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Ampullary duodenal diverticulum and cholangitis
Joaquim Mendes Castilho Netto1, Manlio Basilio Speranzini
1Surgical Clinical Service, Hospital Universitário, Department of Medical Sciences, Universidade de Taubaté, Taubaté, São Paulo, Brazil. jmcnetto@uol.com.br
Sao Paulo Medical Journal = Revista Paulista De Medicina
|November 5, 2003
Summary
Ampullary duodenal diverticulum can cause cholangitis without typical signs like gallstones. Surgical biliary-enteric bypass effectively treated this rare complication in a diabetic patient.
Area of Science:
- Gastroenterology
- Hepatobiliary Surgery
Background:
- Ampullary duodenal diverticula are uncommon causes of biliary complications.
- Cholangitis associated with ampullary diverticula, especially without gallstones or biliary dilation, is rarely reported.
Observation:
- A 74-year-old female with a history of cholecystectomy presented with jaundice, fever, and right upper quadrant pain (Charcot's triad).
- Diagnostic imaging, including ultrasound, CT, and ERCP, was performed.
- The patient had no gallstones in the common bile duct, biliary tree ectasia, or hyperamylasemia.
Findings:
- Surgical intervention involved a choledochojejunostomy using a Roux-en-y loop.
- Postoperative recovery was uneventful.
- A DISIDA scan confirmed successful biliary excretion, and the patient remained asymptomatic.
Implications:
- This case highlights the importance of considering ampullary duodenal diverticulum as a cause of cholangitis, even in atypical presentations.
- Biliary-enteric bypass can be a successful treatment modality for this rare condition.
- Early diagnosis and surgical management are crucial for favorable outcomes.