Abdominal Radiology

, Volume 43, Issue 5, pp 1270–1270 | Cite as

Cloverleaf duodenum

  • Robert D’Agostino
Classics in Abdominal Imaging

Lewis Gregory Cole, M.D., first described this peculiar deformity of the duodenal bulb. He insisted that this conformation was characteristic of duodenal ulcer in the vast majority of cases, and periduodenal disease in some others. In 1922, it was hailed as a pathognomonic sign to a round of applause [1].

Because of the recurrent course of duodenal ulcer disease before the advent of H-2 blockers and proton-pump inhibitors, after several episodes of ulceration and healing, permanent strands of scar tissue constrict the lumen of the duodenal bulb limiting its normal distensibility [2]. The resultant bulging of the fornices creates “pseudodiverticula” along the duodenal bulb margins, forming the classic cloverleaf or trifoliate appearance seen during a fluoroscopic examination (Fig. 1).
Fig. 1

Cloverleaf deformity of the duodenum on upper GI series

Named after the plants of the genus Trifolium, most are familiar with the three leaf (Fig. 2), and the rare four leaf clover.
Fig. 2

Cloverleaf and shadow

Although some maybe asymptomatic [3], patients with this deformity can present with symptoms of gastric outlet obstruction [4].


  1. 1.
    Carmen RD (1922) Errors in the roentogenologic diagnosis of duodenal ulcer. J Radiol 3(5):163–169Google Scholar
  2. 2.
    Novelline RA (2004) Squire’s fundamentals of radiology, 6th edn. Boston: Harvard University PressGoogle Scholar
  3. 3.
    Bilbao MK, Frische LH, Rösch J, Benson JA Jr, Dotter CT (1971) Postbulbar duodenal ulcer and ring-stricture cause and effect. Radiology 100:27–35CrossRefPubMedGoogle Scholar
  4. 4.
    Freeman AH, Sala E (2007) Radiology of the stomach and duodenum. Berlin: SpringerGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  1. 1.Department of RadiologyThe University of Vermont Medical CenterBurlingtonUSA

Personalised recommendations