Imaging description

Duodenal diverticula are common, affecting up to 22% of the population [1]. They can be diagnostically challenging for two reasons. Firstly, uncomplicated diverticula can be mistaken for another emergent pathology requiring surgery, and secondly they can cause complications.

Almost all (95%) duodenal diverticula arise from the medial wall of the duodenum, mostly in the second and third parts, and they can be either congenital diverticula (so-called “intraluminal diverticula”) or, more commonly, pulsion type diverticula [1]. The most common location is adjacent to the entry point of the common bile duct into the duodenum, where they are termed “periampullary diverticula.”

The typical imaging appearance on CT or MRI is of a saccular outpouching from the medial wall of the duodenum, which may contain gas, a gas–fluid or gas-contrast level, or debris (Figures 63.1 and 63.2).

Duodenal diverticula rarely arise from the bulb of the duodenum; most that do are probably healed duodenal ulcers. Duodenal diverticula may mimic a duodenal ulcer, paraduodenal abscess, or duodenal injury with extraluminal gas (Figure 63.3). Complications of duodenal diverticula include bleeding, diverticulitis, perforation, and biliary duct obstruction (Figure 63.4) [1]