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Digestive Diseases and Sciences Dec 2023
Topics: Humans; Duodenal Diseases; Duodenum; Intestinal Polyps
PubMed: 37775623
DOI: 10.1007/s10620-023-08113-x -
The American Journal of the Medical... Jul 2023
Topics: Humans; Lymphoma, Follicular; Duodenal Neoplasms
PubMed: 36933863
DOI: 10.1016/j.amjms.2023.03.013 -
The New England Journal of Medicine Nov 2020
Topics: Aged, 80 and over; Deglutition Disorders; Duodenal Diseases; Duodenum; Endoscopy, Digestive System; Esophageal Diseases; Humans; Incidental Findings; Male; Melanosis
PubMed: 33176088
DOI: 10.1056/NEJMicm2001352 -
World Journal of Emergency Surgery :... May 2023A common feature of external duodenal fistulae is the devastating effect of the duodenal content rich in bile and pancreatic juice on nearby tissues with...
INTRODUCTION
A common feature of external duodenal fistulae is the devastating effect of the duodenal content rich in bile and pancreatic juice on nearby tissues with therapy-resistant local and systemic complications. This study analyzes the results of different management options with emphasis on successful fistula closure rates.
METHODS
A retrospective single academic center study of adult patients treated for complex duodenal fistulas over a 17-year period with descriptive and univariate analyses was performed.
RESULTS
Fifty patients were identified. First line treatment was surgical in 38 (76%) cases and consisted of resuture or resection with anastomosis combined with duodenal decompression and periduodenal drainage in 36 cases, rectus muscle patch, and surgical decompression with T-tube in one each. Fistula closure rate was 29/38 (76%). In 12 cases, the initial management was nonoperative with or without percutaneous drainage. The fistula was closed without surgery in 5/6 patients (1 patient died with persistent fistula). Among the remaining 6 patients eventually operated, fistula closure was achieved in 4 cases. There was no difference in successful fistula closure rates among initially operatively versus nonoperatively managed patients (29/38 vs. 9/12, p = 1.000). However, when considering eventually failed nonoperative management in 7/12 patients, there was a significant difference in the fistula closure rate (29/38 vs. 5/12, p = 0.036). The overall in-hospital mortality rate was 20/50 (40%).
CONCLUSIONS
Surgical closure combined with duodenal decompression in complex duodenal leaks offers the best chance of successful outcome. In selected cases, nonoperative management can be tried, accepting that some patients may require surgery later.
Topics: Adult; Humans; Retrospective Studies; Duodenal Diseases; Duodenum; Intestinal Fistula; Anastomosis, Surgical
PubMed: 37208716
DOI: 10.1186/s13017-023-00503-w -
The American Surgeon Apr 2023Traumatic duodenal injury is a rare, potentially devastating condition with challenging management decisions. Contemporary literature on operative management of duodenal...
BACKGROUND
Traumatic duodenal injury is a rare, potentially devastating condition with challenging management decisions. Contemporary literature on operative management of duodenal injury is lacking. The purpose of this study is to assess optimal management strategies based on outcomes of patients with traumatic duodenal injury at a single trauma center.
METHODS
A retrospective study of patients with traumatic duodenal injury from 2013-2020 at a level 1 trauma center was performed. Patient demographics, grade of injury as noted on CT scan or intraoperatively, surgical procedure(s) performed, and resultant outcomes were extracted.
RESULTS
After excluding one patient due to death on arrival, 23 patients met inclusion criteria. Injuries consisted of grade 1 (n = 7), grade 2 (n = 2), grade 3 (n = 12), and grade 5 (n = 2); there were no grade 4 injuries. Patients were predominantly male (83%) with a median age of 30 years old. Nineteen patients (82%) underwent surgery. Four of nine patients (44%) with grade 1/2 injuries had hematomas and were managed non-operatively. The remaining five patients (56%) with grade 1/2 injuries underwent operation, which included primary repair (n = 3), duodenal exclusion (n = 1), and periduodenal drainage (n = 1). Of 12 patients with grade 3 injury, 6 underwent primary repair and 6 underwent resection. Three patients who underwent primary repair and one who underwent resection developed a duodenal leak. All patients with grade 5 injury (n = 2) underwent pancreaticoduodenectomy.
CONCLUSION
Grade 1 and 2 duodenal hematomas can be managed non-operatively, while lacerations require operative repair. Outcomes may be better following resection in patients with grade 3 injury.
Topics: Humans; Male; Adult; Female; Retrospective Studies; Duodenum; Duodenal Diseases; Abdominal Injuries; Wounds, Nonpenetrating; Hematoma
PubMed: 33596103
DOI: 10.1177/0003134821995054 -
Surgical Pathology Clinics Sep 2020The evaluation of gastrointestinal pathology in children often requires a different approach from that in adults. In this concise review, the authors outline 3... (Review)
Review
The evaluation of gastrointestinal pathology in children often requires a different approach from that in adults. In this concise review, the authors outline 3 diagnostic challenges that are often encountered in daily practice; these include eosinophilic diseases, duodenal intraepithelial lymphocytosis with preserved villous architecture, and terminal ileal inflammation in the setting of idiopathic inflammatory bowel disease.
Topics: Age Factors; Biopsy; Child; Duodenal Diseases; Eosinophilia; Gastrointestinal Diseases; Gastrointestinal Tract; Humans; Inflammatory Bowel Diseases; Lymphocytosis
PubMed: 32773191
DOI: 10.1016/j.path.2020.05.002 -
Acta Gastro-enterologica Belgica 2021
Topics: Duodenal Diseases; Humans; Intestinal Polyps; Polyps
PubMed: 34599583
DOI: 10.51821/84.2.021 -
Journal of Gastrointestinal Surgery :... Jun 2021
Topics: Cysts; Duodenal Diseases; Duodenum; Humans
PubMed: 33443687
DOI: 10.1007/s11605-020-04890-2 -
Langenbeck's Archives of Surgery Apr 2024Operative options for duodenal Crohn's disease include bypass, stricturoplasty, or resection. What factors are associated with operation selection and whether...
BACKGROUND
Operative options for duodenal Crohn's disease include bypass, stricturoplasty, or resection. What factors are associated with operation selection and whether differences exist in outcomes is unknown.
METHODS
Patients with duodenal Crohn's disease requiring operative intervention across a multi-state health system were identified. Patient and operative characteristics, short-term surgical outcomes, and the need for future endoscopic or surgical management of duodenal Crohn's disease were analyzed.
RESULTS
40 patients underwent bypass (n = 26), stricturoplasty (n = 8), or resection (n = 6). Median age of diagnosis of Crohn's disease was 23.5 years, and over half of the patients had undergone prior surgery for CD. Operation type varied by the most proximal extent of duodenal involvement. Patients with proximal duodenal CD underwent bypass operations more commonly than those with mid- or distal duodenal disease (p = 0.03). Patients who underwent duodenal stricturoplasty more often required concomitant operations for other sites of small bowel or colonic CD (63%) compared to those who underwent bypass (39%) or resection (33%). No patients required subsequent surgery for duodenal CD at a median follow-up of 2.8 years, but two patients required endoscopic dilation (n = 1 after stricturoplasty, n = 1 after resection).
CONCLUSION
Patients who require surgery for duodenal Crohn's disease appear to have an aggressive Crohn's disease phenotype, represented by a younger age of diagnosis and a high rate of prior resection for Crohn's disease. Choice of operation varied by proximal extent of duodenal Crohn's disease.
Topics: Humans; Young Adult; Adult; Crohn Disease; Duodenal Diseases; Duodenum; Intestine, Small; Colon
PubMed: 38639899
DOI: 10.1007/s00423-024-03324-w -
ANZ Journal of Surgery May 2023Duodenal diverticulum occurs in approximately 20% of the population and can lead to life-threatening complications such as perforation. Most perforations are secondary...
BACKGROUND
Duodenal diverticulum occurs in approximately 20% of the population and can lead to life-threatening complications such as perforation. Most perforations are secondary to diverticulitis, with iatrogenic causes being exceptionally rare. This systematic review explores the aetiology, prevention and outcomes of iatrogenic perforation of duodenal diverticulum.
METHODS
A systematic review was performed according to the PRISMA guidelines. Four databases were searched, including Pubmed, Medline, Scopus and Embase. The primary data extracted were clinical findings, type of procedure, prevention and management of perforation and outcomes.
RESULTS
Forty-six studies were identified, of which 14 articles met inclusion criteria and comprised 19 cases of iatrogenic duodenal diverticulum perforation. Four cases identified duodenal diverticulum pre-intervention, nine were identified peri-intervention, and the remainder were identified post-intervention. Perforation secondary to endoscopic retrograde cholangiopancreatography (n = 8) was most common, followed by open and laparoscopic surgery (n = 5), gastroduodenoscopy (n = 4) and other (n = 2). Operative management with diverticulectomy was the most frequent treatment (63%). Iatrogenic perforation was associated with 50% morbidity and 10% mortality.
CONCLUSION
Iatrogenic perforation of duodenal diverticulum is exceptionally rare and associated with high morbidity and mortality. There are limited guidelines surrounding standard perioperative steps to prevent iatrogenic perforations. A review of preoperative imaging helps identify potential aberrant anatomy, such as a duodenal diverticulum, to allow for recognition and prompt management initiation in the event of perforation. Intraoperative recognition and immediate surgical repair are safe options for this complication.
Topics: Humans; Duodenal Ulcer; Cholangiopancreatography, Endoscopic Retrograde; Gastroscopy; Diverticulum; Iatrogenic Disease; Intestinal Perforation
PubMed: 36881513
DOI: 10.1111/ans.18376