RSS-Feed abonnieren
DOI: 10.1055/s-0030-1255704
© Georg Thieme Verlag KG Stuttgart · New York
Acute obstructive cholangitis caused by an enterolith in a duodenal diverticulum
M. InamoriMD, PhD
Gastroenterology Division
Yokohama City University School of Medicine
3-9 Fukuura
Kanazawa-ku
Yokohama
236-0004 Japan
Fax: +81-45-784-3546
eMail: inamorim@med.yokohama-cu.ac.jp
Publikationsverlauf
Publikationsdatum:
15. September 2010 (online)
Duodenal diverticula are common. While they are usually asymptomatic, several complications have been reported.
A 78-year-old man was admitted to our hospital with high-grade fever (39.6 ° C) and jaundice. His laboratory data showed liver dysfunction and elevations of the white blood cell count and serum C-reactive protein concentration. Abdominal ultrasonography demonstrated dilated biliary ducts. Abdominal computed tomography (CT) revealed a diverticulum in the second part of the duodenum ([Fig. 1]).
We suspected obstructive cholangitis. Endoscopic retrograde cholangiography (ERC) was performed. Gastrointestinal endoscopy revealed a periampullary diverticulum occupied by a yellow stone ([Fig. 2]).
ERC showed no abnormalities ([Fig. 3]).
Therefore, we made a diagnosis of biliary tract obstruction caused by an enterolith in the periampullary duodenal diverticulum. We performed successful endoscopic removal of the enterolith ([Fig. 4]).
The extracted enterolith was oval-shaped, yellowish in color, measured approximately 3 cm in diameter, and had a hard outer rim with an irregular surface ([Fig. 5]).
Separate layers within the wall were appreciated and there was no evidence of any nidus, such as a fruit pit.
Infrared absorption spectrophotometry showed that the enterolith consisted mainly of deoxycholic acid ([Fig. 6]).
Duodenal diverticula are commonly encountered and are generally regarded as clinically insignificant entities. They can, however, sometimes produce serious complications, including diverticulitis, perforation, hemorrhage, biliary and/or pancreatic obstruction, partial duodenal obstruction, fistula formation with adjacent organs, diarrhea secondary to blind loop syndrome, and enterolith formation [1].
Enterolith formation is known to occur within regions of stasis, such as Meckel’s diverticulum or a blind loop, or as a result of stricture due to Crohn’s disease or tuberculosis. Duodenal diverticula may also represent such a region of stasis [2].
In conclusion, we performed successful endoscopic removal of an enterolith in a duodenal diverticulum. Obstructive cholangitis caused by an enterolith in a periampullary diverticulum is rare, but is an important entity for endoscopists.
Competing interests: None
Endoscopy_UCTN_Code_CCL_1AZ_2AI
#References
- 1 Eeckhout G, Vanstiphout J, Van Pottelbergh I. et al . Endoscopic treatment of a perforated duodenal diverticulum. Endoscopy. 2000; 32 991-993
- 2 Shocket E, Simon S A. Small bowel obstruction due to enterolith (bezoar) formed in a duodenal diverticulum: a case report and review of the literature. Am J Gastroenterol. 1982; 77 621-624
M. InamoriMD, PhD
Gastroenterology Division
Yokohama City University School of Medicine
3-9 Fukuura
Kanazawa-ku
Yokohama
236-0004 Japan
Fax: +81-45-784-3546
eMail: inamorim@med.yokohama-cu.ac.jp
References
- 1 Eeckhout G, Vanstiphout J, Van Pottelbergh I. et al . Endoscopic treatment of a perforated duodenal diverticulum. Endoscopy. 2000; 32 991-993
- 2 Shocket E, Simon S A. Small bowel obstruction due to enterolith (bezoar) formed in a duodenal diverticulum: a case report and review of the literature. Am J Gastroenterol. 1982; 77 621-624
M. InamoriMD, PhD
Gastroenterology Division
Yokohama City University School of Medicine
3-9 Fukuura
Kanazawa-ku
Yokohama
236-0004 Japan
Fax: +81-45-784-3546
eMail: inamorim@med.yokohama-cu.ac.jp