Periampullary Diverticulectomy

Abstract

Although the duodenal diverticulum, which occurs in about 15 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 widenecked lesions. In the absence of a muscular coat the diverticulum is unable to expel food particles. This sequence of events may lead to ulceration and bleeding into the gastrointestinal tract, compression of the common bile duct (CBD) with episodes of cholangitis, recurrent pancreatitis, as well as perforation of the diverticulum with abscess formation or peritonitis.