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Though duodenal diverticula are frequent and most often asymptomatic, they can cause serious complications. We present a case of duodenal diverticulitis without perforation, diagnosed by CT and treated conservatively by means of endoscopic maneuvers and medical therapy. A review of the recent literature regarding duodenal diverticula, complications, diagnosis and management is included.

From April 89 to October 90, 41 patients operated for a Dukes B or C colorectal cancer were randomized to receive 6 courses of adjuvant treatment with (A) 5-FU alone (440 mg/m2 IV bolus 5/21 days) or (B) folinic acid (200 mg/m2 IV bolus 5/21 days) preceding 5-FU (370 mg/m2 in short infusion 5/21 days). Ten patients received also one course of immediate post-operative continuous portal infusion (5-FU 500 mg/m2/day x 7 followed by a 2 hours infusion of mitomycin C 10 mg/m2). The portal treatment was well tolerated (1 case of GI tract disturbances, 1 catheter obstruction). The toxicity of adjuvant systemic treatment was evaluated on 232 courses (125 A, 107 B). Hematologic and skin toxicities, alopecia and nausea-vomiting were mild. The limiting toxicities (expressed as percentages of courses) were stomatitis (grades 2-3: 11.4% A; 22.6% B) and diarrhea (grades 3-4: 7.3% A; 14.2% B; one toxic death was to deplore in arm B from a grade 4 diarrhea). The pilot study has demonstrated the feasibility of the adjuvant treatment proposed; a multicentric randomized trial (expected accrual: 800 patients) has therefore been activated on 11.01.90; all patients will also receive levamisole while radio-therapy will be mandatory for rectal cancer.

A 38-year-old woman was examined because of vague abdominal symptoms. Cholecystography and US studies demonstrated a lobulated tumor, 14 mm in length, with a homogeneous structure, sharp limits, adjacent to the posterior wall of the gallbladder and producing no acoustic shadow. Pathological examination demonstrated subserosal pancreatic heteropia. More than 22 different kinds of focal lesions affecting the gallbladder wall have been described. Unfortunately, no clinical or US criteria allow a definite diagnosis. Only the size makes a difference: more than 94% of the adenomas measuring less than 10 mm are benign whereas 88% of the malignant lesions are over 10 mm. Considering the absence of specific criteria, surgical removal is therefore indicated for lesions over 10 mm.