New Feature - Illustrated Forensic PathologyAn Inflamed, Giant, True, Extramural Duodenal Diverticulum A Rare Autopsy FindingSakry, Rachel C. BS∗; Kemp, Walter L. MD, PhD†Author Information From the ∗University of North Dakota School of Medicine and Health Sciences †Department of Pathology, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND. The authors report no conflict of interest. Reprints: Walter L. Kemp, MD, PhD, University of North Dakota School of Medicine and Health Sciences, 1301 North Columbia Rd., Mailstop 9037, Grand Forks, ND 58202. E-mail: [email protected]. The American Journal of Forensic Medicine and Pathology: September 2020 - Volume 41 - Issue 3 - p e54-e55 doi: 10.1097/PAF.0000000000000571 Buy Metrics Abstract A 53-year-old man was found to have a giant 16 × 6-cm hemorrhagic and cystic mass centered on the pancreas and duodenum. Initially diagnosed as a pancreatic pseudocyst at the time of autopsy, the cystic mass was later determined by histologic examination to be a true diverticulum of the duodenum as microscopic examination of the wall revealed 2 layers of muscle, as well as a neutrophilic infiltrate. While the cause of death of the individual was certified as methamphetamine toxicity, cardiomegaly and probable dehydration associated with a giant duodenal diverticulum were listed as contributory conditions. While duodenal diverticula in general are relatively uncommon findings, an extramural, true, giant duodenal diverticulum that is inflamed is a rare clinical or autopsy finding, with only 2 case reports identified in the clinical medical literature and none in the forensic literature. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.