Duodenal Diverticulosis as an Unusual Cause of Severe Abdominal Pain

Abstract

Duodenal diverticulosis (DD) is a rare disease in children, and its etiology is unknown. Here, we report a 13-year-old boy with severe abdominal pain. A diagnosis of DD was made based on clinical and image findings. He responds to analgesic, antibiotic and nutritional treatment. The early identification of child with DD as potential cause of severe abdominal pain with pancreatitis is important - because delayed diagnosis might lead to irreversible consequences - to avoid morbidity and mortality, and unnecessary surgery.

Keywords: abdominal pain; child; diverticulitis; duodenal diverticulosis.

Figure 1. MRI selected images: Coronal T2WI (a) and axial T1WI (b) with fat sat and post IV contrast administration demonstrate the duodenal diverticula (green arrows) with air fluid level. The MR images confirm the diverticulitis changes and exclude the pancreatic pathologies. Note the distended CBD (red arrow).

Figure 2. Selected frontal radiograph from gastrografin swallow study demonstrates the contrast filled out-pouch from the second part of the duodenum (star). Note the narrowing of the duodenal lumen with thumb printing (arrows) changes suggestive of bowel wall edema.

Figure 3. Selected contrast enhanced CT scan of the abdomen in axial (a), with sagittal (b) and coronal (c) reconstructed images, demonstrates the duodenal diverticuli (green and red arrows) outpouching from the second duodenum, medial in location. The larger diverticulum shows air fluid level. The diverticular neck is better depicted in the coronal plane (blue arrow). Noted are the periduodenal inflammatory changes with bowel wall thickening and edema.