Duodenitis

R. Brooke Jeffrey, MD

Harpreet Dhatt, BA

Key Facts

Imaging

Best imaging tool
- UGI, CECT
Best diagnostic clue
- UGI: Aphthous ulcers in duodenal bulb; fold thickening in antrum and duodenal bulb
- CECT: Mural thickening of duodenum

Top Differential Diagnoses

Cholecystitis
Pancreatitis
Ureteral colic
Hepatic abscess
Bouveret syndrome
Zollinger-Ellison syndrome

Clinical Issues

Most common signs/symptoms
- Abdominal pain, nausea, vomiting; sepsis if perforation
Other signs/symptoms
- Gastrointestinal bleeding if ulceration
Epidemiology
- H. pylori infection

Diagnostic Checklist

Consider
- Acute pancreatitis if fluid along Gerota fascia in left anterior pararenal space
- Zollinger-Ellison syndrome
Image interpretation pearls
- Ectopic gas &/or fluid in right anterior pararenal space indicates perforation

(Left) Prone view from a double-contrast upper GI series in a 47-year-old woman with rheumatoid arthritis and chronic NSAID use, presenting with a 2-week history of upper abdominal pain. Note the numerous discrete aphthous ulcers

in the gastric antrum and duodenal bulb, consistent with duodenitis from NSAIDs. (Right) Additional image from the upper GI series in the same patient shows pronounced fold thickening