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Langenbeck's Archives of Surgery Feb 2022The perforated duodenal diverticulum remains a rare clinical entity, the optimal management of which has not been well established. Historically, primary surgery has...
BACKGROUND
The perforated duodenal diverticulum remains a rare clinical entity, the optimal management of which has not been well established. Historically, primary surgery has been the preferred treatment modality. This was called into question during the last decade, with the successful application of non-operative therapy in selected patients. The aim of this systematic review is to identify cases of perforated duodenal diverticula published over the past decade and to assess any subsequent evolution in treatment.
METHODS
A systematic review of English and non-English articles reporting on perforated duodenal diverticula using MEDLINE (2008-2020) was performed. Only cases of perforated duodenal diverticula in adults (> 18 years) that reported on diagnosis and treatment were included.
RESULTS
Some 328 studies were identified, of which 31 articles met the inclusion criteria. These studies included a total of 47 patients with perforated duodenal diverticula. This series suggests a trend towards conservative management with 34% (16/47) of patients managed non-operatively. In 31% (5/16) patients initially managed conservatively, a step-up approach to surgical intervention was required.
CONCLUSION
Conservative treatment of perforated duodenal diverticula appears to be an acceptable and safe treatment strategy in stable patients without signs of peritonitis under careful observation. For patients who fail to respond to conservative treatment, a step-up approach to percutaneous drainage or surgery can be applied. If surgery is required, competence in techniques ranging from simple diverticulectomy to Roux-en-Y gastric diversion or even Whipple's procedure may be required depending on tissue friability and diverticular collar size.
Topics: Adult; Conservative Treatment; Diverticulum; Drainage; Duodenal Diseases; Humans; Intestinal Perforation
PubMed: 34164722
DOI: 10.1007/s00423-021-02238-1 -
Folia Morphologica 2021Although duodenal diverticula are associated with less frequent pathology than the colonic diverticula in the large intestine, their periampullary position may have...
BACKGROUND
Although duodenal diverticula are associated with less frequent pathology than the colonic diverticula in the large intestine, their periampullary position may have significant clinical implications. The aim of the study was to identify any possible correlation between the type of localisation of the major duodenal papilla, duodenal diverticula, and some particular clinical issues.
MATERIALS AND METHODS
In total, 628 patients (408 females and 220 males; aged 21-91 years), who underwent endoscopic retrograde cholangiopancreatography were included in this study. The patients were divided into two groups: a study group comprising 66 (10.5%) patients with periampullary position of diverticula (group A), and a control group comprising 562 (89.5%) patients without diverticula (group B).
RESULTS
A duodenal diverticulum was diagnosed in the periampullary position in 66/628 (10.5%) patients: 41 women (aged 52-91 years) and 25 men (aged 54-83 years).
CONCLUSIONS
Three types of localisation were observed for the major duodenal papilla with regard to the diverticula, with the most common type being next to each other (type III). In patients with diverticula, similar frequencies of gallstone occurrence are observed in men and women. Patients with papilla in the diverticulum who underwent cholecystectomy are more prone to develop lithiasis.
Topics: Ampulla of Vater; Cholangiopancreatography, Endoscopic Retrograde; Diverticulum; Duodenal Diseases; Female; Humans; Male; Taste Buds
PubMed: 32020575
DOI: 10.5603/FM.a2020.0012 -
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 -
Scientific Reports Dec 2014Helicobacter pylori infection results in diverse clinical conditions ranging from chronic gastritis and ulceration to gastric adenocarcinoma. Among the multiethnic... (Comparative Study)
Comparative Study
Helicobacter pylori infection results in diverse clinical conditions ranging from chronic gastritis and ulceration to gastric adenocarcinoma. Among the multiethnic population of Malaysia, Indians consistently have a higher H. pylori prevalence as compared with Chinese and Malays. Despite the high prevalence of H. pylori, Indians have a relatively low incidence of peptic ulcer disease and gastric cancer. In contrast, gastric cancer and peptic ulcer disease incidence is high in Chinese. H. pylori strains from Chinese strains predominantly belong to the hspEAsia subpopulation while Indian/Malay strains mainly belong to the hspIndia subpopulation. By comparing the genome of 27 Asian strains from different subpopulations, we identified six genes associated with risk of H. pylori-induced peptic ulcer disease and gastric cancer. This study serves as an important foundation for future studies aiming to understand the role of bacterial factors in H. pylori-induced gastro-duodenal diseases.
Topics: Amino Acid Sequence; Bacterial Outer Membrane Proteins; Fructose-Bisphosphate Aldolase; Gastritis; Genes, Bacterial; Genetic Association Studies; Genetic Variation; Helicobacter Infections; Helicobacter pylori; Humans; Malaysia; Molecular Sequence Data; Multilocus Sequence Typing; Peptic Ulcer; Phylogeny; Stomach Neoplasms
PubMed: 25503415
DOI: 10.1038/srep07431 -
African Health Sciences Jun 2023To investigate the demographic features, primary endoscopic findings, and the status of Helicobacter Pylori (H. pylori) infection of the enrolled subjects who underwent...
BACKGROUND/OBJECTIVES
To investigate the demographic features, primary endoscopic findings, and the status of Helicobacter Pylori (H. pylori) infection of the enrolled subjects who underwent upper gastrointestinal endoscopy (UGIE) in the Zanzibar Archipelago, Tanzania.
METHODS
Between December 2013 and October 2021, a total of 3146 eligible participants were finally recruited in present retrospective cohort. Demographic information and endoscopic findings of each participant was retrieved. H. pylori infection was confirmed by rapid-urease test of gastric antral and body biopsies at endoscopy.
RESULTS
Among the recruited subjects, 1691 (53.76%) are females, remaining 1455 (46.24%) are males. The median age of this retrospective cohort was 40 years ranging from 8 to 97 years. The common identified endoscopic findings included gastro-duodenitis, normal endoscopic finding, peptic ulcer disease (PUD), esophagitis, esophagogastric varices, esophageal and gastric cancer, respectively. After adjustment for sex and age, a significant risk of gastric and/or duodenal ulcer (OR, 2.51; 95% CI, 1.82-3.48, P<0.001) and gastric cancer (OR, 3.49; 95% CI, 1.27-9.58, P=0.015) in H. positive group was observed. Stratified analysis indicated a significant relationship between duodenal ulcer with younger age (adjusted OR, 0.98; 95% CI, 0.97-0.99, p = 0.002), and the presence of H. pylori (OR, 2.01; 95% CI, 1.12-3.91, p= 0.021).
CONCLUSIONS
The present study revealed that gastro-duodenitis, PUD, and normal finding are the most common endoscopic diagnoses in Zanzibar. The presence of H. is significantly associated with duodenal ulcer and gastric cancer.
Topics: Male; Female; Humans; Adult; Duodenal Ulcer; Retrospective Studies; Tanzania; Duodenitis; Stomach Neoplasms; Esophageal Neoplasms; Peptic Ulcer; Helicobacter pylori; Endoscopy, Gastrointestinal; Helicobacter Infections
PubMed: 38223625
DOI: 10.4314/ahs.v23i2.45 -
BMC Cancer May 2018The relatively low incidence of duodenal gastrointestinal stromal tumors (GISTs) and the unique anatomy make the surgical management and outcomes of this kind of tumor... (Comparative Study)
Comparative Study
BACKGROUND
The relatively low incidence of duodenal gastrointestinal stromal tumors (GISTs) and the unique anatomy make the surgical management and outcomes of this kind of tumor still under debate. Thus, this study aimed to explore the optimal surgical strategy and prognosis of duodenal GISTs.
METHODS
A total of 300 cases of duodenal GISTs were obtained from our center (37 cases) and from case reports or series (263 cases) extracted from MEDLINE. Clinicopathological features, type of resections and survivals of duodenal GISTs were analyzed.
RESULTS
The most common location of duodenal GISTs was descending portion (137/266, 51.5%). The median tumor size was 4 cm (0.1-28). Most patients (66.3%) received limited resection (LR). Pancreaticoduodenectomy (PD) was mainly performed for GISTs with larger tumor size or arose from descending portion (both P < 0.05). For both the entire cohort and tumors located in the descending portion, PD was not an independent risk factor for disease-free survival (DFS) and disease-specific survival (DSS) (both P > 0.05). Duodenal GISTs were significantly different from gastric GISTs with respect to tumor size, mitotic index and NIH risk category (all P < 0.05). The DFS and DSS of duodenal GISTs was significantly worse than that of gastric GISTs (both P < 0.05).
CONCLUSIONS
LR was a more prevalent surgical procedure and PD was mainly performed for tumors with larger diameter or located in descending portion. Type of resection was not an independent risk factor for the prognosis of duodenal GISTs. Prognosis of duodenal GISTs was significantly worse than that of gastric GISTs.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Disease-Free Survival; Duodenal Neoplasms; Duodenum; Female; Gastrointestinal Stromal Tumors; Humans; Male; Middle Aged; Pancreaticoduodenectomy; Prognosis; Retrospective Studies; Risk Factors; Stomach Neoplasms; Young Adult
PubMed: 29764388
DOI: 10.1186/s12885-018-4485-4 -
Journal of Medical Case Reports Jul 2020A retroperitoneal abscess caused by duodenal perforation is a relatively rare disease clinically. We report the case of a patient with a local high-density shadow at the... (Review)
Review
INTRODUCTION
A retroperitoneal abscess caused by duodenal perforation is a relatively rare disease clinically. We report the case of a patient with a local high-density shadow at the head of the retroperitoneal pancreas.
CASE PRESENTATION
A 28-year-old Chinese man presented with fever and abdominal pain after overeating and heavy drinking. On physical examination, he had mild tenderness in his upper abdomen. Laboratory examination results showed a white blood cell count of 24.06 10/L and a neutrophil absolute value of 18.81 10/L, and a computed tomography scan showed an irregular soft tissue mass with uneven enhancement of the cystic wall in the retroperitoneal space. Gastroscopy showed that there was a fistula in the anterior wall of the duodenal bulb. Endoscopic anastomosis clip system (over-the-scope clip) of the duodenal fistula was performed successfully. After the operation, nasal feeding was provided with a nutrition tube, and empiric anti-infection, acid-inhibiting, and stomach-protecting treatments were administered. Our patient's body temperature gradually returned to normal, and his abdominal pain decreased.
CONCLUSIONS
A retroperitoneal abscess caused by duodenal perforation can be diagnosed by clinical symptoms and abdominal computed tomography imaging. The choice of treatment should be based on accurate and timely clinical and imaging data.
Topics: Abdomen; Abdominal Abscess; Abscess; Adult; Duodenal Diseases; Duodenum; Humans; Male
PubMed: 32678002
DOI: 10.1186/s13256-020-02393-x -
The Turkish Journal of Gastroenterology... Nov 2018Transient receptor potential ankyrin 1 (TRPA1) and substance P (SP), both expression in sensory neurons, have important roles in stress-induced duodenal lesions. The...
BACKGROUND/AIMS
Transient receptor potential ankyrin 1 (TRPA1) and substance P (SP), both expression in sensory neurons, have important roles in stress-induced duodenal lesions. The possible contribution of TRPA1 and SP to stress-induced duodenal lesions was explored by using the water immersion restraint stress (WIRS) rat model.
MATERIALS AND METHODS
Western blotting, Real-time polymerase chain reaction (RT-PCR), and immunohistochemistry assay were used to evaluate the changes of TRPA1and SP expression in the dorsal root ganglia (DRG, T8-11), the corresponding segment of the spinal cord (T8-11), and the duodenum in a duodenal lesions rat model. The SP concentrations of duodenal mucosa were investigated using an enzyme-linked immunosorbent assay (ELISA). Duodenal lesions were assessed according to histopathological changes. TRPA1 specific antagonist HC-030031 was intrathecally or intraperitoneally performed to suppress the expression of both TRPA1 and SP for evaluating the roles of TRPA1 and SP in duodenal lesions.
RESULTS
In contrast to the control group, TRPA1 and substance P in the DRG (T8-11) and duodenum were up-regulated, and concentrations of SP in the duodenal mucosa were increased after WIRS (p<0.05), which are closely associated with duodenal lesions. SP concentrations in the duodenal mucosa were decreased and duodenal lesions were alleviated by pretreatment with TRPA1 antagonist HC-030031. We identified a protective role for HC-030031 in WIRS-induced duodenal lesions. Furthermore, we demonstrated that WIRS increased the concentrations of SP in the duodenal mucosa in a TRPA1-dependent manner. However, WIRS caused no significant changes of TRPA1 and SP in the spinal cord (T8-11) compared with the control group (p>0.05).
CONCLUSION
Our study indicates that TRPA1 antagonist HC-030031 alleviates duodenal lesions. TRPA1 is activated and sensitized, therefore concomitant neuropeptide SP is released, which exerts a critical role in inducing and maintaining duodenal lesions following WIRS in rats. This provides evidence that neuroimmune interactions may control duodenal injury. TRPA1 may be a potential drug target to inhibit the development of duodenal lesions by stress-induced in patients.
Topics: Animals; Blotting, Western; Disease Models, Animal; Duodenal Diseases; Duodenum; Ganglia, Spinal; Immunohistochemistry; Intestinal Mucosa; Male; Rats; Rats, Wistar; Real-Time Polymerase Chain Reaction; Stress, Physiological; Substance P; TRPA1 Cation Channel
PubMed: 30381276
DOI: 10.5152/tjg.2018.17817 -
BioMed Research International 2022Duodenal ulcer seriously affects the quality of life and life safety of children, but the pathogenesis of children with duodenal ulcer is still unclear. As an important... (Clinical Trial)
Clinical Trial
Duodenal ulcer seriously affects the quality of life and life safety of children, but the pathogenesis of children with duodenal ulcer is still unclear. As an important second messenger in the body, Ca participates in the physiological and pathological processes of various diseases. Therefore, transient receptor potential vanilloid type 4 (TRPV4) as one of the channels that mediate Ca has attracted widespread attention in recent years. Here, we found that TRPV4 is highly expressed in children with duodenal ulcer and has good diagnostic value through specimens of children with duodenal ulcer, and animal experiments have proved that TRPV4 is also highly expressed in duodenal ulcer mice. In addition, TRPV4 can enhance intestinal permeability, thereby promoting further infiltration of inflammatory factors. In summary, these results indicate that TRPV4 is involved in the occurrence and development of duodenal ulcer. Therefore, this study provides the diagnostic and therapeutic value of TRPV4 in children with duodenal ulcer.
Topics: Adolescent; Animals; Child; Child, Preschool; Duodenal Ulcer; Female; Gene Expression Regulation; Helicobacter Infections; Helicobacter pylori; Humans; Male; Mice; TRPV Cation Channels
PubMed: 35028313
DOI: 10.1155/2022/2777882