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Pediatric Radiology Oct 2018The magnetic resonance imaging (MRI) characteristics of evolving duodenal hematomas in children are unknown. (Observational Study)
Observational Study
BACKGROUND
The magnetic resonance imaging (MRI) characteristics of evolving duodenal hematomas in children are unknown.
OBJECTIVE
To describe the MRI changes exhibited by evolving duodenal hematomas and the likely mechanisms behind these changes.
MATERIALS AND METHODS
We retrospectively reviewed the MR features of intramural duodenal hematomas (6 lesions, 10 examinations) studied on a 1.5-T MR unit. All patients had clinical histories of blunt abdominal trauma or endoscopic procedures and we were able to determine the time interval between the onset and MR imaging. We evaluated and analyzed the appearance and signal intensity patterns of hematomas of varying ages and we compared the results with those in previously reported intracranial hematomas.
RESULTS
The imaging appearances on five examinations were consistent with presence of deoxyhemoglobin. Two of these lesions were hypointense on T2-weighted images and iso- to hyperintense on T1-weighted images. Three had heterogeneous appearances on both T1- and T2-weighted images, and the bulk of the hematoma progressively increased in size and signal intensity on T2-weighted images. On the remaining five examinations, one lesion was hyperintense on T1-weighted images and iso- to hyperintense on T2-weighted images, consistent with intracellular methemoglobin, and four lesions were hyperintense on both T1- and T2-weighted images, consistent with the presence of extracellular methemoglobin. Duodenal hematoma stages were slower than those of intracranial hematomas; the acute stage spanned 2-7 days, and early and late subacute stages occurred 10-17 days after the injury.
CONCLUSION
Duodenal hematomas evolve like intracranial hematomas, but slower. Signal heterogeneity is common in the acute stage.
Topics: Child; Diagnosis, Differential; Disease Progression; Duodenal Diseases; Female; Hematoma; Humans; Magnetic Resonance Imaging; Male; Retrospective Studies; Wounds, Nonpenetrating
PubMed: 30109380
DOI: 10.1007/s00247-018-4178-9 -
Gastrointestinal Endoscopy Aug 2022
Topics: Adenocarcinoma; Choristoma; Cysts; Duodenal Diseases; Humans; Pancreas
PubMed: 35487298
DOI: 10.1016/j.gie.2022.04.021 -
Clinical Journal of Gastroenterology Aug 2017Crohn's disease (CD) is a type of chronic inflammatory bowel disease (IBD) associated with ulceration, and the main foci of the inflammation in CD patients are typically... (Review)
Review
Crohn's disease (CD) is a type of chronic inflammatory bowel disease (IBD) associated with ulceration, and the main foci of the inflammation in CD patients are typically the terminal ileum and colon. However, in the upper gastrointestinal tract (GIT), including the esophagus, stomach and duodenum, inflammatory lesions are also detected as well, with a relatively high frequency (30-75%). Recent advances in imaging modalities, including endoscopy, have aided in the diagnosis of CD. Various lesions, including aphtha, erosion, ulcers, bamboo-joint-like appearance and notch-like appearance, are detected in the upper GI of CD patients. Of these lesions, the bamboo-joint-like appearance in the gastric cardiac region and notch-like appearance in the second portion of the duodenum are highly specific for CD, regardless of the disease activity at other sites. These two findings, particularly a bamboo-joint-like appearance, have therefore been considered as potential biomarkers for CD. Although proton pump inhibitors (PPIs) are administered as an initial treatment for upper GIT lesions of CD, the efficacy of this treatment remains controversial. The administration of mesalazine, steroids, immunosuppressant and biologic agents is expected to be effective for treating such lesions.
Topics: Crohn Disease; Duodenal Diseases; Endoscopy, Gastrointestinal; Esophageal Diseases; Female; Humans; Male; Stomach Diseases
PubMed: 28695451
DOI: 10.1007/s12328-017-0759-7 -
The New England Journal of Medicine Nov 2017
Topics: Abdominal Pain; Aged, 80 and over; Duodenal Diseases; Female; Humans; Intestinal Perforation; Pneumoperitoneum; Radiography, Abdominal; Tomography, X-Ray Computed
PubMed: 29141173
DOI: 10.1056/NEJMicm1613914 -
BMC Surgery Nov 2019Duodenal fibrolipoma and duodenum-jejunum intussusception are both rare occasions in clinical practice. The diagnosis of duodenal fibrolipoma mainly depends on endoscopy...
BACKGROUND
Duodenal fibrolipoma and duodenum-jejunum intussusception are both rare occasions in clinical practice. The diagnosis of duodenal fibrolipoma mainly depends on endoscopy examination, supplemented by CT and MRI. As the tumor grows, some severe symptoms need surgical intervention. As the development of endoscopic techniques, the operation plan should be made individually.
CASE PRESENTATION
A 47-year-old female with the complaint of upper abdominal pain and melena was reported. Abdominal examination revealed upper abdomen lightly tender and blood test showed severe anemia. Image and endoscopy examination exhibited "a giant mass" in the descending (D2) part of duodenum, dragged by the tumor into the distal intestinal canal and causing intussusception. Intermittent blood transfusion treatment, enteral and parenteral nutrition were adopted to adjust her general state. Two weeks later, the mass was resected together with the basement intestinal wall via the jejunum incision and then the intussuscepted D2 part was restored. The paraffin pathological diagnosis correlated with the preoperative judgment of fibrolipoma and the patient was discharged healthy on POD 14.
CONCLUSIONS
Duodenal fibrolipoma is a rare disease, infrequently causing intussusception and severe upper GIB. Duodenoscopy and endoscopic ultrasound contribute to making an appropriate diagnosis, and for patients with severe symptoms needed surgical intervention, operation plan should be individualized depending on the size and location of the lesion.
Topics: Duodenal Diseases; Duodenal Neoplasms; Duodenoscopy; Endosonography; Female; Gastrointestinal Hemorrhage; Humans; Intussusception; Jejunal Diseases; Laparoscopy; Lipoma; Middle Aged; Tomography, X-Ray Computed
PubMed: 31718616
DOI: 10.1186/s12893-019-0634-1 -
Khirurgiia 2021Duodenal duplication cyst (DDC) is a rare form of intestinal malformation (2-12% of all gastrointestinal duplications). There are many difficulties in diagnosis and...
Duodenal duplication cyst (DDC) is a rare form of intestinal malformation (2-12% of all gastrointestinal duplications). There are many difficulties in diagnosis and management of DDC. We present a case of successful endoscopic transluminal treatment of DDC in a 30-year-old female. She complained of epigastric pain, nausea and vomiting, weight loss of 5 kg over the past 3 months. Laparoscopic cholecystectomy for gallstone disease was performed 18 months prior to admission. Examination revealed a cyst 52×60?35 mm in descending part of duodenum. There was a calculus inside the cyst. Transluminal endoscopic cyst fenestration was performed. Histological examination confirmed DDC. According to control duodenoscopy data, cyst was collapsed. The patient remains asymptomatic three months after surgery. DDC is a rare disease of gastrointestinal tract, which should be differentiated first with choledochocele Todani type III and intraluminal duodenal diverticulum. Endoscopic treatment may be an adequate alternative to traditional interventions in some cases.
Topics: Adult; Digestive System Abnormalities; Duodenal Diseases; Duodenoscopy; Duodenum; Female; Humans
PubMed: 33710829
DOI: 10.17116/hirurgia202103166 -
Sao Paulo Medical Journal = Revista... 2018Spontaneous intramural duodenal hematoma is uncommon and is usually associated with coagulopathy, anticoagulant therapy and endoscopic procedures. The aim here was to... (Review)
Review
CONTEXT
Spontaneous intramural duodenal hematoma is uncommon and is usually associated with coagulopathy, anticoagulant therapy and endoscopic procedures. The aim here was to describe a case of intramural duodenal hematoma caused by chronic exacerbation of pancreatitis.
CASE REPORT
A 46-year-old male with chronic alcoholic pancreatitis was admitted to hospital due to abdominal pain, melena and low hemoglobin. An intramural duodenal hematoma with active bleeding was detected and selective angioembolization was warranted. The patient evolved with a perforated duodenum and underwent laparotomy with exclusion of the pylorus and Roux-en-Y gastrojejunostomy. He was discharged nine days later.
CONCLUSION
Intramural duodenal hematoma is a rare complication of pancreatitis. Selective embolization is the preferred treatment for hemorrhagic complications of pancreatitis. However, the risk of visceral ischemia and perforation should be considered.
Topics: Acute Disease; Chronic Disease; Duodenal Diseases; Embolization, Therapeutic; Endoscopy, Digestive System; Gastrointestinal Hemorrhage; Hematoma; Humans; Male; Middle Aged; Pancreatitis; Tomography, X-Ray Computed
PubMed: 29236933
DOI: 10.1590/1516-3180.2017.0134290517 -
Journal of Gastroenterology and... Mar 2018Amyloid tends to deposit in the gastrointestinal tract, which, being easily accessible, is often the target organ for a pathological diagnostic examination. Although a... (Review)
Review
Amyloid tends to deposit in the gastrointestinal tract, which, being easily accessible, is often the target organ for a pathological diagnostic examination. Although a mucosal biopsy is necessary for a definitive diagnosis and several studies have reported positive results for each possible biopsy site, there remain many unclear features in various aspects. This review focuses on the current literature to determine a better understanding of the diagnosis from endoscopic and histological views in patients with systemic amyloidosis with gastrointestinal involvement. A literature search was performed using PubMed to identify relevant studies; linked references were also reviewed. Endoscopic findings vary based on the organ and the depositing amyloids. A fine granular appearance or polypoid protrusions are likely to occur in the duodenum. AL, Aβ2M, and ATTR amyloids are likely to deposit submucosally, while AA amyloid is easily deposited in the superficial layer of the mucous membrane. Furthermore, it is necessary to consider the collection of biopsy specimens from the duodenum, which has high positive biopsy rates. However, the difference in the positive biopsy rates depends on whether endoscopic findings are available or whether the appropriate number has not been fully elucidated. A duodenal biopsy is strongly recommended to confirm the deposition of amyloid in patients with systemic amyloidosis having gastrointestinal involvement. Because amyloidosis is a disease with a poor prognosis, early diagnosis and treatment are required; gastroenterologists and endoscopists play important roles.
Topics: Amyloid; Amyloidosis; Biopsy; Duodenal Diseases; Duodenum; Early Diagnosis; Endoscopy, Gastrointestinal; Humans; Intestinal Mucosa; Prealbumin; beta 2-Microglobulin
PubMed: 28940821
DOI: 10.1111/jgh.13996 -
BMC Gastroenterology Feb 2021Upper gastrointestinal (GI) bleeding is the most important presentation of an aorto-duodenal fistula (ADF). Early diagnosis is difficult, and the disease is associated... (Observational Study)
Observational Study
BACKGROUND
Upper gastrointestinal (GI) bleeding is the most important presentation of an aorto-duodenal fistula (ADF). Early diagnosis is difficult, and the disease is associated with high mortality. The present study aimed to examine the clinical and the endoscopic characteristics of ADF in eight patients who presented to our hospital. We also sought to clarify the diagnostic approach towards the disease.
METHODS
The present study examined the clinical and the endoscopic/computed tomography (CT) characteristics of ADF in eight patients who were definitively diagnosed with this condition in a 12-year period at our hospital.
RESULTS
The patients comprised of five men and three women, with a mean age of 69.8 years. Upper gastrointestinal bleeding was the chief complaint for all the patients. Out of these, two patients presented with shock. The patients' mean haemoglobin at presentation was 7.09 g/dL, and the mean number of blood transfusions was 7.5. All patients had undergone intervention to manage an aortic pathology in the past. As the first investigation, an upper GI endoscopy in 5 and a CT scan in 3 patients were performed. In cases where CT scan was performed first, no definitive diagnosis was obtained, and the diagnosis was confirmed by performing an upper GI endoscopy. In cases where endoscopy was performed first, definitive diagnosis was made in only one case, and the other cases were confirmed by the CT scan. In some cases, tip attachments, converting to long endoscopes, and marking clips were found useful.
CONCLUSIONS
In patients who have undergone intervention to manage an aortic pathology and have episodes of upper gastrointestinal bleeding, ADF cannot be definitively diagnosed with only one investigation. In addition, when performing upper GI endoscopy in cases where an ADF is suspected, tip attachment, converting to a long endoscope, and using marking clips can be helpful.
Topics: Aged; Aorta; Aortic Diseases; Duodenal Diseases; Female; Gastrointestinal Hemorrhage; Humans; Intestinal Fistula; Male
PubMed: 33526013
DOI: 10.1186/s12876-021-01616-9 -
Internal Medicine (Tokyo, Japan) Jul 2022Mesenteric hematoma is an uncommon condition caused by focal bleeding in the mesenteric vessels. Hematomas are related to trauma, pancreatitis, arteriopathy, and the use...
Mesenteric hematoma is an uncommon condition caused by focal bleeding in the mesenteric vessels. Hematomas are related to trauma, pancreatitis, arteriopathy, and the use of antithrombotic agents. Although hematomas cause intestinal stenosis by compressing the adjacent small bowel, duodenal stenosis due to hematoma is rare. Therefore, the treatment indications for cases of hematoma with stenosis have not been established. We herein report a case with a large mesenteric hematoma that caused duodenal stenosis by compressing the third portion of the duodenum. Stenosis was successfully ameliorated after long-term use of a double elementary diet tube.
Topics: Constriction, Pathologic; Diet; Duodenal Diseases; Duodenal Obstruction; Gastrointestinal Hemorrhage; Hematoma; Humans; Intestinal Atresia
PubMed: 34924462
DOI: 10.2169/internalmedicine.8721-21