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European Journal of Vascular and... Dec 2022
Topics: Humans; Endovascular Aneurysm Repair; Intestinal Fistula; Duodenal Diseases; Aortic Diseases; Gastrointestinal Hemorrhage
PubMed: 36209965
DOI: 10.1016/j.ejvs.2022.10.012 -
The American Journal of Emergency... Oct 2021Gallstone disease is a burden affecting about 15% percent of the population around the world. The complications of gallstone disease are numerous and many require...
BACKGROUND
Gallstone disease is a burden affecting about 15% percent of the population around the world. The complications of gallstone disease are numerous and many require emergency care. Severe complications are not uncommon and require special attention, as lethal outcome is possible.
CASE PRESENTATION
We present a retrospective analysis of eight cases describing severe complications of gallstones in patients undergoing endoscopic treatment of chronic gallstones conditions. All patients were admitted to our emergency care department following symptoms onset. The diagnostic difficulties, treatment strategies and outcomes are presented. The associated risk factors and preventative measures are discussed. Two patients developed profuse bleeding, two developed acute pancreatitis, two patients had perforation related complications. One rare case of bilioma and one case of iatrogenic injury are presented. All patients had severe condition, in two cases lethal outcome was a result of co-morbidity and difficulties in management.
CONCLUSION
Special care should be taken in patients with risk factors of severe complications in order to improve outcome and prevent the development of life-threatening conditions.
Topics: Adult; Aged; Biliary Fistula; Cholangiopancreatography, Endoscopic Retrograde; Cholecystectomy, Laparoscopic; Cholelithiasis; Chronic Disease; Common Bile Duct; Duodenal Diseases; Emergency Service, Hospital; Female; Gallstones; Gastrointestinal Hemorrhage; Humans; Iatrogenic Disease; Intestinal Perforation; Male; Middle Aged; Pancreatitis; Portal Vein; Postcholecystectomy Syndrome; Postoperative Complications; Sphincterotomy, Endoscopic; Vascular Fistula
PubMed: 33773867
DOI: 10.1016/j.ajem.2021.03.052 -
The American Surgeon Jul 2023The duodenum is the second most common location for a diverticulum to form after the colon. These duodenal diverticula (DD) are often found incidentally and rarely... (Review)
Review
The duodenum is the second most common location for a diverticulum to form after the colon. These duodenal diverticula (DD) are often found incidentally and rarely require intervention. In recent years, surgical management has been restricted to patients with significant complicated sequelae, such as perforation, abscess, or fistula formation. We present the rare case of a perforated broad-based diverticulum in the third portion of the duodenum necessitating surgical correction. The patient presented with persistent symptoms following failure of conservative management and underwent surgical resection. Due to difficulty visualizing the extent of the diverticulum, a novel intraoperative technique of bowel insufflation via nasogastric tube was used allowing for elucidation of the diverticular borders and complete resection. Although DD are common, there exists no consensus on when operative intervention is indicated. Given that significant morbidity and mortality can be associated with symptomatic DD, a systematic way to guide management decisions is needed. After conducting a review of the literature, we propose that the modified Hinchey classification can be used not only to categorize duodenal diverticulitis but to guide treatment choice in cases with unclear risk benefit profiles.
Topics: Humans; Duodenal Diseases; Diverticulum; Diverticulitis; Duodenum; Intestinal Perforation
PubMed: 36533836
DOI: 10.1177/00031348221146957 -
Arquivos Brasileiros de Cirurgia... 2021
Topics: Duodenal Diseases; Humans; Intestinal Fistula; Tuberculosis
PubMed: 34008711
DOI: 10.1590/0102-672020190004e1570 -
Journal of Digestive Diseases Dec 2017Functional dyspepsia (FD) is a highly prevalent disorder that affects more than 10% of the population. In the past decade, the theoretical underpinning of the concept of...
Functional dyspepsia (FD) is a highly prevalent disorder that affects more than 10% of the population. In the past decade, the theoretical underpinning of the concept of FD has begun to change, in light of new data on the underlying pathophysiological mechanisms of this disorder, with a focus on the duodenum. The Rome IV criteria, published in 2016, note that gastroesophageal reflux disease and irritable bowel syndrome overlap with FD more than expected by chance, suggesting that they may be part of the same disease spectrum. Infection by Helicobacter pylori (H. pylori) may explain a minority of cases of FD and in the Rome IV criteria H. pylori-associated dyspepsia (defined as symptom relief after eradication therapy) is considered a separate entity. Duodenal inflammation characterized by increased eosinophils and in some cases mast cells, may impair the intestinal barrier. Post-infectious gastroenteritis is now an established risk factor for FD. Other risk factors may include atopy, owning herbivore pets and exposure to antibiotics, together with gastroduodenal microbiome disturbances. Small bowel homing T cells and increased cytokines in the circulation occur in FD, correlating with slow gastric emptying, and a possible association with autoimmune rheumatological disease supports background immune system activation. A genetic predisposition is possible. FD has been linked to psychological disorders, but in some cases psychological distress may be driven by gut mechanisms. Therapeutic options are limited and, aside from responders to H. pylori eradication, provide only modest and temporary relief. Advances in understanding FD may alter clinical practice, and the treatment of duodenal inflammation or microbiome alterations may lead to a cure for a subset of these patients in the future.
Topics: Diagnosis, Differential; Duodenal Diseases; Dyspepsia; Eosinophilia; Helicobacter Infections; Helicobacter pylori; Humans; Stress, Psychological
PubMed: 29083538
DOI: 10.1111/1751-2980.12556 -
Endoscopy 2015
Topics: Colonic Diseases; Colonoscopy; Duodenal Diseases; Endoscopy, Digestive System; Female; Humans; Intestinal Diseases, Parasitic; Middle Aged; Strongyloidiasis
PubMed: 26062140
DOI: 10.1055/s-0034-1365386 -
The Surgical Clinics of North America Dec 2015Crohn's disease of the foregut is more common than previously recognized, with up to 40% of patients with Crohn's disease in the distal intestine also having evidence of... (Review)
Review
Crohn's disease of the foregut is more common than previously recognized, with up to 40% of patients with Crohn's disease in the distal intestine also having evidence of foregut disease. Esophageal disease is best managed medically with proton pump inhibition, steroids, thiopurines, methotrexate, and anti-tumor necrosis factor-α biologic medications. Esophageal strictures are dealt with using endoscopic dilation. Surgery is generally reserved of resistant strictures or esophageal fistulas. Patients with gastroduodenal disease more commonly come to surgery. The most commonly performed operations for gastroduodenal Crohn's disease are intestinal bypass or strictureplasty. The concomitant use of vagotomy remains controversial.
Topics: Crohn Disease; Duodenal Diseases; Esophageal Diseases; Humans; Intestinal Obstruction
PubMed: 26596921
DOI: 10.1016/j.suc.2015.07.004 -
Scandinavian Journal of Gastroenterology May 2019Seronegative celiac disease (CD) poses a diagnostic challenge. Characterize and identify differences between seronegative and seropositive CD. Retrospective cohort...
Seronegative celiac disease (CD) poses a diagnostic challenge. Characterize and identify differences between seronegative and seropositive CD. Retrospective cohort study examining adult patients diagnosed with CD (1980-2017). Clinical, analytical, histological, genetic and immunophenotypic data were compiled. Seronegative CD was defined as a anti-tissue transglutaminase type 2 IgA and endomysial antibodies (EMA) negative and HLA-DQ2 and/or DQ8 positive, showing clinical signs of CD plus an abnormal duodenal biopsy, and responding to a gluten-free diet (GFD). Factors associated with seronegative CD were identified through binomial logistic regression. Of 315 CD patients, 289 were seropositive (91.7%) and 26 seronegative (8.3%). Among the seronegative patients, higher prevalence was observed for autoimmune thyroiditis (26.9% 9.7%, = .016), HLA-DQ8 heterozygosity (23.1% 2.5%, ˂ .001) and Marsh I lesion (34.6% 3.7%, ˂ .001). The two groups showed similar flow cytometry-determined duodenal immunophenotypes and rates of refractory CD. Seronegative CD differs mostly in genetic (more HLA-DQ8) and histologic (milder atrophy) features as compared with seropositive. Intestinal intraepithelial immunophenotype by flow cytometry, similar in both modalities, is a useful tool to diagnose seronegative CD.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Atrophy; Autoantibodies; Biopsy; Celiac Disease; Diet, Gluten-Free; Duodenal Diseases; Duodenum; Female; Flow Cytometry; GTP-Binding Proteins; HLA-DQ Antigens; Humans; Immunoglobulin A; Intestinal Mucosa; Logistic Models; Lymphocytes; Male; Middle Aged; Protein Glutamine gamma Glutamyltransferase 2; Retrospective Studies; Transglutaminases; Young Adult
PubMed: 31057009
DOI: 10.1080/00365521.2019.1608466 -
Gastroenterology Clinics of North... Dec 2014
Topics: Acute Disease; Duodenal Diseases; Esophageal and Gastric Varices; Gastrointestinal Hemorrhage; Humans; Stomach Diseases
PubMed: 25440931
DOI: 10.1016/j.gtc.2014.09.001 -
Jornal de Pediatria 2018Several studies have been performed concerning pathologies of the stomach and esophagus in the pediatric age group. However, there have been very few studies of duodenal...
OBJECTIVE
Several studies have been performed concerning pathologies of the stomach and esophagus in the pediatric age group. However, there have been very few studies of duodenal pathologies in children. The authors aimed to examine the clinical, endoscopic, and histopathological characteristics, as well as the etiology of duodenal pathologies in children.
METHOD
Patients aged between 1 and 17 years undergoing esophagogastroduodenoscopy during two years at this unit, were investigated retrospectively. Demographic, clinical, endoscopic data, and the presence of duodenal pathologies, gastritis, and esophagitis were recorded in all of the children.
RESULTS
Out of 747 children who underwent endoscopy, duodenal pathology was observed in 226 (30.3%) patients. Pathology was also present in the esophagus in 31.6% of patients and in the stomach in 58.4%. The level of chronic diarrhea was higher in patients with duodenal pathology when compared with those without duodenal pathology (p=0.002, OR: 3.91, 95% CI: 1.59-9.57). Helicobacter pylori infection was more common in patients with pathology in the duodenum (59.3%).
CONCLUSION
Duodenal pathology was detected in 30.3% of the present patients. A significantly higher level of chronic diarrhea was observed in subjects with duodenal pathologies compared to those with no such pathology. The rate of Helicobacter pylori infection was considerably higher than that in previous studies. In addition, there is a weak correlation between endoscopic appearance and histology of duodenitis.
Topics: Adolescent; Biopsy; Child; Child, Preschool; Duodenal Diseases; Endoscopy, Digestive System; Female; Helicobacter Infections; Helicobacter pylori; Humans; Infant; Male; Retrospective Studies
PubMed: 28888898
DOI: 10.1016/j.jped.2017.06.018