Journal Article

O.J. in the Small Bowel

Gupta, Nikita, Green, Jason, Iqbal, Sadat, Pourriahi, Mahbod, Pourriahi, Mayhar, South, Christopher D

2018

Overview

We present a unique case of partial small bowel obstruction that is secondary to a foreign body in the duodenal diverticulum and impingement on the third segment. An 84 year-old Asian female, with a past medical history of type II Diabetes Mellitus and gastro-esophageal reflux disease, presented to the emergency department with acute onset of nausea and ten episodes of non-bloody emesis. She complained of mild dull, generalized abdominal pain. Physical exam was notable for mild abdominal distention and epigastric pain on palpation. A CT of the abdomen with contrast demonstrated gastric distention without progression of contrast past the second portion of duodenum. She was kept NPO and a nasogastric tube was inserted for gastric and bowel decompression. An EGD was performed; it was advanced 5cm beyond the papilla to the third portion of duodenum where a single large diverticulum full of debris was observed. Forceps were used to remove the debris, which was identified as an un-chewed orange slice. Patient was discharged home that same day after significant improvement post procedure. Duodenal diverticula are less common than colonic diverticula with a prevalence of 5 to 10% in the general population.1 Diverticula are believed to be due to advanced aging.2 While most patients are asymptomatic, some complications include bleeding, obstruction, and/or perforation.3 CT is the modality of choice for identifying the diverticulum. 3 Conservative management consists of nasogastric decompression and antibiotics if there is obstruction or abscess. 3 Often surgical approach is needed if there is perforation. 3 Endoscopic approach can be used for direct visualization, extraction, and/or excision of the diverticulum especially if there is no abscess. 4 1. Metcalfe MJ, Rashid TG, Bird Rle. Isolated perforation of a duodenal diverticulum following blunt abdominal trauma. JEmerg Trauma Shock. 2010; 3(1):79-81 2. Bincy GM, Satheesha NB, Snigdha M. Presence of a simple lateral extramural diverticulum at the junction of second and third parts of the duodenum -- a case report. Int J Anat Variations. 2012; 5, 132-133 3. Martinez-Cecilia D, Arjona-Sanchez A, Gomez-Alvarez M. Conservative management of perforated duodenal diverticulum: a case report and review of the literature. World J Gastroenterol. 2009; 14(12):1949-51. 4. Sathyanarayana SA, Agaba E, Kamath V. Duodenal diverticulum: an unusual cause of high-grade duodenal obstruction. Am Surg. 2011; 77(7):E138-9.

• Publisher: Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins
• Subject: Abdomen / Abscesses / Gastroenterology / Small intestine