Abstract
An 18-year-old woman with intraluminal duodenal diverticulum (IDD) and chronic obstructive pancreatitis suffered occasional nausea and had a 6-year history of episodes of increasingly upper abdominal pain. Upper gastrointestinal radiography showed a pocket-like lesion extending caudally in the second portion of the duodenum. Magnetic resonance cholangiopancreatography revealed stricture of the main pancreatic duct at the pancreatic head and upstream dilation. A preoperative diagnosis of IDD and chronic obstructive pancreatitis was made, necessitating excision of the IDD at duodenotomy and a Roux-Y lateral pancreaticojejunostomy. Symptoms completely disappeared and pancreatic exocrine function recovered to within normal ranges. In the literature, 18 cases of pancreatitis combined with IDD have been reported thus far and most were treated with excision of the IDD surgically or endoscopically. In our case, pancreaticojejunostomy was needed to eliminate pancreatitis, because stricture of the pancreatic duct was present at the fusion of forsal and ventral pancreatic ducts. Such strictures have been reported mostly associated with congenital anomalies. We concluded that chronic obstructive pancreatitis with IDD was caused by incomplete fusion of the pancreatic ducts.
