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BMJ Case Reports Oct 2023This report describes an unusual case of a symptomatic Brunner's gland adenoma arising in a man in his 40s that underwent robotic transduodenal resection. Initial...
This report describes an unusual case of a symptomatic Brunner's gland adenoma arising in a man in his 40s that underwent robotic transduodenal resection. Initial investigations revealed a polypoidal, submucosal lesion that was found in the first part of the duodenum. Microscopically, there was neither dysplasia nor evidence of adenocarcinoma, suggesting differentials of gastrointestinal stroma tumour and duodenal adenoma. Given the size of the lesion, he underwent a surgical resection. Symptomatic Brunner's gland adenoma is uncommon and should be considered as a differential diagnosis in patients presenting with obstructive symptoms.
Topics: Male; Humans; Brunner Glands; Robotic Surgical Procedures; Duodenum; Duodenal Neoplasms; Adenoma
PubMed: 37907319
DOI: 10.1136/bcr-2023-254566 -
Pathologica Dec 2017Brunner's gland hyperplasia is a rare benign lesion arising from the duodenum. It is often an incidental finding on endoscopy with the majority of patients being... (Review)
Review
Brunner's gland hyperplasia is a rare benign lesion arising from the duodenum. It is often an incidental finding on endoscopy with the majority of patients being asymptomatic. It may also present with various symptoms depending on location and tumor size, such as gastrointestinal bleeding, obstruction and abdominal pain. We report an unusual case of large Brunner's gland hyperplasia in 72-years old man, admitted to hospital for epigastric pain, recurrent vomiting and significantly weight loss. Upper endoscopy showed an obstructive submucosis tumour of the bulb. Abdominal computed tomography scan revealed a circumferential thickening and stenosing mass of the first part of the duodenum leading to severe obstruction. Though pre-operative biopsies were negative, imaging studies and endoscopy were strongly suggestive of malignancy and the patient underwent duodenocephalopancreatectomy. Brunner's gland hyperplasia may have unusual presentation, mimicking malignancy. Therefore, extensive pre-operative evaluation, including repetitive tumor biopsies, is necessary to avoid radical surgical procedure.
Topics: Adenoma; Aged; Biopsy; Brunner Glands; Duodenal Obstruction; Duodenum; Humans; Hyperplasia; Male; Tomography, X-Ray Computed
PubMed: 29449737
DOI: No ID Found -
BMJ Case Reports Oct 2022A man in his late 60s with prior Hartman's procedure underwent colostomy takedown and complex ventral hernia repair. He subsequently developed gastrointestinal (GI)...
A man in his late 60s with prior Hartman's procedure underwent colostomy takedown and complex ventral hernia repair. He subsequently developed gastrointestinal (GI) bleeding from a duodenal bulb ulcer. Despite five endoscopic procedures aimed at achieving haemostasis, including placement of an over-the-scope clip, and four endovascular embolisations (inferior and superior pancreaticoduodenal, right gastroepiploic and gastroduodenal arteries), the patient continued to experience episodic, haemodynamically significant bleeding. He eventually required emergency exploratory laparotomy, where the proper hepatic artery was identified as the source (a previously unreported phenomenon). He underwent antrectomy and proper hepatic artery ligation. This case highlights the need to interrogate all portions of the hepatic vasculature in the treatment of refractory GI bleeding.
Topics: Male; Humans; Duodenal Ulcer; Hepatic Artery; Duodenum; Gastrointestinal Hemorrhage; Embolization, Therapeutic; Peptic Ulcer Hemorrhage
PubMed: 36316056
DOI: 10.1136/bcr-2022-249523 -
The Pan African Medical Journal 2017Renal transplantation is the definitive treatment for end stage renal disease. Patients subjected to transplantation require lifelong immunosuppression and are prone to...
INTRODUCTION
Renal transplantation is the definitive treatment for end stage renal disease. Patients subjected to transplantation require lifelong immunosuppression and are prone to several gastrointestinal disorders. Dyspepsia is a common disorder in these patients. The objective of this study was to determine factors leading to dyspepsia in renal (kidney) transplant recipients.
METHODS
It was a cross sectional study conducted at department of hepatogastroenterology and transplant sciences, SIUT Karachi, from 1-6-15 to 1-12-15 for six months. All renal transplanted patients having dyspeptic symptoms for more than 6 weeks. EGD was performed, biopsy specimens obtained from antrum and duodenum, these were sent for histopathological examination. Frequency and percentages were obtained for categorical variables, mean ± SD was calculated for continuous variables. Chi square test was used for categorical variable and student t-test for continuous variables.
RESULTS
Ninety patients were included in the study out of which 64 (71.1%) were males, mean age was 35.82 ± 10.04 years (range: 18-65 years). Gastritis (non associated) in 78 (78.6%), duodenitis in 35 (38.9%) and infection in 29 (32.2%), renal transplant recipients. Most of the patients belonged to Sindhi ethnicity, 27 (30%), followed by Punjabi. Hypertension was the most common co-morbid condition in our patients found in 29 (32.2%), while most of them don't have any co morbid condition. Duodenitis was found to be associated with tacrolimus use (p = 0.037).
CONCLUSION
Gastritis is the most common factor accountable for this symptoms, followed by duodenitis and . Patients taking tacrolimus as immunosuppressant are more prone to develop duodenitis.
Topics: Adolescent; Adult; Aged; Cross-Sectional Studies; Duodenitis; Dyspepsia; Female; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Immunosuppressive Agents; Kidney Failure, Chronic; Kidney Transplantation; Male; Middle Aged; Pakistan; Risk Factors; Tacrolimus; Young Adult
PubMed: 29515738
DOI: 10.11604/pamj.2017.28.120.12767 -
Revista Espanola de Enfermedades... May 2022An 83-year-old female with history of silicosis was referred for upper endoscopy due to duodenal wall thickness detected in thoracic computer tomography (CT). Upper...
An 83-year-old female with history of silicosis was referred for upper endoscopy due to duodenal wall thickness detected in thoracic computer tomography (CT). Upper endoscopy revealed multiple small (1 to 5 mm), whitish polypoid lesions, involving a discrete portion of the descending part of the duodenum with 3 cm extension.
Topics: Aged, 80 and over; Duodenal Neoplasms; Duodenum; Female; Humans; Lymphoma, Follicular
PubMed: 34470459
DOI: 10.17235/reed.2021.8233/2021 -
Allergology International : Official... Apr 2023Non-esophageal eosinophilic gastrointestinal disorders (non-EoE EGIDs) are chronic inflammatory disorders with massive infiltration of eosinophils into the...
BACKGROUND
Non-esophageal eosinophilic gastrointestinal disorders (non-EoE EGIDs) are chronic inflammatory disorders with massive infiltration of eosinophils into the gastrointestinal tract. Food elimination diets are potentially effective treatments. But the existing dietary therapies have various weak points. We developed a new regimen to compensate for the shortcomings of the elemental diet and 6-food elimination diet. The new regimen consists of an amino-acid-based formula, potatoes, vegetables, fruits and restricted seasonings. We named it the "Rainbow Elimination Diet (ED)." The aims of this study were to evaluate the tolerability and safety of this diet.
METHODS
A retrospective medical record examination was conducted at the National Center for Child Health and Development covering the period from January 2010 through December 2018. The medical records of patients (age 2-17 y) with histologically diagnosed non-EoE EGIDs were reviewed. The tolerability, nutritional intake, symptoms, and blood test findings were evaluated.
RESULTS
Nineteen patients were offered several kinds of food-elimination diets. Seven patients (eosinophilic gastritis: 5; gastroenteritis: 1; duodenitis: 1) were treated with Rainbow ED. Six patients were compliant with this diet. The median duration of the diet induction phase was 15 days (range 14-30). All 5 patients who had had symptoms just before the induction phase became symptom-free. The body weight decreased in 5 patients (median -0.6 kg), probably because the serum protein increased, resulting in reduced edema. All 5 patients with hypoproteinemia had elevated serum albumin (median 2.9-3.5 g/dL). The ingested nutritional elements were calculated, and most of them were sufficient, except for fat and selenium.
CONCLUSIONS
The Rainbow ED was well-tolerated and safe for pediatric non-EoE EGIDs.
Topics: Humans; Duodenitis; Eosinophilic Esophagitis; Elimination Diets; Retrospective Studies; Enteritis
PubMed: 36414511
DOI: 10.1016/j.alit.2022.11.001 -
BMC Gastroenterology May 2023The Rome IV criteria have been established as an international standard for diagnosing disorders of gut-brain interaction. In this study, we aimed to examine the upper...
Upper gastrointestinal endoscopic findings in functional constipation and irritable bowel syndrome diagnosed using the Rome IV criteria: a cross-sectional survey during a medical check-up in Japan.
BACKGROUND
The Rome IV criteria have been established as an international standard for diagnosing disorders of gut-brain interaction. In this study, we aimed to examine the upper gastrointestinal (GI) endoscopic findings and symptoms of subjects with functional constipation (FC) and irritable bowel syndrome (IBS) of individuals undergoing a medical check-up.
METHODS
A total of 13,729 subjects underwent a medical check-up at Osaka City University-affiliated clinic, MedCity21, between April 2018 and March 2019. Among the 5,840 subjects who underwent screening upper GI endoscopy and completed a questionnaire based on the Rome IV criteria, 5,402 subjects were consecutively enrolled after excluding subjects with a large amount of gastric residue (n = 6), those who had previously undergone partial or total gastrectomy (n = 40), or those with daily use of low-dose aspirin (n = 82), nonsteroidal anti-inflammatory drugs (n = 63), or acid secretion inhibitors (n = 308).
RESULTS
Robust Poisson regression analyses adjusted for age, sex, Helicobacter pylori infection status, alcohol intake, and smoking habits showed a significant association between FC and corpus erosion (adjusted prevalence ratio [aPR], 2.93; 95% confidence interval [CI], 1.51-5.67; p < 0.01) and red streaks (aPR, 3.83; 95% CI, 2.53-5.79; p < 0.01), whereas IBS was significantly associated with erosive gastritis (aPR, 8.46; 95% CI, 4.89-14.67; p < 0.01) and duodenitis (aPR, 7.28; 95% CI, 3.64-14.59; p < 0.01). Red streaks tended to be associated with IBS (aPR, 1.96; 95% CI, 1.00-3.83; p = 0.05). Subjects with IBS were the most to complain of both upper and lower GI symptoms and psychological symptoms, followed by those with FC and controls. IBS subjects with erosive gastritis or duodenitis had significantly more complaints of stomachache and feeling stressed than those without erosive gastritis or duodenitis (54.5% vs. 18.8%; p = 0.03 and 66.7% vs. 25.0%; p = 0.01).
CONCLUSIONS
Subjects with FC and IBS had a variety of upper GI and psychological symptoms. In the upper GI endoscopic findings, corpus erosion and red streaks were associated with FC, and erosive gastritis, duodenitis, and possibly red streaks were associated with IBS.
Topics: Humans; Irritable Bowel Syndrome; Cross-Sectional Studies; Japan; Duodenitis; Helicobacter Infections; Rome; Helicobacter pylori; Constipation; Surveys and Questionnaires; Gastritis
PubMed: 37138209
DOI: 10.1186/s12876-023-02784-6 -
Journal of Gastrointestinal Surgery :... Nov 2023Segmental resections of the duodenum are uncommonly performed and are technically challenging due to intimate relationships with the biliary tree, pancreas, and superior...
BACKGROUND
Segmental resections of the duodenum are uncommonly performed and are technically challenging due to intimate relationships with the biliary tree, pancreas, and superior mesenteric vessels. The objective of this study was to assess indications, operative strategy, and outcomes of duodenal resections and to advocate that this form of resection deserves its own unique Current Procedural Terminology (CPT) and Relative Value Unit (RVU) structure.
METHODS
Patients undergoing isolated and partial duodenal resection from 2008-2023 at University of Tennessee Health Science Center affiliated hospitals were retrospectively reviewed. Factors examined included clinical presentation, diagnostic evaluation, operative time, and technique, 90-day morbidity and mortality, and pathologic and survival outcomes.
RESULTS
Thirty-one patients were identified with majority female and a median age of 61. Diagnostic studies included computed tomography and upper (including push) endoscopy. Reconstruction most often involved side-to-side duodenojejunostomy following distal duodenal resection. Intraoperative evaluation (IOE) of the biliary tree was utilized to assess and protect pancreaticobiliary structures in eleven patients. Median operative time was 206 min, increasing to 236 min when IOE was necessary. Procedure-related morbidity was 23% with one 90-day mortality. Median postoperative length of stay was 9 days. Pathology included benign adenoma, adenocarcinoma, GIST, neuroendocrine neoplasms, and erosive metastatic deposit.
CONCLUSION
Duodenal resections can be effectively employed to safely address diverse pathologies. These procedures are characterized by long operative times, extended hospital stays, and an incidence of postoperative complications that mimics that of pancreatic resection. This work highlights the need for modification to the CPT system to accurately define these distinct procedures for future research endeavors and development of a more accurate valuation unit.
Topics: Humans; Duodenal Neoplasms; Retrospective Studies; Duodenum; Pancreas; Pancreatectomy
PubMed: 37749459
DOI: 10.1007/s11605-023-05837-z -
Acta Medica (Hradec Kralove) 2022Primary melanoma of the duodenum is an extremely rare, aggressive and life-threatening malignant neoplasm. Published data regarding the effectiveness of current... (Review)
Review
Primary melanoma of the duodenum is an extremely rare, aggressive and life-threatening malignant neoplasm. Published data regarding the effectiveness of current treatment strategies is limited, and our knowledge relies mostly on sporadic case reports. The diagnosis of primary duodenal melanoma is challenging and is based on the patient's medical history and findings from physical examination and radiological and endoscopic imaging as well as proper and careful pathological examinations of the tumor. Despite the many advances in cancer treatment, the prognosis for patients with this type of melanoma remains extremely poor. Delayed diagnosis at advanced disease stage, the general aggressive behavior of this neoplasm, the technical difficulty in achieving complete surgical resection, along with the rich vascular and lymphatic drainage of the intestinal mucosa, all have a negative impact on patients' outcome. In the present review, we aimed to collect and summarize the currently available data in the literature regarding the pathogenesis, clinical features, diagnosis, management and long-term outcomes of this rare, malignant tumor, in order to expand knowledge of its biological behavior and investigate optimal therapeutic options for these patients. Additionally, we present our experience of a case involving a 73-year-old female with primary duodenal melanoma, who was successfully treated with complete surgical resection.
Topics: Female; Humans; Aged; Melanoma; Endoscopy; Duodenum
PubMed: 36942702
DOI: 10.14712/18059694.2023.2 -
Gastrointestinal Endoscopy Feb 2021
Topics: Duodenal Diseases; Duodenal Neoplasms; Duodenum; Humans; Intestinal Polyps; Neoplasms, Glandular and Epithelial
PubMed: 33478662
DOI: 10.1016/j.gie.2020.10.010