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Khirurgii

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Year 2010 Vol. 18 No 4

HYPOTHESIS

LEVIN M.D., MENDELSON G., TROYAN V.V., KORSHUN Z.

TO THE PATHOGENESIS OF THE PRIMARY DUODENAL DIVERTICULA

Objectives. To study the pathological physiology of the duodenum in patients with the duodenal diverticula.
Methods. 116 X-ray examinations of the upper part of the alimentary tract were analyzed in the patients with the dyspeptic syndrome. The patients’ age varied from 55 to 92 years (the average age composed 82).
Results. The duodenal diverticula were detected in 21,5% of investigations while performing a standard X-ray examination. The parapapillary diverticula (PPD) made up 60%. The length of Kapandzhi and Ochsner sphincters was determined. The acidification of barium suspension was shown to lead to a sharp contraction of the functional duodenal sphincters. A reliable narrowing of the duodenum, located between Kapandzhi and Ochsner sphincters was revealed in the patients with PPD in comparison with the patients without PPD.
Conclusion. A comprehensive hypothesis of the pathogenesis of PPD and pathology in the pancreato-biliary area is suggested. Dyskinesia of the functional sphincters and rise in the duodenal tonus occur reacting to the irritating impact of the hydrochloric acid in the gastric juice. As the result the increase of the intraluminal pressure periodically occurs between sphincters.. It results in the prolapse of the mucous layer through the weakened muscular layer of the bowel wall. Thus diverticula are formed. As the result of the increased intraluminal pressure the reflux of the duodenal contents with the local flora into the bile ducts happens causing the congestion and inflammatory reaction as well as leading to the development of cholelithiasis and chronic pancreatitis.

Keywords: duodenum, duodenal diverticula pathogenesis, functional sphincters, hypothesis, cholelithiasis pathoqenesis, pancreatitis pathoqenesis
p. 105-112 of the original issue
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