Purpose: To clarify the difference in clinical characteristics between juxtapapillary duodenal diverticulum (JPDD) and intradiverticular papillae (IDP) patients, we performed a clinical study comparing these 2 groups. Methords: Patients with duodenal diverticula located less than 2 cm from the papilla Vateri were divided into 2 groups [groups A (10 JPDD patients: 5 men and 5 women, 47 to 84 years of age; mean age: 67.3 years) and B (6 IDP patients; 4 men and 2 women, 52 to 89 years of age; mean age: 70.3 years)]. We retrospectively assessed differences in the clinical characteristics between groups A and B. Results: Clinical symptoms: Abdominal pain was detected in all patients in both groups. Fever and jaundice were more frequent in group B than A. Laboratory data (AST, ALT, AlP, LAP,γGTP, amylase, bilirubin) on admission: Abnormal values were more common in group B than group A. The frequency of the elevation of the serum values, such as ALP, LAP, and γGTP in group A was significantly lower than that in group B (p=0.010). Size of the diverticulum: Patients in group A had a smaller diverticulum than those in group B. Diameter of the common bile duct: Patients in group A had a narrower bile duct than those in group B. Sites of stones: Choledocholithiasis was more frequent in group B than group A. Kinds of stone: Calcium bilirubinate stones were more common in group B than group A. Bactobilia in the gallbladder was more frequent in group B than group A. Conclusions: Patients with IDP showed abnormal data in their clinical characteristics compared with those with JPDD. Especially, abnormal data on ALP, LAP andγGTP were clearly found in patients with IDP compared with those with JPDD.
A 77-year-old female with a 3-year history of left thigh pain and a diagnosis of hip osteoarthritis presented with worsening left thigh pain and the onset of lower abdominal pain and cold sweat. Computed tomography showed a left obturator hernia. The small bowel was not obstructed, and the obturator hernia was thought to contain the urinary bladder. Cystoscopy showed a recess in the left wall of the bladder, and cystography revealed protrusion of the bladder into the left obturator foramen. The patient was preoperatively diagnosed with obturator hernia of the bladder. Repair was performed using the midline preperitoneal approach. Within the obturator foramen, there was a hernia sac composed of thick peritoneum with the bladder lying along the medial wall of the sac. Intraoperative diagnosis was paraperitoneal bladder hernia through the obturator foramen. The obturator foramen was repaired with a polypropylene mesh, which was placed in the preperitoneal space and fixed to Cooperʼs ligament. We report a rare case of obturator hernia of the bladder treated by midline preperitoneal approach.