Symptomatic duodenal diverticulum.

To determine management guidelines for symptomatic duodenal diverticulum, we reviewed medical records of 26 patients. Complicated duodenal diverticulum was the only possible cause of symptoms-abdominal pain, fever and chills, melena, vomiting-in 18 patients. Ten patients improved with conservative management, and eight patients underwent diverticulectomy with or without various other procedures. Among the eight patients, one patient who had duodenal fistula died of respiratory complications on the second postoperative day. Symptoms recurred in two patients: One had a distal common bile duct (CBD) stricture and underwent choledochojejunostomy. In the other patient a CBD stone developed 3 years later, and choledocholithotomy and choledochojejunostomy were performed. Eight patients had associated gallstone disease as well as the diverticulum. Five of the eight had a history of operation for gallstone disease; four improved with conservative treatment, and one underwent choledochojejunostomy. Two patients were thought to have an innocent diverticulum and underwent cholecystectomy and choledocholithotomy only. One patient underwent diverticulectomy and sphincteroplasty for a CBD stone and pervaterian diverticulum. In conclusion, operations for duodenal diverticulum should be reserved for seriously complicated diverticula, and the surgeon should be aware that pervaterian diverticulum can be a cause of choledocholithiasis.