A RARE CAUSE OF RECURRENT PANCREATITIS TREATED BY ENDOSCOPIC DIVERTICULOTOMY

Aims:

Intraluminal (“windsock”) diverticulum of the duodenum (IDD) is a rare congenital anomaly associated with incomplete duodenal luminal formation during embryonic development that clinically manifests in adulthood (usually in the fourth decade of life). Main symptoms are partial or complete obstruction of the duodenal lumen, and the most common complications are bleeding, acute or recurrent pancreatitis, acute cholangitis or intestinal intussusception.

Methods:

A 36-year-old woman with a recent episode of acute pancreatitis was hospitalized for recurrent mild acute pancreatitis. The first episode of acute pancreatitis remained etiologically unclear. Pancreas divisum, autoimmune pancreatitis, as well as other more common causes were excluded and testing for hereditary causes was negative. Upper gastrointestinal (GI) endoscopy revealed an IDD containing food remnants located adjacent to the papilla, which was confirmed by radiologic upper GI series. It was presumed that the recurrent pancreatitis could be a consequence of compression of the papilla or distortion of the final part of the pancreatic duct due to the traction of the IDD by a trapped food bolus. Complete endoscopic diverticulotomy of the IDD was therefore performed. The procedure involved first filling the IDD with radiographic contrast and then cutting the IDD wall from the outside in the direction from apex to the base, first with a needle knife and then with an insulated-tip ESD knife. The diverticulum was thus fully opened and the walls were finally secured by clips.

Results:

The intervention went without complications, the patient was discharged the next day and remained asymptomatic during the follow-up period.

Conclusions:

Endoscopic diverticulotomy is the method of choice in treating recurrent acute pancreatitis caused by an IDD.