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BMJ Case Reports Mar 2022Duodenal gastrointestinal stromal tumours (D-GISTs) are a rare disease. It may arise commonly from the second or third part of the duodenum and can be erroneously...
Duodenal gastrointestinal stromal tumours (D-GISTs) are a rare disease. It may arise commonly from the second or third part of the duodenum and can be erroneously diagnosed as a pancreatic head tumour due to proximity and morphology on imaging studies. We present a case of a 60-year-old woman who presented with abdominal pain and was diagnosed as a case of pancreatic neuroendocrine tumour on radiologic imaging and granulomatous lesion on aspiration cytology. A ~5×3 cm mass was noted in the pancreatic head on laparotomy, and pancreatoduodenectomy was performed. Histopathology reported an exophytic GIST arising from the second part of the duodenum. Hence, D-GIST can invade the pancreas and mimic pancreatic head tumours; therefore, these tumours should be kept in the differential diagnosis of an atypical pancreatic head mass.
Topics: Duodenum; Female; Gastrointestinal Stromal Tumors; Head and Neck Neoplasms; Humans; Middle Aged; Pancreas; Pancreatic Neoplasms
PubMed: 35232747
DOI: 10.1136/bcr-2022-248828 -
BMJ Case Reports May 2018A 21-year-old woman presented with a 2-week history of vomiting, diarrhoea and epigastric pain, with 9 kg weight loss over the last two months. Laboratory tests were...
A 21-year-old woman presented with a 2-week history of vomiting, diarrhoea and epigastric pain, with 9 kg weight loss over the last two months. Laboratory tests were normal with negative coeliac serology. Duodenal biopsies revealed total villous atrophy, crypt hypertrophy and intraepithelial lymphocytosis. A diagnosis of seronegative coeliac disease was made, and she started a gluten-free diet. However, she did not respond and her weight fell to 30.6 kg (body mass index 11), becoming dependent on parenteral nutrition. Her diagnosis was reconsidered and the histology reviewed. The histopathological features were of severe active chronic duodenitis. By diagnosis of exclusion, with the absence of other clear pathology, she was treated as Crohn's disease. She responded to third-line therapy with biologics. In this case, the patient had refractory villous atrophy and the mucosal features, in addition to response with anti-tumour necrosis factor therapy, suggest inflammatory bowel disease, although not with complete diagnostic certainty.
Topics: Biological Products; Celiac Disease; Crohn Disease; Diagnosis, Differential; Duodenitis; Female; Humans; Malnutrition; Young Adult
PubMed: 29804077
DOI: 10.1136/bcr-2018-224397 -
Veterinary Medicine and Science Jul 2023A 7-year-old male mixed intact breed dog was presented with a 6-day history of lethargy and anorexia. A linear foreign body was diagnosed and an exploratory laparotomy...
A 7-year-old male mixed intact breed dog was presented with a 6-day history of lethargy and anorexia. A linear foreign body was diagnosed and an exploratory laparotomy performed. The foreign body was pushed orad and removed via gastrotomy. Two mesenteric duodenal perforations were found: one at the level of the common bile duct and a second at the duodenal flexure. Both lesions were debrided and primarily closed in a simple interrupted appositional pattern. A gastrostomy tube and closed suction drain were placed routinely. The dog recovered without complications and ate voluntarily the first day postoperatively. The drain and gastrostomy tube were removed without incident at 4 and 15 days, respectively. Five months postoperatively the dog was reported to be clinically normal. Debridement and primary closure may represent an alternative to more extensive surgery with rerouting for duodenal perforations in select cases.
Topics: Male; Dogs; Animals; Debridement; Duodenum; Catheterization; Foreign Bodies; Dog Diseases
PubMed: 37203295
DOI: 10.1002/vms3.1157 -
JOP : Journal of the Pancreas Jan 2012Endoscopic retrograde cholangiopancreatography (ERCP) has evolved from a diagnostic tool to primarily therapeutic procedure. With this, the complexity of the procedure... (Review)
Review
CONTEXT
Endoscopic retrograde cholangiopancreatography (ERCP) has evolved from a diagnostic tool to primarily therapeutic procedure. With this, the complexity of the procedure and risk of complication including duodenal perforation have increased. In this article, the recent literature is reviewed to identify the optimal management and factors influencing the clinical outcome.
METHOD
Recent literature in English language from the year 2000 onwards, containing major studies of 9 or more cases on duodenal perforation post ERCP were analyzed.
RESULTS
Literature review revealed a total of 251 cases of duodenal perforation reported in 10 major reports presenting 9 or more cases each. The mean age of these patients was 58.5 years with nearly two third (62.9%) being female patients. The predominant location of the perforation was: duodenal wall (34.5%), perivaterian (31.3%), common bile duct (23.0%), and unknown in 7.9%.Early diagnosis within 24 hours was made in 78.5%, with 55.8% of these being diagnosed during or immediately after ERCP. CT scan was the most useful investigations in detecting perforations missed during ERCP (44.6%). Conservative management was employed in 62.2%, which was successful in 92.9% of these cases. Ten of these who failed conservative management required salvage surgery (6.4%) and one died of pneumothorax (0.6%). The predominant surgical intervention was closure of perforation (49.0%) with or without other procedures, retroperitoneal drainage (39.0%), duodenal exclusion (24.0%) and common bile duct exploration and T tube insertion (13.0%). The overall mortality was 8.0% which appears to be better than previously reported (16-18%). Among the 20 patients who died, six (30.0%) had salvage surgery, five (25.0%) had delay in diagnosis/intervention beyond 3 days and 3 (15.0%) required multiple operations.
CONCLUSION
While the patients with duodenal perforation invariably require surgical intervention, most of the patients with perivaterian injuries can be successfully managed conservatively. The most important factors for recent better outcome were early detection and prompt treatment. Delay in diagnosis and intervention, salvage surgery after failed conservative management, multiple operations, and older age group contributed significantly to the poor outcome.
Topics: Cholangiopancreatography, Endoscopic Retrograde; Duodenum; Early Diagnosis; Female; Humans; Intestinal Perforation; Male; Middle Aged; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 22233942
DOI: No ID Found -
Pain Physician 2009Neurolytic celiac plexus block is a well established intervention to palliate pain, and it potentially improves quality of life in patients suffering from an upper...
INTRODUCTION
Neurolytic celiac plexus block is a well established intervention to palliate pain, and it potentially improves quality of life in patients suffering from an upper abdominal malignancy, specifically pancreatic cancer.
METHODS
We describe a 61-year-old female with a history of pancreatic cancer, unexplained transfusion dependent anemia with a normal recent upper endoscopy, and abdominal pain, who had previously undergone gastrojejunostomy and a Roux-en-Y hepaticojejunostomy as well as chemotherapy and radiation therapy. She suffered from intractable abdominal pain and elected to undergo palliative celiac plexus neurolysis.
RESULTS
The patient initially appeared to tolerate celiac plexus block well, however, 45 minutes after the procedure, the patient had bright red blood per rectum followed by bloody diarrhea. Her abdomen was soft and non-tender with minimal distention and positive bowel sounds. The patient's hemoglobin decreased to 7.5 g/dl from 9.0 g/dl, and she received a blood transfusion. Upper endoscopy and enteroscopy demonstrated diffuse hemorrhagic gastritis and duodenitis. The bleeding was controlled and the patient remained hemodynamically stable. Ultimately, the patient did well and was discharged home.
DISCUSSION
We report a case of a patient with known history of gastritis and duodenitis, who developed severe upper GI bleeding immediately following the celiac plexus neurolysis. There are no published reports documenting similar cases. It is difficult to offer a precise physiologic explanation for this complication. However, we speculate that inhibition of sympathetic tone from the celiac plexus neurolysis caused increased blood flow to the GI system, and this resulted in active bleeding from previously indolent hemorrhagic gastritis and duodenitis.
CONCLUSION
It may be beneficial for patients with a history of gastritis, duodenitis or GI bleeding to undergo a careful upper GI evaluation prior to celiac plexus neurolysis.
Topics: Abdominal Pain; Autonomic Nerve Block; Celiac Plexus; Duodenitis; Female; Gastrointestinal Hemorrhage; Humans; Middle Aged; Pancreatic Neoplasms
PubMed: 19935986
DOI: No ID Found -
Revista Espanola de Enfermedades... May 2022A 53-year-old man presented to our hospital for resection of a duodenal mass because of the increasing diameter. Esophagogastroduodenoscopy revealed a giant oval mass in...
A 53-year-old man presented to our hospital for resection of a duodenal mass because of the increasing diameter. Esophagogastroduodenoscopy revealed a giant oval mass in the back wall of duodenal bulb, which was protruded to the second part of duodenum(Figure 1). Endoscopic ultrasonography (EUS) revealed a submucosal mass with heterogeneous echogenicity and regular shape(Figure 2). Eventually, the patient received endoscopic submucosal dissection (ESD) after signing informed consent. The mass was resected completely and measured 6.0×4.2×3.0 cm [Figure 3]. Histopathological examination revealed a brunner's gland adenoma. There was no complication besides minor intraoperative bleeding. Both surgery and endoscopic resection (ER) are alternative treatments for duodenal adenoma, but the best way remains controversial. Due to the thin wall, narrow cavity and plentiful vascular network of the duodenal bulb, ER is challenging because of the technical difficulty and probability of perforation and bleeding [1]. Our previous study found that ER is an effective and safe way for treating duodenal adenoma on experienced hands, and ER possesses several advantages over surgical resection for selected patients [2,3]. In the present case, we removed the giant BGA by ESD, as far as we know, this is the largest yet removed by ER.
Topics: Adenoma; Brunner Glands; Duodenal Neoplasms; Duodenum; Endoscopic Mucosal Resection; Humans; Male; Middle Aged
PubMed: 35026952
DOI: 10.17235/reed.2022.8595/2022 -
Chirurgia (Bucharest, Romania : 1990) Jun 2022Iatrogenic duodenal injuries represent a condition associated with high morbidity and even mortality. Management is still controversial with a lack of consensus among...
Iatrogenic duodenal injuries represent a condition associated with high morbidity and even mortality. Management is still controversial with a lack of consensus among experts regarding the optimal treatment. The purpose of the present study was to test and assess the results of a certain reconstruction technique. Material and Four patients (2 males and 2 females) of a mean age of 83 years with iatrogenic duodenal injuries underwent surgical repair of the duodenal perforation, with a two-layer duodenojejunostomy and a Roux-en-Y jejunal loop. Three out of four patients (75%) had a rapid and uncomplicated recovery (13 days mean postoperative length of hospital stay), while the fourth patient died in the ICU due to ARDS three weeks later, without however evidence of anastomotic leak. Conclusion: A variety of surgical repair techniques have been proposed to date; however, with controversial results. A repair using an isolated jejunal Roux-en-Y loop seems to fulfill all the optimal prerequisites for a successful anastomotic outcome and proved efficient in its certain form for the given patient sample.
Topics: Aged, 80 and over; Anastomosis, Roux-en-Y; Duodenum; Female; Humans; Iatrogenic Disease; Jejunum; Male; Treatment Outcome
PubMed: 35792544
DOI: 10.21614/chirurgia.2524 -
World Journal of Gastroenterology Jul 2019Congenital duodenal obstruction (CDO) can be complete (CCDO) or incomplete (ICDO). To date there is no outcome analysis available that compares both subtypes. (Comparative Study)
Comparative Study
BACKGROUND
Congenital duodenal obstruction (CDO) can be complete (CCDO) or incomplete (ICDO). To date there is no outcome analysis available that compares both subtypes.
AIM
To quantify and compare the association between CCDO and ICDO with outcome parameters.
METHODS
We retrospectively reviewed all patients who underwent operative repair of CCDO or ICDO in our tertiary care institution between January 2004 and January 2017. The demographics, clinical presentation, preoperative diagnostics and postoperative outcomes of 50 patients were compared between CCDO ( = 27; atresia type 1-3, annular pancreas) and ICDO ( = 23; annular pancreas, web, Ladd´s bands).
RESULTS
In total, 50 patients who underwent CDO repair were enrolled and followed for a median of 5.2 and 3.9 years (CCDO and ICDO, resp.). CCDO was associated with a significantly higher prenatal ultrasonographic detection rate (88% versus 4%; CCDO ICDO, < 0.01), lower gestational age at birth, lower age and weight at operation, higher rate of associated congenital heart disease (CHD), more extensive preoperative radiologic diagnostics, higher morbidity according to Clavien-Dindo classification and comprehensive complication index (all ≤ 0.01). The subgroup analysis of patients without CHD and prematurity showed a longer time from operation to the initiation of enteral feeds in the CCDO group ( < 0.01).
CONCLUSION
CCDO and ICDO differ with regard to prenatal detection rate, gestational age, age and weight at operation, rate of associated CHD, preoperative diagnostics and morbidity. The degree of CDO in mature patients without CHD influences the postoperative initiation of enteral feeding.
Topics: Age Factors; Child; Child, Preschool; Digestive System Surgical Procedures; Duodenal Obstruction; Duodenum; Enteral Nutrition; Female; Gestational Age; Humans; Infant; Infant, Low Birth Weight; Infant, Newborn; Infant, Premature; Laparoscopy; Male; Postoperative Period; Retrospective Studies; Treatment Outcome
PubMed: 31391773
DOI: 10.3748/wjg.v25.i28.3787 -
BMJ Case Reports Apr 2017Isolated duodenal rupture is a rare injury encountered among children following blunt abdominal trauma. Early diagnosis and treatment are essential to decrease the... (Review)
Review
Isolated duodenal rupture is a rare injury encountered among children following blunt abdominal trauma. Early diagnosis and treatment are essential to decrease the associated morbidity and mortality. The debate is about the optimum operative management. We report a 6-year-old child who presented with acute abdominal pain due to isolated duodenal injury following blunt abdominal trauma. Emergency laparotomy revealed duodenal rupture at the junction of the first and second part of duodenum and absence of any other visceral injuries. The duodenal injury was defined as grade III, that is, involving 75% of the circumference. We opted to perform primary repair of the injured duodenum in two layers alone without diversion. The abdominal cavity was drained using an open system drain next to the repair. Nasogastric and jejunostomy tubes were used postoperatively for gastric decompression and enteral feeding, respectively. The child had an uneventful recovery, was discharged well on the 10th postoperative day and no stenosis was found on long-term follow-up. The debate was whether to repair the defect primarily or to combine the repair with diversion. Early diagnosis, the isolated nature of the duodenal injury and the possibility of minimal contamination favoured primary repair of the defect without diversion. The good outcome attributed to these factors were in agreement with most of the literature.
Topics: Child; Duodenum; Humans; Intubation, Gastrointestinal; Jejunostomy; Laparotomy; Treatment Outcome; Wounds, Nonpenetrating
PubMed: 28433976
DOI: 10.1136/bcr-2016-215251 -
Scientific Reports Mar 2021Abdominal pain has been associated with disaccharidase deficiencies. While relationships with individual symptoms have been assessed, relationships between...
Abdominal pain has been associated with disaccharidase deficiencies. While relationships with individual symptoms have been assessed, relationships between disaccharidase deficiencies and symptom complexes or inflammation have not been evaluated in this group. The primary aims of the current study were to assess relationships between disaccharidase deficiency and symptoms or symptom complexes and duodenal inflammation, respectively. Patients with abdominal pain who underwent endoscopy with evaluation of disaccharidase activity levels were identified. After excluding all patients with inflammatory bowel disease, celiac disease, H. pylori, or gross endoscopic lesions, patients were evaluated for disaccharidase deficiency frequency. Disaccharidase were compared between patients with and without histologic duodenitis. Lastly, relationships between individual gastrointestinal symptoms or symptom complexes were evaluated. Lactase deficiency was found in 34.3% of patients and disaccharidase pan-deficiency in 7.6%. No individual symptoms or symptom complexes predicted disaccharidase deficiency. While duodenitis was not associated with disaccharidase deficiency, it was only present in 5.9% of patients. Disaccharidase deficiency, particularly lactase deficiency, is common in youth with abdominal pain and multiple deficiencies are not uncommon. Disaccharidase deficiency cannot be predicted by symptoms in this population. Further studies are needed to assess the clinical significance of disaccharidase deficiency.
Topics: Abdominal Pain; Adolescent; Child; Disaccharidases; Duodenitis; Female; Humans; Inflammation; Male; Retrospective Studies
PubMed: 33649365
DOI: 10.1038/s41598-021-84535-9