-
Journal of Contemporary Brachytherapy Apr 2024Few studies have focused on the management of inoperable ampullary carcinoma (AC), and patients with jaundice suffer from biliary stents replacement frequently....
PURPOSE
Few studies have focused on the management of inoperable ampullary carcinoma (AC), and patients with jaundice suffer from biliary stents replacement frequently. Iodine-125 (I) brachytherapy has been used in the treatment of malignant tumors owing to its curative effect, minimal surgical trauma, and tolerable complications. The aim of the study was to investigate the role of I seed implantation in patients with unresectable ampullary carcinoma after relief of obstructive jaundice.
MATERIAL AND METHODS
A total of 44 patients with obstructive jaundice resulting from unresectable ampullary carcinoma from January 1, 2010 to October 31, 2020 were enrolled in the study. Eleven patients underwent implantation of I seeds under endoscopic ultrasound (EUS) after receiving biliary stent placement endoscopic retrograde cholangiopancreatography (ERCP) (treatment group), and 33 patients received a stent alone ERCP (control group). Cox regression model was applied in this single-center retrospective comparison study.
RESULTS
The median maximum intervention interval for biliary obstruction was 381 days (interquartile range [IQR]: 204-419 days) in the treatment group and 175 days (IQR: 126-274 days) in the control group ( < 0.05). Stent occlusion rates at 90 and 180 days in the control group were 12.9% and 51.6%, respectively. No stent occlusion occurred in the treatment group. Patients in the treatment group obtained longer survival time (median, 26 vs. 13 months; < 0.01) and prolonged duodenal obstruction (median, 20.5 vs. 11 months; < 0.05). No brachytherapy-related grade 3 or 4 adverse events were observed.
CONCLUSIONS
Longer intervention interval for biliary obstruction and survival as well as better stent patency and prolonged time to duodenal obstruction could be achieved by implanting I seeds combined with biliary stent in patients with unresectable ampullary cancer.
PubMed: 38808212
DOI: 10.5114/jcb.2024.139279 -
Clinical Case Reports Jun 2024This case highlights the importance of a definite diagnosis of an IgG4-related chronic sclerosing duodenitis based on histological and radiological findings to rule out...
KEY CLINICAL MESSAGE
This case highlights the importance of a definite diagnosis of an IgG4-related chronic sclerosing duodenitis based on histological and radiological findings to rule out any malignancy in the mass. While dealing with patients having concentric duodenal thickening resulting in stricture formation, one should think of inflammatory etiology as well. IgG4-related disease is one of these inflammatory disorders where we see soft tissue thickening without a large mass or any associated lymphadenopathy as in our case.
ABSTRACT
Immunoglobulin G4-related disease (IgG4-RD) is distinguished as an infiltration of IgG-4-positive plasmacytes involving inflammatory lesions across multiple organs which is accompanied by raised IgG4 levels in the serum. Several inflammatory disorders are recognized as part of the IgG4-RD family based on shared histopathological features, which include Mikulicz's disease, chronic sclerosing sialadenitis, or Riedel's thyroiditis. Our case highlights a distinctive presentation of IgG4-related diseases; a 58-year-old man presenting with duodenal stricture highly suspicious of a duodenal mass/ampullary mass later found to be due to IgG4-related sclerosing duodenitis with negative malignancy on biopsy. We present the diagnostic challenges faced and relevant findings noted.
PubMed: 38808195
DOI: 10.1002/ccr3.8980 -
Cureus Apr 2024We present a case of a 58-year-old male with a rare duodenal carcinosarcoma causing gastric outlet obstruction. Despite its aggressive nature and poor prognosis, with...
We present a case of a 58-year-old male with a rare duodenal carcinosarcoma causing gastric outlet obstruction. Despite its aggressive nature and poor prognosis, with only 12 documented cases in the literature, this report sheds light on the clinical presentation and challenges in diagnosis and treatment. Carcinosarcoma, characterized by both carcinomatous and sarcomatous elements, poses difficulties in management due to its diverse tissue characteristics. Surgical resection remains the primary treatment, although the prognosis remains grim, emphasizing the need for further research into advanced therapeutic strategies to improve patient outcomes. This case underscores the rarity and clinical complexities associated with duodenal carcinosarcomas.
PubMed: 38779294
DOI: 10.7759/cureus.58725 -
Gut and Liver May 2024Malignant duodenal obstruction has become more common with the development of palliative therapies.The outcomes of endoscopic ultrasound-guided gastrojejunostomy...
Clinical Outcomes of Secondary Duodenal Self-Expandable Metallic Stenting for Duodenal Stent Dysfunction in Patients with Malignant Duodenal Obstruction: A Retrospective Multicenter Study.
BACKGROUND/AIMS
Malignant duodenal obstruction has become more common with the development of palliative therapies.The outcomes of endoscopic ultrasound-guided gastrojejunostomy (EUS-GJ) are comparable to those of surgical gastrojejunostomy or duodenal stenting. However, EUS-GJ is technically challenging. Duodenal self-expandable metallic stent (SEMS) placement is popular; however, obstructions are common. Duodenal SEMS obstruction can be managed with the insertion of a second SEMS in a stent-in-stent manner. Therefore, we aimed to analyze the clinical outcomes of secondary duodenal SEMS placement in patients with malignant duodenal obstruction.
METHODS
We retrospectively analyzed the data of patients who underwent secondary duodenal stent insertion for duodenal stent dysfunction between January 2016 and December 2021. The primary outcome was stent patency. The secondary outcomes were clinical success, factors associated with dysfunction, patient survival, and adverse events.
RESULTS
A total of 109 patients were included. The mean age was 64.4±11.2 years, and 63 patients (57.8%) were male. Ninety-two patients (84.4%) had pancreaticobiliary cancer. Clinical success was achieved in 94 cases (86.2%). Twenty-three patients experienced stent dysfunction with 231 days of median stent patency (95% confidence interval [CI], 169 to not available). After a multivariable Cox hazard analysis of stent patency, the Eastern Cooperative Oncology Group performance status (hazard ratio [HR], 2.13; 95% CI, 1.20 to 3.81; p=0.010) and the first stent patency ≥6 months (HR, 0.33; 95% CI, 0.11 to 0.95; p=0.050) remained significant associated factors. Adverse events occurred in five patients (4.6%).
CONCLUSIONS
Secondary duodenal stent insertion is a viable option for first duodenal stent obstruction. Further comparative studies involving surgery or EUS-GJ for obstructed duodenal stents are warranted.
PubMed: 38772730
DOI: 10.5009/gnl240014 -
JFMS Open Reports 2024A 5-year-old neutered Somali cat presented with a 2-week history of icterus. Diagnostic imaging revealed extrahepatic biliary obstruction (EHBO) due to a common bile...
CASE SUMMARY
A 5-year-old neutered Somali cat presented with a 2-week history of icterus. Diagnostic imaging revealed extrahepatic biliary obstruction (EHBO) due to a common bile duct (CBD) mass. During exploratory laparotomy, a duodenal perforation was discovered incidentally. Choledochoduodenostomy combined with the Billroth II procedure was performed after resection of the CBD mass and the proximal duodenum to treat the EHBO and duodenal perforation. Based on histological and immunohistochemical findings, the CBD mass was diagnosed as a neuroendocrine carcinoma with gastrin-producing cell differentiation. The cat recovered almost uneventfully and was discharged 11 days after surgery. The cat survived for nearly 100 days without recurrence of EHBO or duodenal perforation; however, intermittent vomiting and weight loss persisted despite supportive medications.
RELEVANCE AND NOVEL INFORMATION
To the best of our knowledge, there is no detailed report on the application of choledochoduodenostomy combined with the Billroth II procedure in cats, as we used to treat the EHBO and duodenal perforation in the present case. As serum gastrin concentrations were elevated on the first day of hospitalisation, the CBD mass was diagnosed as a neuroendocrine carcinoma with gastrin-producing cell differentiation, which seemed to have caused not only EHBO but also duodenal perforation (Zollinger-Ellison syndrome). The cat survived for almost 100 days without any perioperative complications. However, this combined procedure might be considered as only a salvage option and not as a definitive treatment option in cats requiring simultaneous biliary and gastrointestinal reconstruction because postoperative supportive care could not improve the cat's condition or maintain its quality of life.
PubMed: 38766407
DOI: 10.1177/20551169241246415 -
Journal of Surgical Case Reports May 2024A paraduodenal hernia is a rare cause of an internal hernia that may require massive bowel resection; prompt diagnosis and surgical treatment are essential. In cases of...
A paraduodenal hernia is a rare cause of an internal hernia that may require massive bowel resection; prompt diagnosis and surgical treatment are essential. In cases of malrotation, strangulation may occur both inside and outside the hernial sac. Strangulation outside the hernial sac makes the preoperative diagnosis more difficult. Herein, we report a patient with a right paraduodenal hernia, intestinal malrotation, and strangulation outside the hernia. An 86-year-old woman was admitted to our hospital with abdominal pain. Enhanced computed tomography showed a closed-loop obstruction of the hypo-enhancing small bowel and absence of a horizontal duodenal leg. The patient underwent an emergency laparotomy and was diagnosed with strangulated bowel obstruction due to a right paraduodenal hernia and malrotation. The patient underwent resection of the ischemic ileum, closure of the hernial orifice, and repositioning of the intestine. The postoperative course was uneventful. The patient reported no abdominal discomfort after 7 months of follow-up.
PubMed: 38764731
DOI: 10.1093/jscr/rjae311 -
International Journal of Surgery Case... May 2024Congenital obstruction of duodenojejunal junction is a rare unexplored pathologic entity. Most of the cases reported so far are regarding extrinsic band or narrower...
INTRODUCTION AND IMPORTANCE
Congenital obstruction of duodenojejunal junction is a rare unexplored pathologic entity. Most of the cases reported so far are regarding extrinsic band or narrower attachment of ligament of Treitz, which will be presenting with vomiting in neonates and children without malrotation.
CASE PRESENTATION
Author is reporting here two rare cases of congenital intrinsic duodenojejunal junctional obstruction and their management in toddlers.
CLINICAL DISCUSSION
Duodenojejunal junction, is an embryologically, pathologically and radiographically, yet unexplored region except anatomically and surgically. Only few pathologies have been described in this region so far CONCLUSION: An abnormal embryogenesis could be speculated and contemplated to be the reason for such rare congenital duodeno jejunal junctional obstruction which should be managed promptly as per required surgical techniques.
PubMed: 38762960
DOI: 10.1016/j.ijscr.2024.109766 -
Prague Medical Report 2024We present a case of obstruction in the third portion of the duodenum secondary to a phytobezoar in an adult patient with no surgical history and without a vegan diet....
We present a case of obstruction in the third portion of the duodenum secondary to a phytobezoar in an adult patient with no surgical history and without a vegan diet. High intestinal obstruction due to a phytobezoar is rarely described in the literature, posing a diagnostic challenge when evaluating potential differentials in the emergency setting. Subsequently, we conduct a review focusing on tomographic findings and the surgical specimen, highlighting key points to consider when addressing such pathologies.
Topics: Bezoars; Humans; Duodenal Obstruction; Duodenum; Male; Female; Middle Aged; Tomography, X-Ray Computed
PubMed: 38761047
DOI: 10.14712/23362936.2024.13 -
Journal of Investigative Medicine High... 2024Diverticular disease is a major cause of hospitalizations, especially in the elderly. Although diverticulosis and its complications predominately affect the colon, the...
Diverticular disease is a major cause of hospitalizations, especially in the elderly. Although diverticulosis and its complications predominately affect the colon, the formation of diverticula in the small intestine, most commonly in the duodenum, is well characterized in the literature. Although small bowel diverticula are typically asymptomatic, and diagnosed incidentally, a complication of periampullary duodenal diverticulum is Lemmel syndrome. Lemmel syndrome is an extremely rare condition whereby periampullary duodenal diverticula, most commonly without diverticulitis, leads to obstruction of the common bile duct due to mass effect and associated complications including acute cholangitis and pancreatitis. Here, we present the first case, to our knowledge, of periampullary duodenal diverticulitis complicated by Lemmel syndrome with concomitant colonic diverticulitis with colovesical fistula. Our case and literature review emphasizes that Lemmel syndrome can present with or without suggestions of obstructive jaundice and can most often be managed conservatively if caught early, except in the setting of emergent complications.
Topics: Humans; Duodenal Diseases; Tomography, X-Ray Computed; Male; Aged; Intestinal Fistula; Diverticulitis, Colonic; Female; Sigmoid Diseases; Diverticulitis
PubMed: 38742534
DOI: 10.1177/23247096241253342 -
Case Reports in Medicine 2024Duodenal atresia or stenosis are different degrees of the same abnormality. They usually occur at the level of the ampulla of Vater and are thought to be an embryologic...
BACKGROUND
Duodenal atresia or stenosis are different degrees of the same abnormality. They usually occur at the level of the ampulla of Vater and are thought to be an embryologic defect during the development of the foregut, leading to abnormal recanalization. Complete duodenal atresia is usually symptomatic in the early neonatal period, while partial obstruction (web, stenosis) may have a late presentation and a more challenging diagnosis such as in our case. . The patient, a 16-year-old girl, presented with abdominal pain, recurrent vomiting, and growth failure. An upper GI study with barium showed an image compatible with gastroptosis. Further diagnostic procedures confirmed a rare finding such as congenital duodenal stenosis. She underwent surgical intervention, and the recovery period was uneventful.
CONCLUSION
Gastroptosis is not diagnostic for a particular disease. This rare radiological finding in children may obscure uncommon diagnosis, such as congenital duodenal stenosis, which can present a diagnostic challenge beyond early childhood.
PubMed: 38736458
DOI: 10.1155/2024/1070253