[Solitary duodenal diverticulum with enterolith as a rare cause of acute abdomen]

Abstract

Diverticula of the duodenum are not rare and in the most cases without any symptoms. The incidence of duodenal diverticula in autopsies is known to be 20-22%. Only in a very small number of cases, they are complicated and therefore clinically presented by diverticulitis, perforation, hemorrhage, pancreatitis, or biliary obstruction. The most uncommon complication is the enterolith formed within the diverticulum. In all reported cases, the enterolith--formation was associated with small bowel obstruction or perforation. Complications of duodenal diverticula have a high mortality rate (33-48%) that could be due to difficulties in diagnostics and the adequate surgical procedure. In our case report, a patient presented at our institution with symptoms of an acute abdomen caused by an enterolith inside a solitary duodenal diverticulum "ante perforationem". The ultrasound and the CT scan of the abdomen showed free intraabdominal fluid beside the duodenum, the exact diagnosis however was not made. The indication for laparotomy was given by the clinical signs. The dicerticula was resected and ligated.