Management of duodenal diverticula.

Duodenal diverticula are not uncommon. Uncomplicated diverticula require no treatment. In the period 1970 to 1980, 104 patients with symptoms presented at the Vancouver General Hospital and the Swedish Hospital in Seattle. Of these, 26% presented with pain and 24% with anemia. Malabsorption and benign tumours were noted infrequently. Fifteen patients were treated surgically for pain, perforation, hemorrhage, tumour, blind loop syndrome and obstruction of the duodenum, biliary tract or pancreatic duct. Two patients died. The second part of the duodenum was involved in 82% and the third part in 10%. Anatomical variations are common in the area of the ampulla; these should be anticipated before operation. Surgical procedures in the area may be technically demanding and associated with high mortality and morbidity. The choice of procedure depends on the urgency and nature of the complication of the diverticulum. Endoscopic retrograde cholangiopancreatography can play a role in evaluating the possible significance of the diverticulum and the anatomy of the area. In some cases endoscopic sphincterotomy may be possible. In some situations diverticulectomy is contraindicated.