Duodenal Diverticula *

The subject of duodenal diverticula is one which is of great interest not only to the radiologist, but to the internist and surgeon as well. This condition, while considered rare, has been recognized fc.r many years, and more especially since the advent of gastro-intestinal roentgenology. The history of duodenal diverticula, in regard to the knowledge of the subject, is divided by Andrews' into two periods: the first is called the "mortuary period", and extended from I7I0 to 19I0. During this period, Chomel5, in I7I0, was the first to mention a duodenal diverticulum. Morgagni25 offered the next description in I839. Habershon described the condition in I 857, Klebs in I869, Roth"9 in I872, Herschel and Good"2 in i88o, Seippel33 in 1895, and LeTulle17 in I898. Linsmayer20 reported I367 necropsies which yielded 45 cases, or 3 per cent, of duodenal diverticula. The literature has been reviewed by Andrews1, Moore29, Cole and Roberts6, Downes7, Ritchie and McWorther"3, Hartung1" and others. Less than IOO cases had been reported up to I9I0, and of these none had been diagnosed prior to operation or autopsy. The second period, the "Roentgen ray period", opened when investigators began to throw new light on the pathology of duodenal diverticula in vivo. Bauer2 in I9I2 evaluated the clinical symptoms, and Case4 in I913 reported four cases found in routine gastro-intestinal Roentgen ray examinations. Larimore and Graham16 state that from the report of the first case in I7I0 to I9I0 the condition was only discovered postmortem or at operation, and was considered rare. From I910 to 1915, descriptions of the condition became more frequent, due to the increasing use of the Roentgen ray in examination of the gastro-intestinal tract. From the available figures, no accurate estimate of-the incidence is possible, but it is probably not much over I per cent. Penhallow31 reviewed 2,200 gastro-intestinal Roentgen ray examinations, and 26, or 1.2 per cent, resembled duodenal diverticula. In reviewing the past 500 gastro-intestinal series of our own, we have found 8 cases of duodenal diverticula, or I.6 per cent. Nagel2T stated in 1925 that the incidence of duodenal diverticula was