Duodenal diverticulum perforation mimicking acute cholecystitis – case reports and a literature review

Background: Duodenal diverticula affect a large part of the population. It is a congenital abnormality that develops over time. The incidence of duodenal diverticulum is estimated at 22% of the population in autopsies. Only 5% of patients present symptoms and of those only 1-2% require surgery. Material and methods: We describe two patients who underwent surgery due to duodenal diverticulum perforation mimicking acute cholecystitis. Results: Perforation of the duodenal diverticulum, combined the difficulty of treatment and potential for complications, is a disease with a high mortality rate. It is a subtle and difficult diagnosis due to the unspecific symptoms and a lack of generalized peritonitis. The rarity and the wide spectrum of the disease, in combination with additional factors to be considered, mean there is no standard treatment. Depending on the patients general condition, disease advancement, age and pathological findings observable only during surgery, we can choose between conservative treatment and a wide spectrum of surgical methods. Conclusions: Duodenal diverticular disease rarely gives any symptoms. However, even after the onset of symptoms, only 1-2% of patients require surgery. Our work is unique because we present two cases, each treated via different approach, conservative and surgical.