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Li Z, Wang D, Hu J, Zhang G, Sun J. Multi-slice spiral computed tomography diagnosis of juxta-papillary duodenal diverticulum and its relationship with biliopancreatic diseases. Technol Health Care 2024; 32:1-8. [PMID: 37270822 PMCID: PMC10789348 DOI: 10.3233/thc-220742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 02/07/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Juxta-papillary duodenal diverticula (JPDD) are common but are usually asymptomatic, and they are often diagnosed by coincidence. OBJECTIVE To analyse the anatomy and classification of JPDD and its relationship with biliary and pancreatic disorders, and to explore the diagnostic value of multi-slice spiral computed tomography (MSCT) in patients with JPDD. METHODS The imaging data of patients with JPDD, which was obtained via abdominal computed tomography examination and confirmed via gastroscopy and/or upper gastrointestinal barium enema, in our hospital from 1 January 2019 to 31 December 2020 were retrospectively analysed. All patients were scanned using MSCT, and the imaging findings, classification and grading were analysed. RESULTS A total of 119 duodenal diverticula were detected in 96 patients, including 73 single diverticula and 23 multiple diverticula. The imaging findings were mainly cystic lesions of the inner wall of the duodenum protruding to the outside of the cavity. The thin layer showed a narrow neck connected with the duodenal cavity, and the shape and size of the diverticula were different: 67 central-type cases and 29 peripheral-type cases. There were 50 cases of type I, 33 cases of type II, 19 cases of type III and six cases of type IV. Furthermore, there were seven small, 87 medium and 14 large diverticula. The differences in the location and size of the JPDD in MSCT grading were statistically significant (P< 0.05). CONCLUSION The MSCT method has an important diagnostic value for the classification of JPDD, and MSCT images are helpful in the clinical evaluation of patients with JPDD and the selection of treatment options.
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Affiliation(s)
- Zhongwei Li
- Department of Radiology, Yantaishan Hospital, Yantai, Shandong, China
| | - Di Wang
- Department of Radiology, Yantaishan Hospital, Yantai, Shandong, China
- Department of Radiology, 970 Hospital of the PLA JLSF, Yantai, Shandong, China
| | - Jiashou Hu
- Department of Radiology, 970 Hospital of the PLA JLSF, Yantai, Shandong, China
| | - Guowei Zhang
- Department of Radiology, Yantaishan Hospital, Yantai, Shandong, China
| | - Jinfeng Sun
- Department of Radiology, 970 Hospital of the PLA JLSF, Yantai, Shandong, China
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Shankar U, Bhandari P, Panchal A, Weeks D, Wu H, Chen F, Maheshwari N, Bansal R, Walfish A, Baum J, Jamidar PA, Aron J. Juxta-papillary duodenal diverticula are associated with pyogenic liver abscesses: a case control study. BMC Gastroenterol 2022; 22:52. [PMID: 35130860 PMCID: PMC8822858 DOI: 10.1186/s12876-022-02120-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 01/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Juxta-papillary duodenal diverticulum (JPDD) has been associated with obstructive jaundice and ascending cholangitis. Potential mechanisms include periampullary colonization of pathogenic bacteria and mechanical obstruction. However, the relation of JPDD with pyogenic liver abscess (PLA) has not been reported. Moreover, approximately one third of patients with PLA have no identifiable risk factors and are labelled as "cryptogenic". We hypothesized that JPDD is an unidentified risk factor for cryptogenic PLA and the aim of this study was to examine this association. METHODS We conducted a retrospective chart review to identify cases of PLA (n = 66) and compare those to matched controls (n = 66). 66 patients met the study inclusion criteria of a diagnosis of PLA using computerized tomography (CT) imaging and either positive culture or confirmed resolution after antibiotic therapy. Patients with diagnoses of amebic liver abscess, traumatic liver abscess, post cholecystectomy liver abscess, concurrent acute cholecystitis, and hepatobiliary malignancy were excluded. Controls were identified from a radiology database and matched one-to-one with the cases by age and sex. Demographic and clinical data was extracted from electronic medical records. CT scan images of all cases and controls were reviewed by a single expert radiologist to identify the presence of JPDD. Statistical tests including Chi-square and t-test with multiple logistic regression were used to examine the group differences in JPDD and other factors. RESULTS Among 132 study samples, 13.6% (9/66) of the cases were found to have JPDD, compared to 3.0% (2/66) among controls (p = 0.03). This corresponded to an odds ratio (OR) of 5.05 [OR 5.05; CI 1.05-24.4] on multiple logistic regression analysis. In addition, 1/3rd of PLA cases with JPDD had no other traditional risk factors (cryptogenic PLA). However, a statistically significant association of JPDD with cryptogenic PLA could not be established possibly because of a small number of cases. We found significantly high rate of diabetes mellitus (DM) (42.4%; n = 28/66) among cases compared to controls (21.2%; n = 14/66; p = 0.01). CONCLUSION We found a significant association between JPDD and PLA. We need studies with larger sample sizes to confirm this relationship and to explore if JPDD could be related to cryptogenic liver abscesses.
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Affiliation(s)
- Uday Shankar
- Gastroenterology Division, Department of Medicine, Icahn School of Medicine at Elmhurst Hospital, Elmhurst, NY, 11373, USA. .,Digestive Disease Center, Trinity Health of New England and St. Mary's Hospital, 133 Scovill Street, Suite 101, Waterbury, CT, 06706, USA.
| | - Priyanka Bhandari
- Department of Medicine, Icahn School of Medicine at Elmhurst Hospital, Elmhurst, NY, 11373, USA
| | - Ankur Panchal
- Department of Medicine, Icahn School of Medicine at Elmhurst Hospital, Elmhurst, NY, 11373, USA
| | - David Weeks
- Department of Radiology, Icahn School of Medicine at Elmhurst Hospital, Elmhurst, NY, 11373, USA
| | - Helen Wu
- Connecticut Convergence Institute, Department of Psychiatry, University of Connecticut Health Center, Farmington, CT, 06312, USA
| | - Fufei Chen
- Connecticut Convergence Institute, University of Connecticut Health Center, Farmington, CT, 06312, USA
| | - Narinder Maheshwari
- Department of Medicine, University of Connecticut Health Center, Farmington, CT, USA
| | - Raghav Bansal
- Gastroenterology Division, Department of Medicine, Icahn School of Medicine at Elmhurst Hospital, Elmhurst, NY, 11373, USA
| | - Aaron Walfish
- Gastroenterology Division, Department of Medicine, Icahn School of Medicine at Elmhurst Hospital, Elmhurst, NY, 11373, USA
| | - Joel Baum
- Gastroenterology Division, Department of Medicine, Icahn School of Medicine at Elmhurst Hospital, Elmhurst, NY, 11373, USA
| | - Priya A Jamidar
- Division of Digestive Diseases and Advanced Endoscopy, Yale University School of Medicine, New Haven, CT, USA
| | - Joshua Aron
- Gastroenterology Division, Department of Medicine, Icahn School of Medicine at Elmhurst Hospital, Elmhurst, NY, 11373, USA
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