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Perforating Duodenal Diverticulitis

George L. Juler, MD; John W. List, MD; Edward A. Stemmer, MD; John E. Connolly, MD
Arch Surg. 1969;99(5):572-578. doi:10.1001/archsurg.1969.01340170024006.
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Duodenal diverticula are not rare. With the exception of the colon, the duodenum is the most common site of enteric diverticula.1,2 Duodenal diverticula occur in about 1% to 2% of the human population,2,3 but seldom become symptomatic.4,5 Of those who do develop symptoms, only 1% to 5% require surgery.4-7 Symptomatic cases usually are associated with other gastrointestinal disease which must be eliminated as the cause of symptoms.2,5,8

Surgeons are becoming more aware of the serious complications associated with duodenal diverticula.9 Of all the complications, perforation is the most serious.1,10 and, fortunately, the rarest.11 Perforation due to enteroliths is the rarest of all.11 It is even rarer to make the preoperative x-ray diagnosis of a perforation; therefore, most perforations have been accidentally found at laparotomy for associated acute gastrointestinal disease.

Difficulties in preoperative x-ray diagnosis of perforation are due, in part, to


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