Juxtapapillary Duodenal Diverticulum Type Ii, A Case of Surgical Treatment
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Abstract
Background: The duodenum represents the second most frequent site of intestinal diverticula after the colon, with approximately 75% occurring in the second portion, typically near the papilla of Vater. Most individuals with a juxtapapillary duodenal diverticulum remain asymptomatic, in which case conservative treatment is recommended. However, if conservative measures are unsuccessful or complications arise, surgical intervention may be considered.
Objective: Conduct a literature review examining the evidence on the most effective treatment strategies for this condition, and compare those findings with the management approach implemented in our unit, based on a case report.
Case report: A 57-year-old female initially diagnosed with choledocholithiasis and treated with ERCP without symptom improvement, who subsequently underwent further evaluation leading to the diagnosis of a type II juxtapapillary duodenal diverticulum and common bile duct stenosis due to extrinsic compression.
Conclusion: Although conservative management remains the standard approach for treating juxtapapillary duodenal diverticula, definitive surgical intervention can be a safe and effective option in carefully selected and individualized cases.
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References
I. Mattacchione S, Mezzetti G. Duodenal diverticulitis: a crossroad between conservative therapy and surgery: a case report. J Med Case Rep [Internet]. 2025;19(1):154.
II. Mazahreh TS, Afaneh MW, Husein A. Conservative management of perforated duodenal diverticulum: A case report and narrative review. Open Access Emerg Med [Internet]. 2025;17:345–52.
III. Arayakarnkul S, Inal E, Mehta A, Ngamruengphong S. A tale of 2 tics: Endoscopic treatment of perforated periampullary diverticulum within a giant duodenal diverticulum. ACG Case Rep J [Internet]. 2023;10(11):e01198.
IV. Dávila-Ruiz EO, García-Manzano RA, Barker-Antonio A, Martínez-Santiago NY, Isidoro-Hernández D, Sánchez-Guerrero RI. Ictericia obstructiva intermitente o síndrome de Lemmel: reporte de caso y revisión de la literatura. Cir Cir. 2020;88(Suppl 2):60-65. English.
doi: 10.24875/CIRU.20000332. PMID: 33284277.
V. Love JS, Yellen M, Melitas C, Yazici C, Zar F. Diagnosis and Management of Lemmel Syndrome: An Unusual Presentation and Literature Review. Case Rep Gastroenterol. 2022 Dec 16;16(3):663-674. doi: 10.1159/000528031. PMID: 36605730; PMCID: PMC9808136.
VI. Houssni JE, Cherraqi A, Chehrastane R, Jellal S, Hsain IH, Oukacem S, Adjou N, Saouab R, En Nouali H, Fenni JE. Lemmel syndrome: an unusual cause of biliary obstruction secondary to a duodenal juxta-ampullary diverticulum: a report of two cases. Radiol Case Rep. 2023 Jan 10;18(3):1147-1151.
doi: 10.1016/j.radcr.2022.11.013. PMID: 36660561; PMCID: PMC9842954.
VII. Alzerwi NAN. Recurrent ascending cholangitis with acute pancreatitis and pancreatic atrophy caused by a juxtapapillary duodenal diverticulum: A case report and literature review. Medicine (Baltimore). 2020 Jul 2;99(27):e21111.
doi: 10.1097/MD.0000000000021111. PMID: 32629744; PMCID: PMC7337422.