Abstract

Background: Fourth-part duodenal diverticulitis is an exceptionally rare condition and is frequently misdiag nosed because its clinical presentation often mimics that of biliary or pancreatic disease.
Case Presentation: A 52-year-old woman presented with abdominal pain in the right upper quadrant, cholestatic laboratory abnormalities, and biliary dilatation according to ultrasonography. Computed tomography and magnetic resonance cholangiopancreatography indicated a large, inflamed diverticulum in the fourth part of the duodenum. Conservative management failed, which necessitated surgical resection with jejunoduodenal anastomosis. The postoperative course was complicated by an anastomotic leak that required reoperation, decompression procedures, and nutritional support. Follow-up imaging showed resolution of the inflammatory collections but revealed a persistent diverticulum in the second part of the duodenum, which caused mild biliary compression.
Discussion: This case highlights the diagnostic difficulty and therapeutic complexity of fourth-part duodenal diverticulitis. Advanced imaging was essential for accurate diagnosis and surgical planning. The postoperative course underscores the challenges associated with surgical management and the importance of multidisciplinary care.
Conclusion: Fourth-part duodenal diverticulitis is a rare but clinically significant entity. Early recognition, appropriate cross-sectional imaging, and readiness for complex surgical management are very important for achieving favorable outcomes.

Key words: Duodenal diverticulitis, fourth-part duodenum, anastomotic leak, case report, jejunoduodenal anastomosis