A juxtapapillary windsock diverticulum connected with the third portion of the duodenum via a natural orifice.

To the Editor, Here, we report an extremely rare endoscopic finding, intramural duodenal diverticulum (IDD), a windsock diverticulum, in a 38-year-old woman who was admitted to our outpatient clinic with the complaint of dyspepsia. Her medical history and physical examination were unremarkable. All laboratory findings, including whole blood count, total biochemistry, erythrocyte sedimentation rate, and C-reactive protein, were in the normal range. Abdominal ultrasonography was normal. An upper gastrointestinal endoscopy revealed antral gastritis, and gastric biopsies were performed for H. pylori infection. Also, a juxtapapillary flat diverticulum was detected in the second portion of the duodenum (Figure 1). When the endoscope was inserted into the diverticulum, there was an orifice approximately 11 mm in diameter at the end of the diverticulum, surrounded with a totally normal mucosa, which revealed that it was a natural orifice (Figure 2). The third portion of the duodenum could be visualized from the orifice. When methylene blue was sprayed from the orifice with a sclerotherapy catheter, it was confirmed that the diverticulum was connected with the third portion of the duodenum via this orifice. Due to the typical endoscopic finding, the diverticulum was thought to be a duodenal windsock diverticulum, and abdominal computerized tomography was performed for possible co-existing gastrointestinal abnormalities, which revealed normal findings. In the follow-up, the patient was symptom free after H. pylori eradication therapy.