Periampullary Diverticulectomy

Abstract

Although the duodenal diverticulum, which occurs in about 1 % of all gastrointestinal X-ray studies, is not an uncommon condition, Whitcomb reported that only one serious complication requiring surgery occurred in a series of 1,064 patients that he studied. More than two-thirds of all duodenal diverticula occur within 2 cm of Vater’s ampulla (Eggert, Teichmann, and Wittmann; Thompson). While the pseudodiverticulum that results from the healing of a duodenal ulcer contains a seromuscular coat as well as mucosa, the periampullary diverticulum, being a true diverticulum, has a sac composed only of mucosa and submucosa. It ranges in size between 0.5 and 6.0 cm, in most cases. Diverticula that have a narrow entrance into the duodenum are more likely to produce symptoms than are wide-necked lesions. In the absence of a muscular coat the diverticulum is unable to expel food particles.