Abstract
A 66-year-old woman had undergone a total gastrectomy for gastric cancer at the age of 55 years. She was now evaluated in our emergency room for several episodes of vomiting and epigastric pain after eating supper. Blood tests showed an inflammatory response and elevated hepatobiliary and pancreatic enzymes. Abdominal computed tomography (CT) showed a 45-mm, high-density mass in a duodenal diverticulum, dilation of the common bile duct, and a slight increase in peripancreatic fat density. The patient was diagnosed with acute pancreatitis and cholangitis due to a duodenal diverticulum calculus and was hospitalized.
The patient was treated conservatively, but abdominal CT on hospital day 2 showed dislodgement of the calculus, its incarceration in the horizontal duodenum, and afferent loop syndrome. In addition, the increased peripancreatic fat density extended bilaterally to Gerota's fascia, and severe pancreatitis was diagnosed. Emergency small bowel endoscopy was performed, and the intestinal calculus was crushed. The patient required multidisciplinary therapy for severe pancreatitis, but she died from multiple organ failure on day 14.
No cases of acute pancreatitis and cholangitis due to a duodenal diverticulum calculus with subsequent dislodgement of the diverticulum calculus leading to afferent loop syndrome have been previously reported. This case is described along with a discussion of the relevant literature.
