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The Surgical Clinics of North America Dec 2023Gastric and small bowel emergencies are often seen in the emergency department and require rapid assessment and intervention as patients can deteriorate quickly. Some of... (Review)
Review
Gastric and small bowel emergencies are often seen in the emergency department and require rapid assessment and intervention as patients can deteriorate quickly. Some of the more frequently seen gastric emergencies include gastric volvulus and peptic ulcer disease, which can present with ischemia, strangulation, perforation, or severe bleeding. Swift diagnosis is crucial to ensuring the proper management whether that is endoscopic or with surgical exploration. Perforated peptic ulcers that are not contained will require surgical intervention, whereas bleeding ulcers can often be controlled with endoscopic interventions.
Topics: Humans; Duodenal Ulcer; Emergencies; Peptic Ulcer Perforation; Intestine, Small
PubMed: 37838458
DOI: 10.1016/j.suc.2023.05.012 -
Drugs May 2023Keverprazan hydrochloride () is a potassium ion competitive acid blocker that is being developed by Jiangsu Carephar Pharmaceuticals for the treatment of acid-related... (Review)
Review
Keverprazan hydrochloride () is a potassium ion competitive acid blocker that is being developed by Jiangsu Carephar Pharmaceuticals for the treatment of acid-related disease. Keverprazan hydrochloride was recently approved in China for the treatment of adults with reflux oesophagitis or duodenal ulcer. This article summarizes the milestones in the development of keverprazan hydrochloride leading to this first approval for reflux oesophagitis and duodenal ulcer.
Topics: Adult; Humans; Duodenal Ulcer; Esophagitis, Peptic; Helicobacter Infections; China
PubMed: 37074491
DOI: 10.1007/s40265-023-01865-w -
Journal of Visceral Surgery Apr 2023Cystic dystrophy in heterotopic pancreas, or paraduodenal pancreatitis, is a rare and complicated presentation involving heterotopic pancreatic tissue in the duodenal... (Review)
Review
Cystic dystrophy in heterotopic pancreas, or paraduodenal pancreatitis, is a rare and complicated presentation involving heterotopic pancreatic tissue in the duodenal wall. This condition is present in 5% of the general population but disease mainly affects middle-aged alcoholic-smoking men with chronic pancreatitis (CP). It may be purely duodenal or segmental (pancreatico-duodenopathy). Its pathophysiology arises from alcohol toxicity with obstruction of small ducts of heterotopic pancreatic tissue present in the duodenal wall and the pancreatic-duodenal sulcus, leading to repeated episodes of pancreatitis. The symptomatology includes episodes of acute pancreatitis, weight loss, and vomiting due to duodenal obstruction. Imaging shows thickening of the wall of the second portion of the duodenum with multiple small cysts. A stepwise therapeutic approach is preferred. Conservative medical treatment is favored in first intention (analgesics, continuous enteral feeding, somatostatin analogues), which allows complete symptomatic regression in 57% of cases associated with a 5% rate of complications (arterial thrombosis and diabetes). Endoscopic treatment may also be associated with conservative measures. Surgery achieves a complete regression of symptoms in 79% of cases but with a 20% rate of complications. Surgery is indicated in case of therapeutic failure or in case of doubt about a malignant tumor. Pancreaticoduodenectomy and duodenal resection with pancreatic preservation (PPDR) seem to be the most effective treatments. PPDR has also been proposed as a first-line treatment for purely duodenal location of paraduodenal pancreatitis, thereby preventing progression to an extended segmental form.
Topics: Male; Middle Aged; Humans; Acute Disease; Pancreas; Pancreaticoduodenectomy; Pancreatitis, Chronic; Cysts; Duodenal Diseases; Choristoma
PubMed: 36966112
DOI: 10.1016/j.jviscsurg.2023.03.001 -
Tidsskrift For Den Norske Laegeforening... May 2023Paraduodenal hernia is a rare form of congenital internal hernia and can lead to small bowel obstruction. This case report describes the case of a young boy who was...
Paraduodenal hernia is a rare form of congenital internal hernia and can lead to small bowel obstruction. This case report describes the case of a young boy who was admitted with acute exacerbation of chronic abdominal pain.
Topics: Male; Humans; Hernia; Paraduodenal Hernia; Duodenal Diseases; Intestine, Small; Intestinal Obstruction
PubMed: 37254989
DOI: 10.4045/tidsskr.22.0506 -
Radiographics : a Review Publication of... Aug 2023Radiologic evaluation of neonatal bowel obstruction is challenging owing to the overlapping clinical features and imaging appearances of the most common differential...
Radiologic evaluation of neonatal bowel obstruction is challenging owing to the overlapping clinical features and imaging appearances of the most common differential diagnoses. The key to providing an appropriate differential diagnosis comes from a combination of the patient's gestational age, clinical features, and imaging findings. While assessment of radiographs can confirm bowel obstruction and indicate whether it is likely proximal or distal, additional findings at upper or lower gastrointestinal contrast study together with use of US are important in providing an appropriate differential diagnosis. The authors provide an in-depth assessment of the appearances of the most common differential diagnoses of proximal and distal neonatal bowel obstruction at abdominal radiography and upper and lower gastrointestinal contrast studies. These are divided into imaging patterns and their associated differential diagnoses on the basis of abdominal radiographic findings. These findings include esophageal atresia variants including the "single bubble," "double bubble," and "triple bubble" and distal bowel obstruction involving the small and large bowel. Entities discussed include esophageal atresia, hypertrophic pyloric stenosis, pyloric atresia, duodenal atresia, duodenal web, malrotation with midgut volvulus, jejunal atresia, ileal atresia, meconium ileus, segmental volvulus, internal hernia, colonic atresia, Hirschsprung disease, and functional immaturity of the large bowel. The authors include the advantages of abdominal US in this algorithm, particularly for hypertrophic pyloric stenosis, duodenal web, malrotation with midgut volvulus, and segmental volvulus. RSNA, 2023 Quiz questions for this article are available through the Online Learning Center.
Topics: Infant, Newborn; Humans; Intestinal Volvulus; Esophageal Atresia; Pyloric Stenosis, Hypertrophic; Intestinal Obstruction; Duodenal Obstruction; Digestive System Abnormalities; Radiography, Abdominal; Duodenal Diseases
PubMed: 37471246
DOI: 10.1148/rg.230035 -
Radiographics : a Review Publication of... 2020The duodenum, the first portion of the small bowel, is divided into four segments and extends to both retro- and intraperitoneal spaces. Some conditions arise primarily... (Review)
Review
The duodenum, the first portion of the small bowel, is divided into four segments and extends to both retro- and intraperitoneal spaces. Some conditions arise primarily from the duodenum, but it can be secondarily affected by processes that involve neighboring structures. When duodenal emergencies are not identified and treated promptly, they may result in high morbidity and mortality. Imaging plays an important role in the diagnosis of duodenal conditions in the acute setting. However, the radiologic findings can be subtle, and awareness of relevant patient history and clinical presentation is important as it may increase the index of suspicion and one's ability to diagnose these conditions. Duodenal peptic disease is common and can be complicated by bleeding and perforation. The duodenum can be secondarily involved by pancreatitis and gallbladder pathologic conditions and may be affected by iatrogenic complications following endoscopic procedures. Traumatic injuries to the duodenum are generally uncommon, with penetrating traumatic injury being the most frequent mechanism of injury. Duodenal vascular pathologic conditions such as aortoduodenal fistula are uncommon but can be life threatening. The knowledge of which pathologic condition can involve which duodenal segment can help the radiologist establish a differential diagnosis and achieve a more targeted imaging approach. RSNA, 2020.
Topics: Abdominal Injuries; Diagnosis, Differential; Duodenal Diseases; Duodenum; Emergencies; Humans
PubMed: 32870765
DOI: 10.1148/rg.2020200045 -
Harefuah Jun 2022Pancreatic cancer (PC) is the 11th most common malignancy worldwide, however, entailing a mortality in excess of 90% within 5 years from diagnosis, it is the 4th most... (Review)
Review
Pancreatic cancer (PC) is the 11th most common malignancy worldwide, however, entailing a mortality in excess of 90% within 5 years from diagnosis, it is the 4th most fatal malignant disease. PC is commonly diagnosed at an advanced stage, in which curative resection is no longer possible. Even patients who present with potentially curable disease will have upward of 30% recurrence of their disease within the first year. Thus, palliative therapy has paramount importance in patient management. The purpose of palliative care in these patients is to relieve symptoms and improve quality of life. This article reviews the current state of invasive palliation techniques for advanced PC, which are commonly directed towards three main symptoms: gastric/duodenal obstruction, obstructive jaundice, and epigastric pain. We describe the pros and cons of the different techniques, along with current front-line technology advancements. Endoscopic stenting is highly efficient in patients with gastric/duodenal obstruction or obstructive jaundice, with a generally low complication rate, short hospitalization and sustained quality of life. Bypass surgery should be considered in patients with a long-anticipated life expectancy, following higher rates of long-term stent failure, or when endoscopic stent procedure is not possible or has failed. When treating abdominal pain, celiac plexus neurolysis is considered as the first-line treatment. Pancreatic cancer is a complex and commonly lethal disease strongly affecting patient quality of life. It is important to consider the specific patient's personal characteristics and disease status when planning their palliative care.
Topics: Duodenal Obstruction; Humans; Jaundice, Obstructive; Palliative Care; Pancreatic Neoplasms; Quality of Life; Stents
PubMed: 35734796
DOI: No ID Found -
Radiographics : a Review Publication of... 2022The duodenum can be affected by a variety of abnormalities because of its development during embryogenesis and its dual intra- and retroperitoneal location. If small...
The duodenum can be affected by a variety of abnormalities because of its development during embryogenesis and its dual intra- and retroperitoneal location. If small bowel embryogenesis is disturbed, congenital errors occur. Although some congenital variants may be asymptomatic and inconsequential to the patient, other anomalies can result in life-threatening emergencies such as malrotation, leading to midgut volvulus. Many infectious processes affect the duodenum, including duodenal ulcers and opportunistic infection in patients with HIV/AIDS or Crohn disease. Small bowel malignancies are uncommon but important to recognize, because the duodenum can be involved in polyposis syndromes or the development of primary adenocarcinoma, neuroendocrine tumors, lymphoma, and metastasis. Although endoscopy is currently the most used diagnostic method to assess the lumen of the upper gastrointestinal tract, fluoroscopy is a valuable adjunct technique and the study of choice for many diseases, specifically those for which anatomic and functional information is required. Fluoroscopy is also commonly used postoperatively to assess for complications such as obstruction and extraluminal leaks. Compared with endoscopy, fluoroscopy is an inexpensive and noninvasive technique that provides salient anatomic information and allows delineation of the duodenal mucosa and assessment of real-time duodenal motility. The authors examine the broad spectrum of conditions that can involve the duodenum, including congenital, infectious, inflammatory, and neoplastic abnormalities, and review their typical appearances at fluoroscopy. RSNA, 2022.
Topics: Duodenal Diseases; Duodenum; Fluoroscopy; Humans; Intestine, Small
PubMed: 35179986
DOI: 10.1148/rg.210165 -
Alimentary Pharmacology & Therapeutics Jan 2022In many countries alike, the time trends of gastric cancer, gastric and duodenal ulcer, ulcerative colitis, Crohn's disease, and colorectal cancer are characterized by...
In many countries alike, the time trends of gastric cancer, gastric and duodenal ulcer, ulcerative colitis, Crohn's disease, and colorectal cancer are characterized by similar birth-cohort patterns. Mortality from these diagnoses rose in cohorts born during the 19th century and then fell in subsequent cohorts born during the 20th century.
Topics: Cohort Studies; Duodenal Ulcer; Helicobacter Infections; Helicobacter pylori; Humans; Stomach Neoplasms; Stomach Ulcer
PubMed: 34989430
DOI: 10.1111/apt.16592 -
Abdominal Radiology (New York) Jan 2020
Review
Topics: Duodenal Diseases; Duodenum; Hematoma; Humans; Tomography, X-Ray Computed
PubMed: 31378827
DOI: 10.1007/s00261-019-02166-1