A clinical case of surgical treatment of duodenal diverticulum in a 15-year-old girl

Abstract

Introduction. Duodenal diverticula account for about 10% of all diverticula in the gastrointestinal tract and occupy the second place in the incidence structure after colon diverticula. They are characterized by the asymptomatic course, as a result of which they are often detected by chance. Clinical manifestations of duodenal diverticula inflammation are not typical, and this diagnosis is a diagnosis of exclusion. Most often, they are revealed after developed complications: first place - strictures of the diverticulum with intestinal obstruction as a result of chronic inflammation, then - bleeding associated with the possible ectopia of pancreatic tissue and peritonitis in case of diverticulum perforation.
Material and methods. Since 1972, 19 patients have been treated for duodenal diverticula at Rostov State Medical University (Rostov-on-Don) and Regional Children's Clinical Hospital (Rostov-on-Don). The main clinical manifestation, almost in all cases, was bleeding. X-ray with contrast examination of the gastrointestinal tract was made almost to all patients. If the contrast leakage into the duodenum was seen at the examination, plus clinical manifestations, it was an indication for surgical management. A clinical case of girl I. ,15 y.o., is given as an example.
Conclusion. Duodenal diverticulum is extremely rare in childhood. So as to verify the diagnosis, it is necessary to follow the examination algorithm, which promotes the choice and tactics of treatment. To the authors' opinion, the key role in the diagnostics of the discussed pathology belongs to fibrogastroduodenoscopy. An indication for surgical treatment is the combination of instrumental diagnostic findings and clinical manifestations. During the duodenal diverticulum resection, surgeons must have a clear visualization of large duodenal papilla localization relative to its mouth.

Keywords

diverticulum / duodenum / diverticulum resection

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Russian Journal of Pediatric Surgery