Periampullary duodenal diverticulum and evaluation of accompanying pancreaticobilier diseases BY multi-slice CT

Purpose: The aim of our study was to investigate the prevalence of periampullary duodenal diverticulum (PAD) using abdomen multi slice computed tomography and determine the relevance of PAD and pancreatico-biliary diseases. In addition, we aimed to explore if the presence of PAD is associated with abnormal dilatation of bile duct. Materials and Methods: In our study, patients with PAD were retrospectively assessed from the radiology database from January 2016 to January 2020 in Afyonkarahisar Health Sciences University Hospital. Patients with known pancreaticobiliary malign neoplasm, liver malign neoplasm, congenital cystic biliary tract disease, biliary stent and artifact images were excluded. Control group, 220 patients without PAD, was added to 222 patients who are called other group with PAD, those were matched in terms of gender and age. PAD size, location, ductal diameter, prior cholecystectomy, cholelithiasis, bile duct stones, benign bile duct strictures, acute cholangitis, acute cholecystitis, chronic cholecystitis, acute pancreatitis, chronic pancreatitis, colonic diverticulum, hepatosteatosis, pancreatic fatty infiltration and liver function tests were noted from electronic medical records. To compare the groups, Mann Whitney test, χ2 analysis, and Spearman's rho correlation tests were used if appropriate. Results: The prevalence was 1,16% for DD and 1,06% for PAD. The mean diameter PAD in our study was 22,98 mm +10,98. A significant positive correlation was found between age and the diameter of PAD. The female/male ratio was 1,02/1 and the median average age was 67,31 years in the PAD group.There was a significantly higher incidence of cholelithiasis, bile duct stone, acute cholecystitis, chronic cholecystitis in PAD group. There was a significantly higher incidence of hepatosteatosis in PAD group. The diameter of extrahepatic bile duct at multiple locations and right intrahepatic bile duct was significantly higher in PAD group than control group. Also, the bile duct diameter at multiple locations of postcholecystectomy patients were significantly larger than non-cholecystectomy patients, both in PAD and control groups. With respect to the non-cholecystectomy groups, the diameter of extrahepatic bile duct at multiple locations was significantly larger in PAD group. A significant positive correlation was found between age and bile duct diameter at multiple locations. Conclusion: As a result, multi-slice CT is a noninvasive, valuable diagnostic method in the diagnosis of PAD, for the evaluation of concomitant pancreaticobiliary diseases and the effects of PADs on bile ducts.