The cause of duodenal diverticulum is mainly due to congenital dysplasia, resulting in a limited outward protrusion of the duodenal wall in a sac-like pattern (primary diverticulum) or caused by scarring from gastroduodenal ulcers (secondary diverticulum). Signs and symptoms: nausea and vomiting, gastrointestinal distention, abdominal pain, jaundice, and eructation. The exact incidence of duodenal diverticula is difficult to quantify because many diverticula do not produce clinical symptoms and are not easily detected in time. The detection rate of duodenal diverticula has been reported to be 1% on barium gastrointestinal examination and up to 22% on autopsy. 90% of diverticula are single and 80% are located in the second part of the duodenum, especially in the medial wall or concave surface. The disease occurs mostly in patients aged 40 to 60 years, and is rarer under 30 years of age, with no difference in its incidence in particular. Examination of duodenal diverticulum Barium examination is best performed in prone or supine position with compression radiographs, the latter showing mucosal folds within the diverticulum. The diverticulum appears as a round or oval pouch protruding outside the lumen, with a smooth outline, narrow neck, and visible duodenal mucosa extending into the diverticulum. Diverticula can vary in size. 2. Adhesive diverticula are generally small, with a wide neck and irregular contours, and occur mostly in the upper duodenum. Duodenal diverticulum can be complicated by cholangitis, pancreatitis, cholelithiasis and other diseases, secondary to bleeding, infection, inflammation and even cancer. Duodenal diverticulum treatment 1, treatment principles There is no symptomatic duodenal diverticulum does not need treatment. When there are certain clinical symptoms and no other lesions exist, medical treatment should be used first, including diet regulation, acid suppressants, antispasmodics, etc., and can be taken in a lateral position or change various positions to help the evacuation of food accumulated within the diverticulum. Because the diverticulum is located in the second part of the duodenum, or even buried in the pancreatic tissue, surgical removal is difficult, so only in the internal treatment is ineffective and repeatedly complicated by diverticulitis, bleeding or compression of adjacent organs to consider surgery. 2.Surgical method. Surgery, in principle, diverticulectomy is the most ideal. Small diverticula can be a single endorectomy. At the same time there are multiple diverticula and encounter technical difficulties in resection, can be used to reroute surgery, that is, Billroth II type partial gastrectomy and selective vagotomy. If there is a momentary difficulty in finding the diverticulum during surgery, the duodenum can be cut open from the lumen to find the opening of the diverticulum, and the bottom of it can be turned into the intestinal cavity for excisional treatment. After diverticula removal, the intestinal wall incision should be sutured in the direction perpendicular to the long axis of the intestinal curvature to avoid intestinal stenosis. (1) The peritoneum is incised laterally in the duodenum, and the duodenum is freed and retracted medially to expose the diverticulum (2) After the diverticulum is excised, the intestinal wall incision is closed with a transverse (i.e., perpendicular to the long axis of the intestinal curvature) suture.