Invited commentary

Perforated duodenal diverticulum

Duodenal diverticula are present in up to 20 per cent of the population but few patients require surgery for acute complications. Perforation is the rarest of these complications; only 101 affected patients have been reported in the world literature. These reports of perforated duodenal diverticulum are reviewed and strategies for the diagnosis and management of this unusual condition are discussed.

The continuing clinical enigma of duodenal diverticulum

Seventy-one cases of duodenal diverticula were reviewed. Fifty-four or 76 percent were associated with symptoms of varying severity. Forty (74 percent) of the symptoms were considered serious. These included bleeding, severe abdominal pain, weight loss, chills, fever and jaundice, and evidence of right upper quadrant peritonitis. Nineteen patients were operated on and gallstones were found in 12. Multiple operative procedures because of recurring symptoms characterized the entire series. Relief of symptoms was achieved only in those who had diverticulectomy or a sidetracking operation. The difficulties of identifying this lesion as the source of the patient's symptoms and the indications for its removal are emphasized.