case_images: PMC11647045_01
case_images: (a) Contrast-enhanced computed tomography (CT) scan on admission revealed edematous wall thickening of the duodenum. (b) A re-examination of plain CT images revealed the presence of calcified duodenal diverticular calculus, leading to a diagnosis of duodenal diverticulitis with parapapillary calculus. (c) The plain CT coronal section showed the calcified duodenal diverticular calculus as a diverticulum located beside the duodenal papillae, slightly toward the mouth on the side of the pancreatic head.
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case_images: Contrast-enhanced computed tomography (CT) scan on admission showed edematous wall thickening of the duodenum (Figure 1a). It revealed a duodenal diverticulum stone and an increased concentration of surrounding fatty tissue, which allowed us to diagnose duodenal diverticulitis associated with a parapapillary stone (Figure 1b,c) which could have been identified by the high CT value at the first time enhanced CT.
case_images: When the double-balloon endoscope first reached a certain papillary diverticulum in the duodenum, a small stone was visible in the duodenal diverticulum, from which pus was draining (a). We used forceps to break up the stone in the diverticulum (b), drain it (c), and flush the diverticular cavity with water (d).
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case_images: We used clamping forceps (Radial Jaw 4 Standard Capacity; Boston Scientific) to crush the stone in the duodenal diverticulum, which was subsequently washed out with water via the scope channel, gradually widening the entrance to the diverticulum (Figure 2).
case_images: We contrasted the diverticulum and found that a fistula had formed from within the diverticulum into the lumen of the blind end of the afferent loop.
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case_images: After that, we used Meglumine sodium amidotrizoate to contrast the diverticulum and found that a fistula had formed from within the diverticulum into the lumen of the blind end of the afferent loop (Figure 3).