Periampullary extraluminal duodenal diverticula and acute pancreatitis: an underestimated etiological association.

OBJECTIVES

The aim of this study was to investigate the etiological role of periampullary extraluminal duodenal diverticula (PEDD) in acute pancreatitis (AP).

METHODS

The study included 433 consecutive patients who underwent successful ERCP during the period 1992-1994; PEDD were discovered in 58 cases (13.4%); patients without PEDD (n = 375) were considered the control group. Indication for ERCP and final diagnosis were recorded in each case.

RESULTS

The age of patients with PEDD was significantly higher (p < 0.0001) than that of controls. The incidence of biliary lithiasis was 65.5% in PEDD and 40.8% in controls (p = 0.0001). A recent episode or acute phase of AP constituted the indication for ERCP in 62% of PEDD and 24.8% of controls (p < 0.0001); idiopathic AP was found more often (p = 0.04) in PEDD patients (13.7%) than in controls (1.8%).

CONCLUSIONS

PEDD should be included in the list of possible etiological factors of AP. The presence of PEDD should be verified, mainly in elderly patients, before defining an AP episode as idiopathic.