S4734 Complicated Duodenal Diverticulitis: A Case of Conservative Medical Management
Bibliographic record
Abstract
Introduction: The duodenum is a common site for small bowel diverticula with only 1%-5% being symptomatic. Diverticula rarely perforates causing a presentation of an acute abdomen. Here, we report a case of an immediate onset complication of a duodenal diverticulitis, with a contained perforation in the 4th part of the duodenum. Case Description/Methods: A 71-year-old man with a past medical history of hypertension and diabetes mellitus presented to emergency with a 1 day history of vague abdominal pain and nausea. White blood count elevated to 18,600 with major left shift, normal amylase & lipase levels. Computed tomography abdominal and pelvis showed a complex large thick-walled collection measuring 7.1 x 6.6 x 8.0 cm, arising off the 4th portion of the duodenum with surrounding stranding/inflammation as well as peripancreatic stranding at the body and tail, concerning for complicated peripancreatic fluid collection sequelae of pancreatitis vs complicated diverticulitis vs contained perforation (Figure 1). Magnetic resonance imaging abdomen and pelvis was performed to further characterization of the pancreatic parenchyma: redemonstrating duodenal diverticulitis with a small focal outpouching arising from the base of the diverticulum, while pancreatic parenchyma appeared as low to intermediate signal on T2-weighted images (Figure 1). Due to difficult anatomy, there was no safe window for drainage, this patient successfully was managed conservatively with intravenous fluids & antibiotics; eventually managed to tolerate diet within 7 days. Discussion: Symptomatic duodenal diverticulitis can be initially thought to be as a peripancreatic complicated fluid collection given anatomical proximity. In the setting of normal lipase & amylase levels, magnetic resonance imaging can provide detailed characterization of the pancreas and organs’ structure. Different imaging modality can provide adequate accuracy to narrow differentials. Intra-abdominal source control of infection is the ideal modality of management; which can also include a conservative approach after adequate risk-benefit evaluation.Figure 1.: A,B) Computed tomography abdomen demonstrating complex lesion with fat stranding. C,D) Magnetic resonance imaging abdomen demonstrating complicated duodenal diverticulitis.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.003 | 0.002 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.005 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".