A rare case of duodenal diaphragm in an adult during ERCP treatment for choledocholithiasis

BMC Surg. 2020 Nov 7;20(1):273. doi: 10.1186/s12893-020-00934-1.

Abstract

Background: Duodenal Diaphragm in adults is very uncommon, caused by congenital and acquired changes. It is reported that acquired duodenal diaphragm is related to the long-term use of nonsteroidal anti-inflammatory drugs. We report an adult presentation of duodenal diaphragm in a 77-year-old woman, suffered from acute cholangitis and choledocholithiasis. She was performed endoscopic retrograde cholangiopancreatography (ERCP) procedure to remove the stone in common bile duct (CBD). After the stenosis ring dilated by endoscopic balloon dilatation, ERCP procedure was applied, and the CBD stone was removed successfully.

Conclusion: Duodenal diaphragm is difficult to diagnose in clinic. Although the patient in this case had relatively mild symptoms of incomplete upper hemi-abdominal obstruction, these symptoms could be obscured by the emergency acute upper abdominal pain with fever as clinical manifestations of acute cholangitis.

Keywords: Acquired; Congenital; Duodenal diaphragm; ERCP; Nsaids.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Anti-Inflammatory Agents, Non-Steroidal / adverse effects
  • Cholangiopancreatography, Endoscopic Retrograde
  • Cholangitis* / diagnostic imaging
  • Cholangitis* / etiology
  • Cholangitis* / surgery
  • Choledocholithiasis* / diagnostic imaging
  • Choledocholithiasis* / surgery
  • Common Bile Duct / diagnostic imaging
  • Common Bile Duct / surgery
  • Dilatation / methods
  • Duodenal Obstruction / etiology
  • Duodenal Obstruction / surgery*
  • Female
  • Humans

Substances

  • Anti-Inflammatory Agents, Non-Steroidal