congenital
malformations, which arise from the second portion of the duodenum due to
faulty recanalization of the foregut during the seventh week of gestation. They
represent progressive elongation of a duodenal web or diaphragm secondary to
chronic antegrade propulsive pressure.
As IDDs are either attached to only a portion of the duodenal wall or are
fenestrated when circumferentially attached, they do not result in complete
obstruction of the duodenum and are often not diagnosed during childhood. Eventually
they present with abdominal pain, nausea/vomiting, a sense of epigastric
fullness, and occasionally symptoms of pancreatitis.
Classically IDDs have been diagnosed through the use of a barium upper GI
series, which demonstrates a contrast-filled, smooth, thin-walled sac
projecting into the second and third portion of the duodenum, often referred to
as the duodenal wind sock sign. Due to the widespread availability of CT,
radiologists should be familiar with the cross-sectional appearance of these
malformations. CT should demonstrate luminal dilation and a concentric,
double-walled appearance of the third portion of the duodenum. The blind ending
sac may be best appreciated on coronal or axial images.
Treatment consists of endoscopic or surgical resection, often depending
on the extent of attachment to the second portion of the duodenum.
- Johnston P, Desser TS, Bastidas JA,
et al. MDCT of Intraluminal “windsock” duodenal diverticulum with surgical
correlation and multiplanar reconstruction. AJR Am J Roentgenol. 2004;183:249-250.
- Harthun NL, Morse JH, Shaffer HA Jr., et al. Duodenal obstruction caused by intraluminal duodenal diverticulum and annular pancreas in an adult. Gastrointest Endosc. 2002;55:940-943.
- Lawler LP, Lillemoe KD, Fishman EK. Multidetector
row computed tomography and volume rendering of an adult duodenal intraluminal
diverticulum. J Comput Assist Tomogr. 2003;27:619-621.