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Purpose To review the incidence, acute presentations and management of duodenal diverticulae presenting to North Shore Hopsital, Auckland, New Zealand. Methodology We present five cases of complicated duodenal diverticulae presenting over the period of 2005 to 2006. We reviewed 1622 consecutive ERCP reports at our institution to determine the endoscopic incidence. Results The endoscopic incidence of reported duodenal diverticulae was approximately 13%. Five cases of severe complicated duodenal diverticulae presented over a 12 month period. There were 3 men and 2 women aged 48 to 83. These included 3 cases of free perforation, 1 of contained perforation and 1 of recurrent severe pancreatitis. The free perforations were treated with emergent surgery including a pancreaticoduodenectomy and 2 excisions and primary closure. The contained perforation was managed conservatively. The patient with severe pancreatitis required a pancreaticoduodenectomy. There were significant complications but all patients survived and have resumed normal diets. Conclusion Complications of duodenal diverticulae are diverse and may be severe. Timely surgical intervention results in good outcomes. [ABSTRACT FROM AUTHOR]