Polypoid intraluminal duodenal lesion producing epigastric symptoms in an elderly man

Abstract

A polypoid, mobile lesion protruding into the duodenal lumen was discovered during an esophagogastroduodenoscopy in a 71 – year old male complaining of epigastric pain. An endoscopic ultrasound, an upper gastrointestinal study (UGIS) with a barium solution and a contrast – enhanced abdominal computed tomography revealed an intraluminal duodenal diverticulum (IDD). The “windsock” or “finger – in– glove” sign was the hallmark of the diagnosis in UGIS, corresponding to a contrast – filled sac surrounded by a radiolucent curved line representing the wall of the diverticulum. This sign made it possible to further validate the diagnosis by both endoscopical ultrasound and computed tomography. Caution must be taken, since if the IDD is empty, it might be impossible to differentiate it from an intraluminal mass. Multiplanar reconstruction and adequate duodenal and sac distention might assist the accurate diagnosis. Diverticulectomy is the treatment of choice, either surgically or endoscopically, and is usually reserved for symptomatic patients.