Zakaria Zouaki, Khalid Gharbi
Periampullary duodenal diverticula (PADD) are acquired mucosal outpouchings arising from weak points in the duodenal wall in close proximity to the ampulla of Vater. Although the vast majority remain asymptomatic, their anatomical relationship with the distal common bile duct and the main pancreatic duct may give rise to potentially life-threatening complications, including obstructive jaundice, acute cholangitis, and recurrent acute pancreatitis. We report two cases illustrating the clinico-radiological spectrum of PADD-related complications. The first is a 68-year-old male with acute cholangitis in the context of Lemmel syndrome: MRI revealed a 4 cm periampullary diverticulum causing extrinsic compression of the distal common bile duct. The second is a 55-year-old female with two episodes of recurrent acute pancreatitis of initially unexplained origin; MRI performed during remission showed a 17 mm air-containing diverticulum on the medial wall of D2, with no ductal dilation in the intercritical period. Both cases highlight the pivotal role of MRI cholangiopancreatography (MRCP) in the non-invasive diagnosis and characterization of PADD, and the importance of tailored multidisciplinary management.