E-ISSN 1658-7820
 
2026, Vol: 10, Issue: 6
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Case Report
Online Published: 04 Mar 2026
 


Delayed diagnosis and surgical management of fourth-part duodenal diverticulitis: a case report

Ibrahim M. Aljohani, Arwa M. Aljohani, Eman Muhsini Alsufyani, Siraj O. Alsulimani, Mohanad Obaid Alkhamas, Mohammad Eid Mahmoud Mahfouz.


Abstract
Background: Fourth-part duodenal diverticulitis is an exceptionally rare condition and is frequently misdiag nosed because its clinical presentation often mimics that of biliary or pancreatic disease.
Case Presentation: A 52-year-old woman presented with abdominal pain in the right upper quadrant, cholestatic laboratory abnormalities, and biliary dilatation according to ultrasonography. Computed tomography and magnetic resonance cholangiopancreatography indicated a large, inflamed diverticulum in the fourth part of the duodenum. Conservative management failed, which necessitated surgical resection with jejunoduodenal anastomosis. The postoperative course was complicated by an anastomotic leak that required reoperation, decompression procedures, and nutritional support. Follow-up imaging showed resolution of the inflammatory collections but revealed a persistent diverticulum in the second part of the duodenum, which caused mild biliary compression.
Discussion: This case highlights the diagnostic difficulty and therapeutic complexity of fourth-part duodenal diverticulitis. Advanced imaging was essential for accurate diagnosis and surgical planning. The postoperative course underscores the challenges associated with surgical management and the importance of multidisciplinary care.
Conclusion: Fourth-part duodenal diverticulitis is a rare but clinically significant entity. Early recognition, appropriate cross-sectional imaging, and readiness for complex surgical management are very important for achieving favorable outcomes.

Key words: Duodenal diverticulitis, fourth-part duodenum, anastomotic leak, case report, jejunoduodenal anastomosis


 
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How to Cite this Article
Pubmed Style

Aljohani IM, Aljohani AM, Alsufyani EM, Alsulimani SO, Alkhamas MO, Mahfouz MEM. Delayed diagnosis and surgical management of fourth-part duodenal diverticulitis: a case report. IJMDC. 2026; 10(4): 1268-1271. doi:10.24911/IJMDC.51-1768645436

Web Style

Aljohani IM, Aljohani AM, Alsufyani EM, Alsulimani SO, Alkhamas MO, Mahfouz MEM. Delayed diagnosis and surgical management of fourth-part duodenal diverticulitis: a case report. https://www.ijmdc.com/?mno=307138 [Access: April 07, 2026]. doi:10.24911/IJMDC.51-1768645436

AMA (American Medical Association) Style

Aljohani IM, Aljohani AM, Alsufyani EM, Alsulimani SO, Alkhamas MO, Mahfouz MEM. Delayed diagnosis and surgical management of fourth-part duodenal diverticulitis: a case report. IJMDC. 2026; 10(4): 1268-1271. doi:10.24911/IJMDC.51-1768645436


Vancouver/ICMJE Style

Aljohani IM, Aljohani AM, Alsufyani EM, Alsulimani SO, Alkhamas MO, Mahfouz MEM. Delayed diagnosis and surgical management of fourth-part duodenal diverticulitis: a case report. IJMDC. (2026), [cited April 07, 2026]; 10(4): 1268-1271. doi:10.24911/IJMDC.51-1768645436


Harvard Style

Aljohani, I. M., Aljohani, . A. M., Alsufyani, . E. M., Alsulimani, . S. O., Alkhamas, . M. O. & Mahfouz, . M. E. M. (2026) Delayed diagnosis and surgical management of fourth-part duodenal diverticulitis: a case report. IJMDC, 10 (4), 1268-1271. doi:10.24911/IJMDC.51-1768645436


Turabian Style

Aljohani, Ibrahim M., Arwa M. Aljohani, Eman Muhsini Alsufyani, Siraj O. Alsulimani, Mohanad Obaid Alkhamas, and Mohammad Eid Mahmoud Mahfouz. 2026. Delayed diagnosis and surgical management of fourth-part duodenal diverticulitis: a case report. International Journal of Medicine in Developing Countries, 10 (4), 1268-1271. doi:10.24911/IJMDC.51-1768645436


Chicago Style

Aljohani, Ibrahim M., Arwa M. Aljohani, Eman Muhsini Alsufyani, Siraj O. Alsulimani, Mohanad Obaid Alkhamas, and Mohammad Eid Mahmoud Mahfouz. "Delayed diagnosis and surgical management of fourth-part duodenal diverticulitis: a case report." International Journal of Medicine in Developing Countries 10 (2026), 1268-1271. doi:10.24911/IJMDC.51-1768645436


MLA (The Modern Language Association) Style

Aljohani, Ibrahim M., Arwa M. Aljohani, Eman Muhsini Alsufyani, Siraj O. Alsulimani, Mohanad Obaid Alkhamas, and Mohammad Eid Mahmoud Mahfouz. "Delayed diagnosis and surgical management of fourth-part duodenal diverticulitis: a case report." International Journal of Medicine in Developing Countries 10.4 (2026), 1268-1271. Print. doi:10.24911/IJMDC.51-1768645436


APA (American Psychological Association) Style

Aljohani, I. M., Aljohani, . A. M., Alsufyani, . E. M., Alsulimani, . S. O., Alkhamas, . M. O. & Mahfouz, . M. E. M. (2026) Delayed diagnosis and surgical management of fourth-part duodenal diverticulitis: a case report. International Journal of Medicine in Developing Countries, 10 (4), 1268-1271. doi:10.24911/IJMDC.51-1768645436




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