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Cirugia Pediatrica : Organo Oficial de... Jan 2022Duodenal atresia associated with apple peel is extremely rare. Duodenal atresia occurs as a result of absence of recanalization at an early stage, whereas intestinal... (Review)
Review
INTRODUCTION
Duodenal atresia associated with apple peel is extremely rare. Duodenal atresia occurs as a result of absence of recanalization at an early stage, whereas intestinal atresia is seemingly due to vascular causes at later stages. The presence of abnormalities associated with diaphragmatic hernia is frequent, but association with duodenal atresia has been little explored.
CASE REPORT
This is the case of a female neonate born at gestational week 31, with duodenal atresia and apple peel, associated with left diaphragmatic hernia and major heart disease. An abdominal muscle flap was performed for diaphragmatic defect closure purposes, and duodenojejunal anastomosis was carried out following resection of part of the non-viable apple peel.
DISCUSSION
To our knowledge, this is the first case described with this rare association. The combination of duodenal atresia and apple peel had been previously described 11 times. However, the association of both with congenital diaphragmatic hernia had not been reported yet.
Topics: Duodenal Obstruction; Female; Hernias, Diaphragmatic, Congenital; Humans; Intestinal Atresia; Malus
PubMed: 35037438
DOI: 10.54847/cp.2022.01.16 -
Medicine Jan 2022Metastases to the duodenum in cervical squamous cell carcinoma are extremely rare, with only 7 cases reported in the published English literature. (Review)
Review
RATIONALE
Metastases to the duodenum in cervical squamous cell carcinoma are extremely rare, with only 7 cases reported in the published English literature.
PATIENT CONCERNS
We present the case of a 66-year-old woman with duodenal metastasis of cervical squamous cell carcinoma who presented with nausea and vomiting within the past 12 days.
DIAGNOSIS
Esophagogastroduodenoscopy revealed a circular narrowed 2nd part of the duodenum with congested and edematous mucosa, which was biopsied for a suspected neoplastic lesion. The pathological diagnosis indicated squamous cell carcinoma identical to the original tumor, confirming duodenal metastasis.
INTERVENTIONS
The patient received total parenteral nutrition on admission, but symptoms of jaundice soon appeared in the following week, suggesting infiltration of carcinoma into the common bile duct. After percutaneous transhepatic cholangial drainage was performed, jaundice eased in the following 3 days, and an uncovered self-expandable metallic stent was subsequently inserted into the stenosis of 2nd and 3rd part of the duodenum. Subsequently, the patient's diet quickly resumed.
OUTCOMES
The patient refused further intervention and was discharged home to continue palliative care at the local hospital.
LESSONS
Clinicians should be alert to patients' past medical history to ensure that duodenal metastasis of other tumors is considered in the differential diagnosis. For endoscopists, awareness of such patterns of duodenal stenosis is vital for the accurate recognition of such infrequent diseases.
Topics: Aged; Carcinoma, Squamous Cell; Common Bile Duct; Duodenal Neoplasms; Duodenal Obstruction; Duodenum; Endoscopy, Digestive System; Female; Humans; Uterine Cervical Neoplasms
PubMed: 35029209
DOI: 10.1097/MD.0000000000028526 -
Acta Medica (Hradec Kralove) 2022The aim of our manuscript is to report of a successful perinatal outcome after treatment of acute polyhydramnios caused by duodenal atresia. A 34-year-old G3P1 was...
The aim of our manuscript is to report of a successful perinatal outcome after treatment of acute polyhydramnios caused by duodenal atresia. A 34-year-old G3P1 was referred due to polyhydramnios in the 30th week of pregnancy. Ultrasound revealed polyhydramnios, amniotic fluid index (AFI) 28, and a double bubble sign that indicated duodenal atresia and dilatated oesophagus. In the 32nd week of gestation, the volume of amniotic fluid increases, AFI 35, along with symptoms of dyspnea and abdominal pain. Due to the clinical picture and the early gestational age, it was decided to perform an amnioreduction. In the 36th week of gestation cesarean section was performed. The baby was taken for exploratory laparotomy and found to have a simultaneous complete duodenal atresia and annular pancreas with associated dilated the first portion of the duodenum and the stomach. A side-to-side duodenoduodenostomy via single-layer hand-sewn anastomosis was performed over a transanastamotic feeding tube (TAFT). The postoperative course was uneventful. Amnioreduction is useful and safe in the treatment of acute polyhydramnios caused by duodenal atresia and thus has a significant role in prolonging gestation until fetal maturity.
Topics: Pregnancy; Humans; Female; Adult; Polyhydramnios; Pregnancy Outcome; Cesarean Section; Amniotic Fluid
PubMed: 36942706
DOI: 10.14712/18059694.2023.6 -
Endoscopy Oct 2022
Topics: Cholangiopancreatography, Endoscopic Retrograde; Cholestasis; Constriction, Pathologic; Drainage; Duodenal Obstruction; Humans; Intestinal Atresia; Stents
PubMed: 34933366
DOI: 10.1055/a-1704-8026 -
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 -
Surgical Case Reports Dec 2021Ectopic opening of the common bile duct is a rare congenital biliary anomaly. Herein, we present a case of duodenal stenosis with ectopic opening of the common bile duct...
BACKGROUND
Ectopic opening of the common bile duct is a rare congenital biliary anomaly. Herein, we present a case of duodenal stenosis with ectopic opening of the common bile duct into the duodenal bulb.
CASE PRESENTATION
A 54-year-old man was referred with fever, nausea, and vomiting. He had experienced epigastric pain several times over the past 30 years. Endoscopy showed a post-bulbar ulcer, a submucosal tumor of the duodenum, and a small opening with bile secretion. Contrast duodenography revealed duodenal stenosis and bile reflux with a common bile duct deformity. Pancreatoduodenectomy was performed because of the clinical suspicion of a biliary neoplasm or groove pancreatitis. The resected specimen showed an ectopic opening of the common bile duct into the duodenal bulb and no tumor.
CONCLUSIONS
Ectopic opening of the common bile duct into the duodenal bulb is complicated by a duodenal ulcer, deformity, and stenosis mimicking groove pancreatitis or pancreatic tumors. Although rare, we should be aware of this anomaly for an accurate diagnosis.
PubMed: 34914022
DOI: 10.1186/s40792-021-01351-z -
Orphanet Journal of Rare Diseases Oct 2021Homozygous mutations in the transcription factor RFX6 are the cause of the Mitchell-Riley syndrome (MRS) associating neonatal diabetes, congenital digestive system,...
Determining oncogenic patterns and cancer predisposition through the transcriptomic profile in Mitchell-Riley syndrome with heterotopic gastric mucosa and duodenal atresia: a case report.
BACKGROUND
Homozygous mutations in the transcription factor RFX6 are the cause of the Mitchell-Riley syndrome (MRS) associating neonatal diabetes, congenital digestive system, such as biliary atresia, pancreatic hypoplasia, duodenal and/or jejunal atresia, intestinal malrotation, gallbladder aplasia, cholestasis. A constitutive inactivation of RFX6 leads also to gastric heterotopia. Application of RNA-seq in human diseases may help to better understand pathogenic mechanism of diseases and to predict the risk of developing chronic disorders and personalizing their prevention and treatment. We evaluated oncogenic patterns and cancer predisposition using the transcriptomic profile in a case of MRS with neonatal diabetes, duodenal atresia, and extensive intestinal tract gastric heterotopia.
RESULTS
We signalled the interactors of RFX6 with other up and downregulated genes, that may be interested in severity of diabetic condition, in multi-organs impairment and cancer predisposition. Furthermore, several dysregulated genes are involved in biological processes that can lead to promote cancer including "Evading apoptosis" (BAD, BBC3, EGF, FGFR2, FLT3LG, HMOX1, HRAS, IFNAR2, IGF1R, IL12RB1, IL13RA1, IL15, IL2RB, IL2RG, IL6R, KEAP1, MGST1, PDGFA, PDGFRB, PIK3R3, RALB, RALGDS, RASSF1, SOS1, TGFA, TXNRD3), "Proliferation" (APC, BRAF, CCND2, CCND3, CCNE2, FGFR2, FLT3LG, FZD1, FZD6, HMOX1, HRAS, IGF1R, KEAP1, LRP6, MAPK3, MGST1, PDGFA, PDGFB, PDGFRB, RB1, SOS1, TGFA, TXNRD3, WNT10B), "Sustained angiogenesis" (BRAF, FGFR2, FLT3LG, HRAS, IGF1R, JAG1, MAPK3, NOTCH2, PDGFA, PDGFB, PDGFRB, SOS1, TGFA, TGFB1), "Genomic instability" (BAD, BBC3) and "Insensitivity to anti-growth signals" (SMAD2, TGFB1). We also inspected the signalings and their related genes in cancer, such as "PI3K signaling", "ERK signaling", "JAK-STAT signaling", "Calcium signaling", "Other RAS signaling", "WNT signaling".
CONCLUSIONS
In our MRS patient, we signaled the interactors of RFX6 with other up- and downregulated genes that may be related to severe diabetic condition, multi-organ impairment, and cancer predisposition. Notably, many dysregulated genes may lead to triggering carcinogenesis. The possibility of the patient developing cancer degeneration in heterotopic gastric mucosa and/or additional long-term tumoral sequelae is not excluded. Personalized prevention and treatment strategies should be proposed.
Topics: Carcinogenesis; Diabetes Mellitus; Duodenal Obstruction; Gallbladder Diseases; Gastric Mucosa; Humans; Infant, Newborn; Intestinal Atresia; Kelch-Like ECH-Associated Protein 1; NF-E2-Related Factor 2; Neoplasms; Phosphatidylinositol 3-Kinases; Regulatory Factor X Transcription Factors; Transcriptome
PubMed: 34715892
DOI: 10.1186/s13023-021-02093-9 -
International Journal of Surgery Case... Nov 2021Duodenal web is a rare pathology presenting infrequently in adults. Diagnosis is challenging and definitive management is commonly delayed. We present a case of a...
INTRODUCTION
Duodenal web is a rare pathology presenting infrequently in adults. Diagnosis is challenging and definitive management is commonly delayed. We present a case of a patient with a late diagnosis of duodenal web, who underwent laparotomy, intraoperative gastroscopy and surgical removal of the web performed by two general surgeons.
CASE PRESENTATION
A 32-year-old woman with a previous diagnosis of irritable bowel syndrome presented with a three day history of abdominal pain, nausea and anorexia, and a one day history of melaena and haematemesis. Investigations including a magnetic resonance enterography, barium swallow study and gastroscopy revealed the diagnosis. The patient underwent laparotomy and excision of duodenal web. Intraoperative gastroscopy assisted with identification of the web's anatomical location. A longitudinal duodenotomy was performed and this was closed in a transverse fashion using the Heineke-Mikulicz technique.
DISCUSSION
This case reports successful application of intraoperative gastroscopy during laparotomy and duodenotomy. Longitudinal duodenotomy with excision of the web and transverse closure of the duodenum appears to be the best approach. There are no previous publications detailing gastroscopy at the time of laparotomy with duodenal web. This technique may be utilised in appropriate situations to improve operative accuracy.
CONCLUSION
Duodenal web is a rare entity in adults, and delayed diagnosis may lead to significant patient morbidity. Incorporating intraoperative endoscopy ensures accurate anatomical visualisation. This technique avoids duodenectomy, organ damage, bypass, or an unnecessarily large incision.
PubMed: 34637991
DOI: 10.1016/j.ijscr.2021.106488 -
Ultrasound in Obstetrics & Gynecology :... Mar 2022
Topics: Duodenal Obstruction; Female; Fetal Death; Humans; Intestinal Atresia; Pregnancy; Pregnancy, Twin; Umbilical Cord
PubMed: 34494319
DOI: 10.1002/uog.24763 -
Radiology Case Reports Oct 2021A 64-year-old man presented with epigastric pain and underwent contrast-enhanced computed tomography. Ruptured aneurysm of the inferior pancreaticoduodenal artery was...
A 64-year-old man presented with epigastric pain and underwent contrast-enhanced computed tomography. Ruptured aneurysm of the inferior pancreaticoduodenal artery was diagnosed. TAE was successfully accomplished using coils, but vomiting appeared 9 days later. Duodenal stenosis was diagnosed from contrast-enhanced computed tomography and upper gastrointestinal endoscopy and was attributed to edematous changes in the duodenum. Conservative management led to successful recovery and discharge.
PubMed: 34401015
DOI: 10.1016/j.radcr.2021.06.090