In this patient, the differentials of periduodenal fat stranding include perforated duodenal ulcer, duodenitis, pancreatitis, and duodenal diverticulitis. Lipase was not elevated in this patient making pancreatitis unlikely. Isolated duodenitis could not explain the presence of gas locules unless it was associated with abscess collection or perforation. A contained duodenal ulcer perforation was a possibility.

Critically, a previous CT chest conducted for a separate unrelated pathology 6 years prior demonstrated the possibility of a duodenal diverticulum in the area of interest and the diagnosis of duodenal diverticulitis was arrived at. The patient was managed conservatively with 1 week of IV antibiotics and was discharged well on a normal diet.