[Surgical treatment of internal duodenal diverticulum. Report of 2 clinical cases]

Internal duodenal diverticulum is a rare disease. Nowadays, less than 100 cases are reported in Western literature. Even if it is a pathology of malformative origin, the first clinical manifestations occur quite always during the III decade. Main symptom is a violent, suddenly arisen, abdominal colic, often associated with meals and with spontaneous remission. Frequency of accesses is variable in time; in most serious cases, colics are so close to cause a considerable reduction of nutrition. Among diagnostical means, very useful are Rx enema (that offers pathognomonical images) and endoscopy, by which the formation can be visualized directly and its connection with papilla can be delineated. In some rare cases, differential diagnosis has to be made with cystic dilatations of bile duct, and particularly with type III according to Alonso-Lej classification or choledochocele. When such a distinction is not possible, differential diagnosis will be made on the basis of histological examination of the type of mucosa present in the internal aspect of the diverticulum. Therapy of symptomatic forms is surgery. The technique of choice is transduodenal diverticulectomy. Cannulation of bile duct is a useful means to found the papilla during intervention, to protect duodenal suture in the postoperative period and to control it radiologically. Two cases of internal duodenal diverticulum operated on in the last 2 years are described and diagnostical and therapeutical items are discussed.