The Valley Hospital, Ridgewood, NJ, 07450, USA.
J Robot Surg. 2010 Jan;3(4):249-52. doi: 10.1007/s11701-009-0167-1. Epub 2010 Jan 14.
The duodenum is the second most common site for diverticulae, after the colon. They are common after the fifth decade and usually asymptomatic. Ten percent of patients present with symptoms, which include abdominal pain, hemorrhage, duodenal obstruction, diverticulitis, perforation, pancreatitis, and obstructive jaundice. After a thorough search of medline we present, for the first time, a case of obstructive jaundice secondary to duodenal diverticulum compressing the common bile duct. It was managed by laparobotic duodenal diverticulectomy with choledocho-duodenostomy. The operative technique is discussed.
A 78-year-old female was found to have an abnormal cholestatic liver function profile and dilated common bile duct during workup for upper abdominal pain. CT scan showed dilated common bile duct measuring 2.7 cm with suspected ampullary mass. Endoscopic ultrasound showed a large diverticulum next to the ampulla. Upper GI endoscopy confirmed duodenal diverticulum, arising from the second part of the duodenum. Laparobotic duodenal diverticulectomy and choledochoduodenostomy were performed. Her post-operative course was complicated by Clostridium difficile diarrhea, treated with metronidazole and she was discharged home on the 6th postoperative day. Follow-up at 18 months demonstrated that she was well.
Obstructive jaundice due to compression by a duodenal diverticulum is rare. It poses a diagnostic challenge and requires technically demanding surgical and endoscopic intervention. Robotic surgery has revolutionized the field of minimally invasive surgery by improving vision and motion control. Robotic duodenal diverticulectomy and choledocho-duodenostomy are safe and feasible.
十二指肠是继结肠之后憩室第二常见的部位。它们在五十岁以后很常见，通常无症状。百分之十的患者出现症状，包括腹痛、出血、十二指肠梗阻、憩室炎、穿孔、胰腺炎和阻塞性黄疸。在彻底搜索了 Medline 之后，我们首次提出了一例因十二指肠憩室压迫胆总管而导致阻塞性黄疸的病例。通过腹腔镜十二指肠憩室切除术和胆总管十二指肠吻合术进行了治疗。讨论了手术技术。
一名 78 岁女性在上腹部疼痛的检查过程中发现肝功能异常和胆总管扩张。CT 扫描显示胆总管扩张至 2.7 厘米，怀疑壶腹有肿块。超声内镜显示壶腹旁有一个大憩室。上消化道内镜证实为十二指肠憩室，起源于十二指肠第二段。进行了腹腔镜十二指肠憩室切除术和胆总管十二指肠吻合术。术后她出现艰难梭菌腹泻，用甲硝唑治疗，术后第 6 天出院回家。18 个月的随访显示她恢复良好。
由十二指肠憩室压迫引起的阻塞性黄疸很少见。它构成了诊断上的挑战，需要技术上要求很高的手术和内镜干预。机器人手术通过改善视觉和运动控制，彻底改变了微创外科领域。机器人十二指肠憩室切除术和胆总管十二指肠吻合术是安全可行的。
