case_images: PMC5438833_01
case_images: (a & b) Computed Tomography of the abdomen, with PO contrast, showing the evidence of a duodenal diverticulum with contrast extravasation, surrounded by fat stranding and air pockets (arrow), suggestive of perforation ((a) axial; (b) coronal). (c) Gastrografin swallow fluoroscopy, upon follow-up, showing the presence of contrast within the diverticulum (arrow) and absence of any extravasation. (d) Enhanced CT scan with IV and PO contrast showing the diverticulum with absence of extravasation and minimal air pocket with fat stranding (arrow).
case_images: CRIS2017-4045970.001.jpg
case_images: PMC5438833_01_CRIS2017-4045970.001.jpg
case_images: fig1
case_images: CT scan, one week later, revealed contrast accumulation within a duodenal pouch, corresponding to the previously described diverticulum, with absence of contrast extravasation (Figures 1(c) and 1(d)). Clear fluid diet was started and advanced gradually as tolerated.
case_images: PMC5438833_02
case_images: (a) Drainogram showing a fistulous tract (arrow) between the retroperitoneal cavity and the duodenum, secondary to a perforated duodenal diverticulum. (b) Gastrografin swallow fluoroscopy, upon follow-up, with absence of any contrast extravasation from within the duodenal diverticulum (arrow). Note the jejunostomy feeding tube and the retroperitoneal drain in place (arrow heads). (c) Layering of contrast, during a gastrografin swallow, into two duodenal diverticula (arrows), without any contrast extravasation, seen upon follow-up.
case_images: CRIS2017-4045970.002.jpg
case_images: PMC5438833_02_CRIS2017-4045970.002.jpg
case_images: fig2
case_images: Fluoroscopic guided drainogram showed delineation of a retroperitoneal collection in the RLQ, with a fistulous tract in junction with a duodenal segment (Figure 2(a)), suggestive of a high output duodenal-retroperitoneal fistula. A feeding jejunostomy tube was then inserted and enteral feeding initiated (Figure 2(b)). Follow-up CT and gastrografin swallow imaging showed the evidence of two outpouching structures within the D2 and D3 segments of the duodenum with layering of contrast (Figure 2(c)), representing two wide-neck duodenal diverticula.