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BMJ Case Reports Feb 2018Dieulafoy's lesion is an abnormally large, tortuous, submucosal vessel that erodes the overlying epithelium without primary ulceration or erosion. The lesion... (Review)
Review
Dieulafoy's lesion is an abnormally large, tortuous, submucosal vessel that erodes the overlying epithelium without primary ulceration or erosion. The lesion predominantly occurs in the proximal stomach but it is also reported in extragastric sites. The pathogenesis and precipitating factors are poorly understood. Patients frequently present with gastrointestinal haemorrhage that can range from being self-limited to massive life threatening. Although there are no standard guidelines, endoscopy has significantly impacted the diagnosis and management. This review outlines our current understanding of the epidemiology of and risk factors for Dieulafoy's lesion of the duodenum, the pathophysiology of this disorder, and currently available approaches to diagnosis and management.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Duodenal Diseases; Duodenum; Endoscopy, Gastrointestinal; Female; Humans; Infant; Male; Middle Aged; Risk Factors; Young Adult
PubMed: 29472423
DOI: 10.1136/bcr-2017-223246 -
Cirugia Espanola Sep 2006Diverticular disease of the duodenum is uncommon. Perforation is the least frequent complication. Diagnosis and treatment are not well defined as the presentation and...
Diverticular disease of the duodenum is uncommon. Perforation is the least frequent complication. Diagnosis and treatment are not well defined as the presentation and symptomatology are nonspecific. Diagnostic delay carries high rates of postoperative mortality (30%). Early diagnosis is essential to reduce morbidity and mortality. We present the case of a male patient with perforated duodenal diverticulum. This case suggests that computed tomography can be highly useful in the preoperative diagnosis of this entity. Treatment consisted of duodenal exclusion and retroperitoneal drainage.
Topics: Diverticulum; Duodenal Diseases; Humans; Intestinal Perforation; Male; Middle Aged
PubMed: 16956555
DOI: 10.1016/s0009-739x(06)70948-4 -
Gut Jul 1994The risk of gastric cancer after vagotomy for benign gastric and duodenal disease was examined in a population based cohort of 7198 patients operated on during 1971-79...
The risk of gastric cancer after vagotomy for benign gastric and duodenal disease was examined in a population based cohort of 7198 patients operated on during 1971-79 and followed up until 1988. After exclusion of the first year of follow up there were 34 cases of gastric cancer compared with 25.6 expected (standardised incidence ratio (SIR) = 1.33; 95% confidence intervals (CI) 0.92 to 1.86). Separate analyses by duration of follow up, sex, age at operation, underlying diagnosis, and operative procedures did not show any significant increased or decreased risk of gastric cancer in any of the subgroups. In conclusion, decreased gastric acid secretion after vagotomy does not increase the risk of gastric cancer in the first 10 years after operation or in the subgroup followed up for 10-18 years. A longer follow-up is needed before an excess risk can be excluded.
Topics: Aged; Cimetidine; Cohort Studies; Duodenal Diseases; Female; Humans; Male; Medical Record Linkage; Middle Aged; Risk Factors; Stomach Diseases; Stomach Neoplasms; Sweden; Vagotomy, Proximal Gastric
PubMed: 8063222
DOI: 10.1136/gut.35.7.946 -
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 -
Ulusal Travma Ve Acil Cerrahi Dergisi =... Sep 2016Endoscopic retrograde cholangiopancreatography (ERCP)-related perforation is an infrequent complication. It is associated with significant morbidity and mortality. The...
BACKGROUND
Endoscopic retrograde cholangiopancreatography (ERCP)-related perforation is an infrequent complication. It is associated with significant morbidity and mortality. The present study is an evaluation of experience with management and outcomes of ERCP-related perforations and a review of relevant literature.
METHODS
Between January 2008 and January 2015, a total of 9383 ERCPs were performed in endoscopy unit. A total of 29 perforations (0.33%) were identified and retrospectively reviewed.
RESULTS
Of the 29 patients, 18 were female and 11 patients were male, with mean age of 70.5 years (range 33-99 years). According to Stapfer's classification, the 29 patients with ERCP related perforations included 5 type 1 perforations, 14 type 2 perforations, 7 type 3 perforations, and 3 cases of type 4 perforation. In total, 15 of 29 patients with ERCP perforation were operated on. Nine (60%) of those who underwent surgery were discharged uneventful, but 6 (40%) patients died due to postoperative complications and/or associated comorbidities. Seven (24.1%) of 29 patients had undergone endoscopic treatment and 5 of the 7 were discharged from the hospital without any problems; however, peritonitis occurred in 2 patients whose initial endoscopic treatment failed. The first of these 2 patients underwent surgery and was discharged uneventfully, but second patient, who refused surgery, died due to sepsis. Six patients were successfully treated with conservative management. Surgery could not be performed in the remaining 2 patients, who died of sepsis following peritonitis; 1 refused surgery, the other had sudden cardiopulmonary arrest during induction of general anesthesia. Mean hospital stay was 13.2 days (range: 2-57 days). In all, 9 (31%) patients died during period of the study.
CONCLUSION
ERCP-related perforation is uncommon complication, but an extremely serious condition. Early diagnosis and prompt management are most important to reduce associated significant morbidity and mortality rates. The most appropriate treatment course should be determined on case-by-case basis.
Topics: Adult; Aged; Aged, 80 and over; Cholangiopancreatography, Endoscopic Retrograde; Duodenal Diseases; Female; Humans; Intestinal Perforation; Length of Stay; Male; Middle Aged; Postoperative Complications; Retrospective Studies; Treatment Outcome; Turkey
PubMed: 27849320
DOI: 10.5505/tjtes.2016.42247 -
World Journal of Gastroenterology Nov 2010To evaluate duodenal polyps, divided into non-neoplastic and neoplastic lesions. In addition, the clinical characteristics of duodenal hyperplastic polyps are determined. (Comparative Study)
Comparative Study
AIM
To evaluate duodenal polyps, divided into non-neoplastic and neoplastic lesions. In addition, the clinical characteristics of duodenal hyperplastic polyps are determined.
METHODS
We analyzed medical records of 50,114 consecutive patients submitted to for first diagnostic esophago-gastroduodenoscopy between January 2004 and December 2009. We excluded lesions on the ampulla of Vater and submucosal tumors. We studied 510 cases that were diagnosed endoscopically with duodenal polyps and enrolled a total of 221 cases that had undergone tissue biopsy. We analyzed the differences between non-neoplastic and neoplastic lesions, and determined the clinical features of duodenal hyperplastic polyps.
RESULTS
Non-neoplastic lesions were found in 196 patients and neoplastic lesions in 25 patients. On univariate analysis, there were significant differences in shape, location, and size. Polyps more than 10 mm in diameter or polyps in the second portion had independent risk factors for being neoplastic lesions, as identified by multivariate analysis. In 23 cases of hyperplastic polyps (79.3%), they were accompanied by gastro-duodenal pathology, which was possibly associated with Helicobacter pylori.
CONCLUSION
Polyps of more than 10 mm or polyps in the second portion of the duodenum should be evaluated by histological examination.
Topics: Adult; Aged; Biopsy; Duodenal Diseases; Duodenal Neoplasms; Duodenum; Endoscopy, Digestive System; Female; Helicobacter pylori; Humans; Hyperplasia; Male; Middle Aged; Multivariate Analysis; Retrospective Studies
PubMed: 21086567
DOI: 10.3748/wjg.v16.i43.5474 -
Gastroenterologie Clinique Et Biologique Apr 2004The pathogenesis of the gastroduodenal lesions induced by non-steroidal anti-inflammatory drugs and aspirin is primarily caused by a reduction in mucosal blood flow,... (Review)
Review
The pathogenesis of the gastroduodenal lesions induced by non-steroidal anti-inflammatory drugs and aspirin is primarily caused by a reduction in mucosal blood flow, which is the consequence of inhibition of cyclooxygenase-producing vasodilator prostaglandins. The subsequent phase is adherence of leukocytes to the endothelium, which may depend on cyclooxygenase-2. Endothelial lesions accentuate the fall of mucosal blood flow and promote the inflammatory process in the gastric mucosa. The inflammatory process is amplified by expression of TNFalpha in polymorphonuclears induced by non-steroidal anti-inflammatory drugs. A few days after starting treatment, epithelial proliferation and increased mucosal blood flow, partly dependent on cyclooxygenase-2 and nitric oxide expression, compensates for the damaging process. Selective inhibitors of inducible cyclooxygenase-2 have reduced gastrointestinal toxicity, which could partially be explained by the protection effect of cyclooxygenase-2 on the gastrointestinal mucosa during inflammation or epithelial repair. Selective inhibitors may worsen inflammatory bowel disease. Non-steroidal inflammatory drugs and aspirin, but perhaps not selective inhibitors, increase the mucosal lesions associated with Helicobacter pylori-induced gastritis. Co-administration of selective inhibitors and aspirin leads to gastrointestinal toxicity equivalent to that of non-specific anti-inflammatory drugs.
Topics: Animals; Anti-Inflammatory Agents, Non-Steroidal; Cyclooxygenase Inhibitors; Duodenal Diseases; Gastrointestinal Diseases; Humans; Nitric Oxide; Peptic Ulcer
PubMed: 15366671
DOI: 10.1016/s0399-8320(04)95275-x -
World Journal of Gastroenterology Jun 2015To assess the evolution of duodenal lymphocytosis (DL), a condition characterized by increased intraepithelial lymphocytes (IELs), over 2 years of follow-up.
AIM
To assess the evolution of duodenal lymphocytosis (DL), a condition characterized by increased intraepithelial lymphocytes (IELs), over 2 years of follow-up.
METHODS
Consecutive patients undergoing upper endoscopy/histology for abdominal pain, diarrhea, weight loss, weakness or other extraintestinal features compatible with celiac disease (CD) were included. Evaluation of IELs infiltrate in duodenal biopsy samples was carried out by CD3-immunohistochemistry and expressed as number of positive cells/100 enterocytes. Diagnostic agreement on the IELs count was tested by calculating the weighted k coefficient. All patients underwent serological detection of autoantibodies associated with CD: IgG and IgA anti-tissue transglutaminase and endomysium. Each patient underwent further investigations to clarify the origin of DL at baseline and/or in the course of 2 years of follow-up every six months. Autoimmune thyroiditis, intestinal infections, parasitic diseases, bacterial intestinal overgrowth, hypolactasia and wheat allergy were detected. Colonoscopy and enteric magnetic resonance imaging were performed when necessary. Risk factors affecting the final diagnosis were detected by multinomial logistic regression and expressed as OR.
RESULTS
Eighty-five patients (16 males, 69 females, aged 34.1 ± 12.5 years) were followed up for a mean period of 21.7 ± 11.7 mo. At baseline, endoscopy/duodenal biopsy, CD3 immunohistochemistry revealed: > 25 IELs/100 enterocytes in 22 subjects, 15-25 IELs in 37 and < 15 IELs in 26. They all had negative serum anti-transglutaminase and anti-endomysium, whilst 5 showed IgG anti-gliadin positivity. In the course of follow-up, 23 developed CD seropositivity and gluten sensitivity (GS) was identified in 19. Other diagnoses were: 5 Helicobacter pylori infections, 4 jejunal Crohn's disease, 1 lymphocytic colitis and 1 systemic sclerosis. The disease in the remaining 32 patients was classified as irritable bowel syndrome because of the lack of diagnostic evidence. At multivariate analysis, the evolution towards CD was associated with an IELs infiltrate > 25 (OR = 1640.4) or 15-25 (OR = 16.95), human leukocyte antigen (HLA) DQ2/8 (OR = 140.85) or DQA1*0501 (OR = 15.36), diarrhea (OR = 5.56) and weakness (OR = 11.57). GS was associated with IELs 15-25 (OR = 28.59), autoimmune thyroiditis (OR = 87.63), folate deficiency (OR = 48.53) and diarrhea (OR = 54.87).
CONCLUSION
DL may have a multifactorial origin but the IELs infiltrate and HLA are strong predictive factors for CD development and a clinical diagnosis of GS.
Topics: Adult; Autoantibodies; Biomarkers; Biopsy; CD3 Complex; Celiac Disease; Chi-Square Distribution; Colonoscopy; Disease Progression; Duodenal Diseases; Duodenoscopy; Duodenum; Female; Follow-Up Studies; Food Hypersensitivity; Glutens; HLA Antigens; Humans; Immunohistochemistry; Intestinal Mucosa; Logistic Models; Lymphocytes; Lymphocytosis; Magnetic Resonance Imaging; Male; Middle Aged; Multivariate Analysis; Odds Ratio; Predictive Value of Tests; Prognosis; Prospective Studies; Risk Factors; Serologic Tests; Time Factors; Young Adult
PubMed: 26140001
DOI: 10.3748/wjg.v21.i24.7545 -
BMJ Case Reports Dec 2021
Topics: Adrenal Gland Neoplasms; Duodenal Diseases; Duodenum; Humans; Intestinal Polyps; Myelolipoma
PubMed: 34887292
DOI: 10.1136/bcr-2021-246444 -
BMJ Case Reports Feb 2021A 57-year-old woman presented with a 5-day history of worsening right upper quadrant pain, bilious emesis and approximately 20 pounds of weight loss. The patient was...
A 57-year-old woman presented with a 5-day history of worsening right upper quadrant pain, bilious emesis and approximately 20 pounds of weight loss. The patient was afebrile, without jaundice and had mild tenderness in her right upper quadrant. She noted an incidental finding of asymptomatic cholelithiasis on imaging 4 years earlier. An abdominal radiograph revealed pneumobilia and a large ectopic calculus. An abdominal CT scan confirmed pneumobilia, a large concretion completely obstructing the third portion of the duodenum and a soft tissue communication between the gallbladder and proximal duodenum. She was brought to the operating room for definitive treatment and had the obstructing gallstone removed via a transverse duodenotomy. Bouveret syndrome is a rare cause of small bowel obstruction that requires a high index of suspicion for diagnosis. It should be considered in older patients with clinical evidence of gastric or duodenal obstruction, particularly with a history of cholelithiasis.
Topics: Duodenal Diseases; Duodenal Obstruction; Female; Gallbladder Diseases; Gallstones; Humans; Intestinal Fistula; Middle Aged; Radiography, Abdominal; Tomography, X-Ray Computed
PubMed: 33526527
DOI: 10.1136/bcr-2020-238126