Duodenum and duodenal diverticulum

Duodenum and Duodenal Diverticulum

By Rajasri Manimaran

Group 2

Anatomy • C shaped• Initial part of

small intestine• Continuous with

stomach• Situated in

epigastric and umbilical region

Blood supply

Lymph drainage Pyloric node

Hepatic node

Celiac node

Superior mesenteric node

Pathology • Various disorders :

oDuodenal ulceroDuodenal diverticulumoDuodenal obstructionoDuodenitis

Duodenal Diverticulum

• It is a pouch attached to the duodenum, the first part of the small intestine just pass the stomach.

• 2 type : intramural and extramural

Extramural diverticulum

• The common type which is present in at least 6% of individuals, is one that sticks out from the duodenum, similar to the more common colonic diverticula.

• This is referred to as an "extramural" diverticulum.

• Extramural diverticula may vary in size from a few millimeters to a few centimeters.

• They usually are located in the area around the Papilla of Vater where the bile and pancreatic ducts enter the duodenum.

Intramural diverticulum

• A second, rare type of diverticulum is referred to as an "intramural" diverticulum. It does not protrude from the duodenum.

• Rather, it protrudes into the duodenal lumen (the hollow inside of the duodenum through which digesting food flows).

• Both types of diverticula, extramural and intramural, communicate with the lumen of the duodenum so that contents of the duodenum can enter the diverticulum.

Symptoms • 80 to 90% of patients are asymptomatic• One of the main symptoms include upper

abdominal pain, right upper quadrant tenderness

• Often accompanied by a sense of fullness or discomfort, and may have nausea, vomiting, or vomiting

• Symptoms tend to appear in the diet or exacerbate, relieved by vomiting.

• Diverticulum oppression of the common bile duct in addition to intermittent abdominal pain, and can be intermittent jaundice.

Symptoms

Causes • The cause of extramural diverticula is

not definitely known; however, they are believed to be acquired (not present from birth) due to a herniation (protrusion) of the duodenum through a defect in the muscle of the wall of the duodenum, perhaps in an area where arteries pass through the intestinal muscle to nourish the lining of the intestine.

• Due to the different types of diverticula, its causes are also different.

Congenital diverticulum

• Congenital diverticulum: a rare congenital developmental abnormalities at birth that exist.

• Intestinal mucosa submucosa and muscular the diverticular wall structure including identical with the normal intestinal wall, also known as a true diverticulum.

Primary and secondary

diverticulum • Primary diverticulum: congenital

anatomical defects due to part of the bowel wall, out due to the the intestines increased pressure leaving the premises intestinal mucosa and submucosa tissue prolapse formation of diverticula. Such diverticular wall muscularis tissue is absent or weak.

• Secondary diverticulum: duodenal ulcer scar contraction or the chronic cholecystitis adhesions caused by traction, it occurred in the duodenum, the first one, also known as false diverticula.

Complications • If the diverticulum is very close to the Ampulla of

Vater, patients more frequently develop gallstones, particularly in the bile duct, and may develop all of the complications of gallstones:o biliary colic (the typical pain of obstruction of the

bile ducts),o cholecystitis (inflammation of the gallbladder), ando cholangitis (inflammation of the bile ducts due to

the spread of bacteria into the ducts from the duodenum).

• Pancreatitis also may occur. These complications are believed to be due to interference by the diverticula with the normal function of the bile and pancreatic ducts.

Diagnosis • Barium X rays• Endoscopy• Ultrasonography• Computerized tomographic (CT) scans• Magnetic resonance imaging (MRI)

studies

Barium X ray

CT scan and endoscopy

MRI scan

Treatment • If treatment is necessary, extramural

diverticula can be surgically removed from the outside of the duodenum.

• The diverticula also may be inverted into the lumen of the duodenum and removed through an incision in the wall of the duodenum.

• (Sometimes, the diverticulum is inverted but left attached to the wall of the duodenum and protruding into the duodenum.)

• In case of multiple diverticula, billroth II gastrectomy is performed

Removal of diverticulum

Billroth 2 gastrectomy