Intraluminal duodenal diverticulum with refractory pancreatitis successfully treated by endoscopic diverticulectomy

摘要

The current report presents a rare case of intraluminal duodenal diverticulum (IDD), which is a congenital anomaly whereby the formation of a pocket-like diverticulum causes intestinal obstruction and/or refractory pancreatitis. The present case was cured by endoscopic resection with a two-channel procedure. A 33-year-old woman was admitted to Asahikawa Red Cross Hospital due to frequent epigastralgia. Blood examination revealed high levels of serum amylase (2278 IU/L) and lipase (7227 U/L). Computed tomography showed swelling of the pancreas and an intussusception-like change of the duodenum. She was diagnosed to have acute pancreatitis. After improving the pancreatitis with gabexate mesilate, gas-troduodenoscopy detected a pocket-like lesion beside the true lumen in the duodenum. The major Vater's papilla was observed at the septum separating the pocket-like lesion. The pocket-like lesion was easily observed by pulling the bottom of the lesion (Fig. 1A,B). Barium duodenography revealed a 4-cm stagnation framed by a clear and smooth translucent line (Fig. S1). The patient was diagnosed with IDD. Magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography revealed normal bile and pancreatic duct structures without ectopic ducts in the pocket-like lesion.