To the Editor.—Periampullary duodenal diverticula are said to cause biliopancreatic stasis and bacterial overgrowth, which may result in pancreatitis, cholangitis, and gallstone formation.1 Different operative interventions have been described, including sphincteroplasty, choledochoduodenostomy, Billroth II gastrectomy, and, recently, duodenojejunostomy.2 An example of the latter procedure is described in the following case report.
Report of a Case.—A 54-year-old man was referred with persistent nausea, vomiting, and hyperamylasemia one month following small-bowel resection for jejunal diverticulitis. He had been hospitalized following a prolonged illness with abdominal distress, nausea, vomiting, and weight loss. Examination revealed a malnourished man with healed abdominal incisions and no tenderness. The serum amylase level was 120 U/L (normal, 20 to 80 U/L). Abdominal ultrasonography and computed tomography were normal. Upper gastrointestinal tract series showed two large diverticula, medially, in the second portion of the duodenum. Endoscopic retrograde cholangiopancreatography (ERCP) confirmed the diverticula and showed normal
SHALLMAN RW, KOLTS RL. Duodenojejunostomy for Pancreatitis Secondary to Periampullary Duodenal Diverticula. Arch Surg. 1987;122(7):850-851. doi:10.1001/archsurg.1987.01400190116030