A case of Acute Duodenal Diverticulitis with an Enterolith treated with endoscopic therapy

A 67-year old man was admitted for evaluation of two days of epigastric pain. Abdominal CT scan showed fluid collection around the horizontal duodenum and a diverticulum with focal calcification, which suggested duodenal diverticulitis with a presence of Enterolith. Initial treatment consisted of fluid resuscitation, broad-spectrum antibiotics began. Initial endoscopy on hospital day three revealed a large diverticulum with an impacted enterolith in the diverticular cavity. After removal of the enterolith using gripping forceps, a significant amount of pus was expressed, revealing a deep ulcer at the base of the diverticulum. Follow-up endoscopy on hospital day eight revealed normal-appearing diverticulum and a reduction of the ulcer. This case demonstrates that in the absence of perforation, endoscopic therapies are effective for Duodenal Diverticulitis. However, early diagnosis and attentive technique is needed.