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A rare complication of the duodenal diverticulum
  1. Hiroshi Sugimoto,
  2. Aoi Fujikawa,
  3. Akihiro Kishida
  1. Department of Gastroenterological Surgery, St. Luke’s International Hospital, Chuo-ku, Japan
  1. Correspondence to Dr Hiroshi Sugimoto, St. Luke's International Hospital, Chuo-ku 104-8560, Japan; dr.sugimoto{at}


Introduction An 80-year-old woman presented to the emergency department with severe right-sided abdominal pain that had started after her last meal. Physical examination revealed fever (38.6°C) and rebound tenderness in the right upper quadrant of the abdomen. The laboratory studies showed a leucocyte count of 11.3×109/L (normal, 3.7–8.0×109/L) and a C-reactive protein level of 2.34 mg/dL (normal, <0.03 mg/dL). There were no other significant findings. A CT scan of the abdomen with contrast revealed retroperitoneal air around a duodenal diverticulum (figures 1 and 2).

Figure 1

Computed tomography scan of the abdomen with contrast (coronal section). A diverticulum in the second portion of the duodenum (arrow) and retroperitoneal air (asterisk) are shown.

Figure 2

Computed tomography scan of the abdomen with contrast (axial section). The area with retroperitoneal air (asterisk) is marked.

Question What is the most likely diagnosis and the cause underlying the condition?

  • abdominal pain
  • abdominal surgery
  • diagnostic and therapeutic endoscopy
  • diverticular disease

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  • Contributors HS drafted and revised the manuscript. AF reviewed and revised the manuscript. AK reviewed and revised the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Parental/gaurdian consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.