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Sample records for ampullary duodenal diverticulum

  1. Ampullary duodenal diverticulum and cholangitis

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    Joaquim Mendes Castilho Netto

    Full Text Available CONTEXT: Ampullary duodenal diverticulum complicated by cholangitis is little known in clinical practice, especially when there are no gallstones in the common bile duct or there is no biliary tree ectasia or hyperamylasemia. A case of this association is presented, in which the surgical treatment was a biliary-enteric bypass. CASE REPORT: A 74-year-old diabetic white woman was admitted to the Taubaté University Hospital, complaining of pain in the right upper quadrant, jaundice and fever with chills (Charcot's triad. She had had cholecystectomy 30 years earlier. She underwent clinical treatment with parenteral hydration, insulin, antibiotics and symptomatic drugs. Imaging examinations were provided for diagnosis: ultrasound, computed tomography and endoscopic retrograde cholangiopancreatography. The surgical treatment consisted of choledochojejunostomy utilizing a Roux-en-y loop. The postoperative period progressed without incidents, and a DISIDA scan demonstrated the presence of dynamic biliary excretion. The patient remained asymptomatic when seen at outpatient follow-up.

  2. [ASSOCIATION OF DUODENAL DIVERTICULUM PRESENCE WITH CHOLEDOCHOLITHIASIS

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    Machado Mayurí, Alberto; Gómez, Aldo; Yriberry, Simón; Valdiviezo, Alfredo; Lozano, Adelina; Villena, Ovidio

    1998-01-01

    OBJECTIVES: The aim of this study was to investigate in aretrospective way the frequency of duodenal diverticulum and its association with choledocholithiasis. Methods:This study included 2728 consecutive patients who underwent ERCP during the period 1993-1997. Duodenal diverticulum was discovered in 122 cases (4.5%). In 22 patients cannulation was not achieved since it was not technically possible. Results: In 100 patients with successful cannulation, 54 cases with juxtapapillary diverticulum were encountered associated with choledocholithiasis. CONCLUSION: These data suggestthat duodenal diverticulum is associated with choledocholithiasis.

  3. Juxta-Ampullary Intraluminal Diverticulum and Acute Pancreatitis

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    Echenique-Elizondo M

    2004-05-01

    Full Text Available CONTEXT: Acute pancreatitis is usually due to well-known causes, such as biliary lithiasis and alcohol consumption. Anatomic abnormalities may represent a less frequent but important etiological factor. CASE REPORT: The case of a 27 year old women complaining of acute pancreatitis associated with a large duodenal juxta-papillary diverticulum is presented. CONCLUSIONS: Anatomic causes of pancreatitis must be considered in the diagnosis of the etiology of acute pancreatitis.

  4. Perforated duodenal diverticulum caused by Bezoar: A case report

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    Lee, Eun Jung; Moon, Sung Kyoung; Park, Seong Jin; Lim, Joo Won; Lee, Dong Ho; Ko, Young Tae [Dept. of Radiology, College of Medicine, Kyung Hee University, Seoul (Korea, Republic of)

    2013-11-15

    Duodenal diverticulum is common, but its perforation is a rare complication. Duodenal diverticulum perforation requires prompt treatments because of its high mortality rate. However, an accurate diagnosis is difficult to make due to nonspecific symptoms and signs. It can be misdiagnosed as pancreatitis, cholecystitis, or peptic ulcer. Herein, we report a case of perforated duodenal diverticulum caused by bezoar in a 33-year-old woman whom was diagnosed by abdomen computed tomography and ultrasonography.

  5. [Perforated duodenal diverticulum: report of a case].

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    Gulotta, G; Agosta, G; Romano, G

    2001-01-01

    After the colon, the duodenum is the most common site of diverticula. Duodenal diverticula can be divided into two types: intraluminal or extraluminal. The latter are more frequent, with a prevalence ranging from 0.6 to 27% in relation to the diagnostic methods utilized. Females are more often affected than males. About 70-75% of extraluminal duodenal diverticula are located in a circular area centred around the ampulla of Vater within a radius of 2-3 cm; these are defined as periampullary or juxtapapillary. Perforation is the rarest type of complication and can simulate different clinical conditions. CT plays a fundamental role in diagnosis also in relation to the different diverticular topography. Perforation is an indication for emergency surgery. The authors describe the clinical case of a duodenal diverticulum containing the outlet of the papilla, complicated by perforation; CT showed retroduodenal fluid and free air. Emergency surgery with an external biliary drainage, naso-biliary probe, and a diverticulo-jejunostomy on a Roux-en-Y defunctionalised loop, resolved the condition.

  6. Endoscopic treatment of sporadic small duodenal and ampullary neuroendocrine tumors.

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    Gincul, Rodica; Ponchon, Thierry; Napoleon, Bertrand; Scoazec, Jean-Yves; Guillaud, Olivier; Saurin, Jean-Christophe; Ciocirlan, Mihai; Lepilliez, Vincent; Pioche, Mathieu; Lefort, Christine; Adham, Mustapha; Pialat, Jean; Chayvialle, Jean-Alain; Walter, Thomas

    2016-11-01

    Background and study aim: As duodenal neuroendocrine tumors (NETs) are rare, their optimal management has not been clearly established. The aim of this study was to evaluate the feasibility and outcome of endoscopic treatment of duodenal NETs. Patients and methods: We reviewed the files of all patients who underwent endoscopic resection of a sporadic duodenal or ampullary NET between 1996 and 2014 at two centers. Results: A total of 29 patients with 32 uT1N0M0 NETs < 20 mm were included. Treatment consisted of endoscopic mucosal resection in 19 cases, and cap aspiration in 13 cases. Prior submucosal saline injection was used in 15 cases. Mortality was 3 % (one severe bleeding). Morbidity was 38 % (11/29). At post-resection analysis, mean tumor size was 8.9 mm (range 3 - 17 mm), 29 lesions were stage pT1, one was pT2, and 2 were pTx because of piecemeal resection. All NETs were well differentiated. A total of 27 lesions were classified as grade 1 and 5 were grade 2. The resection was R0, R1, and Rx for 16, 14, and 2 lesions, respectively. Three R1 patients underwent additional surgical treatment, with no residual tumor on the surgical specimen but with positive metastatic lymph nodes in two cases. One patient was lost to follow-up. Finally, 24 patients were included in the follow-up analysis. The median follow-up period was 56 months (range 6 - 175 months). Two patients presented a tumor recurrence during the follow-up period. Conclusions: Endoscopic treatment of small duodenal NETs was associated with significant morbidity, a difficulty in obtaining an R0 specimen, and the risk of lymph node metastasis. Nevertheless, it represents an interesting alternative in small grade 1 duodenal lesions and in patients at high surgical risk.

  7. Abdominal compartment syndrome from bleeding duodenal diverticulum

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    Vakhtang Tchantchaleishvili

    2012-01-01

    Full Text Available Duodenal diverticuli are acquired false diverticuli of unknown etiology. Although mostly asymptomatic, they can occasionally cause upper gastrointestinal hemorrhage, rarely with massive bleeding. In this report, we present (to the best of our knowledge the first reported case of duodenal diverticular bleeding, causing abdominal compartment syndrome. Albeit a rare event, duodenal diverticular bleeding should be included in the differential diagnosis of upper gastrointestinal bleeding. As with our case, a multidisciplinary approach to managing such patients is crucial.

  8. Isolated perforation of a duodenal diverticulum following blunt abdominal trauma

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    Metcalfe Matthew

    2010-01-01

    Full Text Available Only 10% of duodenal diverticula are symptomatic. We present the case of a man who fell from a height of 6 ft, landing on his abdomen and presenting 4 h later with severe back pain and a rigid abdomen. At laparotomy, a perforated retroperitoneal duodenal diverticulum was found and repaired with an omental patch. No other injury was noted. Not only is this perforation unusual, but the absence of other injuries sustained during this minor blunt trauma makes this case unique. This case highlights the need for a high index of suspicion when managing patients with back or abdominal pain following minor trauma.

  9. Giant Brunner’s Gland Adenoma of the Duodenal Bulb Presenting with Ampullary and Duodenal Obstruction Mimicking Pancreatic Malignancy

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    Vishal Gupta

    2011-07-01

    Full Text Available Context Brunner’s gland adenoma is a rare benign duodenal neoplasm. It usually presents with luminal obstruction or gastrointestinal bleeding. In rare cases, it may mimic a pancreatic malignancy and may present with obstructive jaundice. Case report A 65-year-old female presented with a two-month history of abdominal pain, early satiety and retrosternal burning pain. Liver function tests showed elevated enzymes with normal bilirubin. Imaging studies revealed a large mass in relation to the uncinate process of the pancreas and the distal duodenum along with the dilated common bile duct and the main pancreatic duct. Initial endoscopic evaluation failed to make a correct diagnosis. Repeat endoscopic evaluation combined with endoscopic sonography, however, revealed a large polypoid mass arising from the duodenal bulb. The patient underwent a transduodenal polypectomy. A diagnosis of Brunner’s gland adenoma was made on histopathological examination. Conclusion Giant Brunner’s adenoma may have unusual presentations. It may present with the features of ampullary obstruction mimicking periampullary or pancreatic malignancies. Extensive preoperative evaluation is required to reach a correct diagnosis in order to avoid more extensive surgery.

  10. Conservative management of perforated duodenal diverticulum: A case report and review of the literature

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    David Martínez-Cecilia; Sebástian Rufián-Pe(n)a; Alvaro Arjona-Sánchez; Manuel Gómez-(A)lvarez; Eva Torres-Tordera; Antonio Luque-Molina; Victor Valentí-Azcárate; Javier Brice(n)o-Delgado; Francisco-Javier Padillo; Pedro López-Cillero

    2008-01-01

    Duodenal diverticula are a relatively common condition.They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.

  11. Intraluminal duodenal diverticulum: CT and gadoxetic acid-enhanced MRI findings

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    Kim, Jeong Myeong; Lee, Nam Kyung; Kim, Suk; Kim, Dong Uk; Kim, Tae Un [Dept. of Radiology, Pusan National University Hospital, Pusan National University School of Medicine, Busan (Korea, Republic of)

    2015-03-15

    Intraluminal duodenal diverticulum (IDD) is a rare congenital anomaly. IDD can become symptomatic in 20% to 25% of cases when complicated by intestinal obstruction, pancreatitis, or hemorrhage. We report the case of a 21-year-old female presenting with IDD mimicking duodenoduodenal intussusception. We describe the imaging features of IDD on the gadoxetic acid-enhanced magnetic resonance image as well as computed tomography.

  12. Active bleeding from a periampullary duodenal diverticulum that was difficult to diagnose but successfully treated using hemostatic forceps: a case report

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    Nishiyama Noriko

    2012-10-01

    Full Text Available Abstract Introduction Although duodenal diverticula are common, periampullary duodenal diverticula are rare. Periampullary duodenal diverticula are usually asymptomatic and may be difficult to diagnose and treat. However, they may present with massive bleeding, requiring prompt diagnosis. Case presentation We report the case of a 71-year-old Asian woman with bleeding from a periampullary duodenal diverticulum. She presented with severe anemia and tarry stools. Two examinations using a forward-viewing endoscope did not identify the source of the bleeding. However, examination using a side-viewing endoscope found an exposed bleeding vessel overlying the bile duct within a periampullary diverticulum of the descending part of the duodenum. The bleeding was successfully controlled by using hemostatic forceps. Conclusions Bleeding periampullary duodenal diverticula are rare, and a bleeding point in the mucosa overlying the bile duct within a large periampullary duodenal diverticulum is very rare. Identification of a bleeding point within a duodenal diverticulum often requires repeated examination and may require the use of a side-viewing endoscope. Use of hemostatic forceps to control bleeding from a periampullary duodenal diverticulum is very rare but, for bleeding lesions overlying the bile duct within a periampullary duodenal diverticulum, is the best way to prevent obstructive jaundice.

  13. [THE COMBINATION OF RECURRENT INTUSSUSCEPTION DUODENAL, ZENKER DIVERTICULUM, HIATAL HERNIA AND HASTROPTOSIS AS A MANIFESTATION OF NON-DIFFERENT DYSPLASIA OF CONNECTIVE TISSUE].

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    Pavlov, M V; Orlova, N V

    2015-01-01

    Presented rare clinical case: a combination of recurrent intussusception duodenal, diverticulum Zenker, hiatal hernia and hastroptosis as a manifestation of non-different dysplasia of connective tissue. Special interest is recurrent intussusception upper horizontal portion duodenal in the bulb, is not detected when esophagogastroduodenoscopy.

  14. Intraluminal duodenal diverticulum causing recurrent pancreatitis: diagnostic role of computed tomography; Diverticulo duodenal intraluminal como causa de pancreatitis recidivante. Diagnostico mediante TC

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    Sanchis-Querol, E.; Abreu, J. A.; Canto, J.; Elizalde, A. [Hospital General d' Igualada. Barcelona (Spain)

    2000-07-01

    Intraluminal duodenal diverticulum is among the infrequent causes of pancreatitis. We present the case of a 23-year-old patient in which this congenital morphological anomaly was diagnosed as the cause of recurrent pancreatitis by means of computed tomography and upper gastrointestinal series. The radiological findings included a contrast-filled, sac-like structure partially occupying the second portion of the duodenum, from which it was separated by a band of radio lucent tissue (halo sign). We review the literature, comparing the findings of other authors with those observed in our patient. (Author) 8 refs.

  15. 十二指肠憩室的诊断与治疗%Diagnosis and management of duodenal diverticulum

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    王思珍; 王新波; 戴洪山; 韩建明

    2011-01-01

    Objective To investigate the manifestations , diagnosis and management of duodenal diverticulum. Methods The clinical data of 105 patients with duodenal diverticulum admitted to our hospital during two years and seven months were retrospectively analyzed. Results Of the patients, the most common symptom was abdominal pain (54 cases) , followed by the symptoms of sour regurgitation, nausea and vomiting (21 cases). The patients were diagnosed mainly by endoscopic and radiographic examination of gastrointestinal tract. Sixty-eight patients received conservative treatment, one of whom underwent duodenal diverticulization operation (Billroth II gastrectomy and gastrojejunostomy) later due to repeated recurrence of symptoms. The other 37 cases received surgical treatment, of which, 22 cases complicated by biliary tract diseases underwent related operations, and 11 cases underwent duodenal diverticulization (5 cases) or diverticulectomy (6 cases) due to recurrent diverticulitis, and 4 cases underwent other procedures. No obvious discomfort was found in all the 105 patients during one year of follow-up. Conclusions The most common symptom of duodenal diverticulum is abdominal pain, and duodenal diverticulum is discovered mainly by endoscopic and radiographic examination of gastrointestinal tract. Conservative management is suitable for the majority of duodenal diverticula, and the indications for surgery should be strictly controlled.%目的 探讨十二指肠憩室的临床表现,诊断和治疗.方法 回顾性分析2年7个月期间收治的105例患者的临床资料.结果 全组患者症状以腹痛多见(54例),其次是以返酸、恶心、呕吐等症状(21例),主要经消化道造影检查和内镜检查诊断.68例行保守治疗,其中1例出现病情反复,行憩室旷置术(胃大部切除、胃肠吻合术,Billroth Ⅱ).37例经外科治疗,其中22例因合并胆道系统疾病行相关手术;11例反复发作憩室炎行憩室旷置手术(5

  16. 症状性十二指肠憩室的临床特点分析%Analysis of the clinical features of symptomatic duodenal diverticulum

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    谭韡; 周巍; 罗和生; 陈继红; 赵亮

    2012-01-01

    Objective To investigate the clinical presentation, characteristics of endoseopy and imaging in patients symptomatic with duodenal diverticulum. Methods The clinical data of patients with symptomatic duodenal diverticulum in Renmin Hospital of Wuhan University from Jan. 2008 to Jan. 201 1 were retrospectively reviewed. Results A-mong the 35 patients with symptomatic duodenal diverticulum, 15 cases suffered from abdominal pain, 2 cases suffered from vomit, 12 cases suffered from hematemesis or melena, 6 cases suffered from jaundice, respectively. In all cases, there were 5 cases of duodenal diverticulitis, 1 case of acute pancreatitis, 6 cases of choledocholithiasis, 1 case of intestinal obstruction, and 12 cases of upper gastrointestinal bleeding. 35 cases of symptomatic duodenal diverticulum patients were located in the duodenal bulb with 9 cases, in the duodenal descending part with 22 cases, in the horizontal part with 4 cases, respectively, including single of 25 cases and multiple of 10 cases. 13 cases of duodenal diverticulum were found by the gastrointestinal barium meal examination, 9 cases were found by gastroscopy examination, 7 cases were found by endoscopic retrograde cholangiopancreatography (ERCP) , 2 cases were found by double-balloon enteros-copy, and 4 cases were found by abdominal CT scan, respectively. Conclusion The symptomatic duodenal diverticulum are not typical. Patients with unexplained upper abdominal pain, gastrointestinal bleeding and pancreatitis should be suspected of duodenal diverticulum. Conservative, endoscopic and surgical treatments are all used to treat duodenal diverticulum.%目的 探讨症状性十二指肠憩室病例的临床、内镜及影像学表现、治疗方法,并分析其临床意义.方法 回顾性分析武汉大学人民医院2008年1月-2011年1月症状性十二指肠憩室病例,分析其临床表现、内镜及影像学表现、治疗方法等临床资料.结果 共35例患者诊断为症状性十

  17. MRI findings of intrinsic and extrinsic duodenal abnormalities and variations

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    Atman, Ebru Dusunceli; Erden, Ayse; Ustuner, Evren; Uzun, Caglar; Bektas, Mehmet [Ankara University School of Medicine, Ankara (Turkmenistan)

    2015-12-15

    This pictorial review aims to illustrate the magnetic resonance imaging (MRI) findings and presentation patterns of anatomical variations and various benign and malignant pathologies of the duodenum, including sphincter contraction, major papilla variation, prominent papilla, diverticulum, annular pancreas, duplication cysts, choledochocele, duodenal wall thickening secondary to acute pancreatitis, postbulbar stenosis, celiac disease, fistula, choledochoduodenostomy, external compression, polyps, Peutz-Jeghers syndrome, ampullary carcinoma and adenocarcinoma. MRI is a useful imaging tool for demonstrating duodenal pathology and its anatomic relationships with adjacent organs, which is critical for establishing correct diagnosis and planning appropriate treatment, especially for surgery.

  18. Adult duodenal intussusception associated with congenital malrotation

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Enteroenteric intussusception is a condition in which full-thickness bowel wall becomes telescoped into the lumen of distal bowel. In adults, there is usually an abnormality acting as a lead point, usually a Meckels' diverticulum, a hamartoma or a tumour. Duodenoduodenal intussusception is exceptionally rare because the retroperitoneal situation fixes the duodenal wall.The aim of this report is to describe the first published case of this condition. A patient with duodeno-duodenal intussusception secondary to an ampullary lesion is reported. A 66 year-old lady presented with intermittent abdominal pain, weight loss and anaemia. Ultrasound scanning showed dilated bile and pancreatic ducts.CT scanning revealed intussusception involving the full-thickness duodenal wall. The lead point was an ampullary villous adenoma. Congenital partial (type Ⅱ)malrotation was found at operation and this abnormality permitted excessive mobility of the duodenal wall such that intussusception was possible. This condition can be diagnosed using enhanced CT. Intussusception can be complicated by bowel obstruction, ischaemia or bleeding,and therefore the underlying cause should be treated as soon as possible.

  19. Nurse of External Drainage Pancreatic Biliary Jejunum Back of Duodenal Diverticulum Child%十二指肠憩室化术外引流胰液胆汁空肠回输患儿的护理

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    李小婷

    2015-01-01

    Summerizing the nurse of external drainage pancreatic biliary jejunum back of duodenal diverticulum child. Observing whether the child appears complication such as fistula of duodenum and abdominal infection, cor ectly handle incision drainage, external drainage of bile by sterile operation and pancreatic juice indirectly through the jejunum nutrition tube to provide nutrition. Children recovered after active treatment and nursing treatment.%本文总结1例十二指肠憩室化手术后双重外引流胰液胆汁空肠回输患儿的护理体会。对患儿严密观察,是否出现十二指肠瘘、腹腔感染等并发症,正确处理切口引流,以无菌操作方法外引流胆汁、胰液间接经空肠营养管回输,并给以营养支持。患儿经积极治疗和护理后痊愈出院。

  20. Surgical Management of Ampullary Somatostatinoma

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    Nicholas Phillips

    2016-07-01

    Full Text Available Introduction Somatostatinomas of the ampulla are rare neuroendocrine tumours with limited studies in the literature. These are often associated with familial genetic predisposition e.g. NF 1 and Von Hippel-Lindau Syndrome. Histology commonly shows classical features such as Psammoma bodies. The classical presentation with inhibitory syndrome is rare, but ampullary mass effects can cause an earlier presentation with potentially better outcomes with earlier intervention and treatment. Case series We report three cases of ampullary somatostatisnomas: one sporadic and two familial, associated with neurofibromatosis type 1. The first patient presented with pruritus, the second with recurrent pancreatitis and the third, with elevated CA19-9 levels. Various preoperative localisation techniques were employed and one had an attempted endoscopic resection yielding involved margins. All patients underwent pancreaticoduodenectomy, of which one was laparoscopic assisted. The median size of the tumour was 10 mm and one patient had nodal involvement. All 3 patients have remained disease free at most recent follow up ranging from 1.5 to 11 years. Discussion Ampullary somatostatinomas can present early with mass related effects while inhibitory syndrome is rare. Early detection and intervention in ampullary somatostatinoma may contribute to better outcomes than pancreatic somatostatinomas. Long-term survival is achievable through pancreaticoduodenectomy for resectable ampullary somatostatinoma and laparoscopic approach is a feasible and viable option.

  1. 口服低浓度顺磁性造影剂对十二指肠憩室的诊断价值研究%The Diagnostic Value of Gd-DTPA at Low Concentration as an oral positive MRI Contrast Agents for the Duodenal Diverticulum

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    陈锦华; 朱斌; 田为中; 王秀兰; 张继; 张剑

    2016-01-01

    目的 探讨以低浓度钆喷酸葡胺(Gd-DTPA注射液)作为阳性造影剂进行MRI检查对诊断十二指肠憩室的可行性.方法 对常规检查疑似十二指肠憩室患者进行MRI薄层及口服低浓度造影剂MRI薄层检查.结果 55例患者65个憩室被检出,46例位于十二指肠降部,9例位于十二指肠水平部.MRI薄层检查59个憩室内含气液平或气体,6个憩室仅表现为十二指肠壁外囊袋状影;口服低浓度造影剂MRI薄层检查65个憩室内均充填造影剂,重建图像清晰显示憩室颈部及憩室腔形态.结论 口服低浓度造影剂MRI薄层检查有助于十二指肠憩室的明确诊断,MRI三维后处理可以与上消化道钡餐检查相媲美.口服低浓度造影剂MRI薄层检查可以作为十二指肠憩室诊断有疑问时的有力补充.%Objective To investigate the feasibility of using the gadolinium-DTPA (Gd-DTPA injection) at low concentration as a positive MRI contrast agents to diagnose the duodenal diverticulum.Methods Thin layer MRI scans with and without oral contrast agents were performed in the patients with suspected duodenal diverticula.Results Among 55 patients, 46 cases were found in the descending duodenum, 9 were found in the horizontal part of duodenum. Sixty-five diverticula were detected in all the patients. Routinely thin layer MRI scans showed that 59 diverticulum contains gas-liquid borderline or gas, 6 diverticulum just exhibited as the pocket hernia shadow in duodenal wall. Thin layer MRI scans with oral contrast agent showed all 65 diverticula were filled with contrast agent. Reconstructed images displayed the cervical part and cavity of the diverticula clearly.Conclusion MRI thin layer scan with oral low concentration of contrast agent can help to the diagnosis of duodenal diverticulum. Three-dimensional reconstruction was comparable with upper gastrointestinal barium meal examination. It can be used as a powerful supplement for the suspicious diverticula

  2. Genomic and proteomic characterization of ARID1A chromatin remodeller in ampullary tumors

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    Nastase, Anca; Teo, Jin Yao; Heng, Hong Lee; Ng, Cedric Chuan Young; Myint, Swe Swe; Rajasegaran, Vikneswari; Loh, Jia Liang; Lee, Ser Yee; Ooi, London Lucien; Chung, Alexander Yaw Fui; Chow, Pierce Kah Hoe; Cheow, Peng Chung; Wan, Wei Keat; Azhar, Rafy; Khoo, Avery; Xiu, Sam Xin; Alkaff, Syed Muhammad Fahmy; Cutcutache, Ioana; Lim, Jing Quan; Ong, Choon Kiat; Herlea, Vlad; Dima, Simona; Duda, Dan G; Teh, Bin Tean; Popescu, Irinel; Lim, Tony Kiat Hon

    2017-01-01

    AT rich interactive domain 1A (ARID1A) is one of the most commonly mutated genes in a broad variety of tumors. The mechanisms that involve ARID1A in ampullary cancer progression remains elusive. Here, we evaluated the frequency of ARID1A and KRAS mutations in ampullary adenomas and adenocarcinomas and in duodenal adenocarcinomas from two cohorts of patients from Singapore and Romania, correlated with clinical and pathological tumor features, and assessed the functional role of ARID1A. In the ampullary adenocarcinomas, the frequency of KRAS and ARID1A mutations was 34.7% and 8.2% respectively, with a loss or reduction of ARID1A protein in 17.2% of the cases. ARID1A mutational status was significantly correlated with ARID1A protein expression level (P=0.023). There was a significant difference in frequency of ARID1A mutation between Romania and Singapore (2.7% versus 25%, P=0.04), suggestive of different etiologies. One somatic mutation was detected in the ampullary adenoma group. In vitro studies indicated the tumor suppressive role of ARID1A. Our results warrant further investigation of this chromatin remodeller as a potential early biomarker of the disease, as well as identification of therapeutic targets in ARID1A mutated ampullary cancers.

  3. [Kommerell's Diverticulum (KD)].

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    Torres-Martel, José Miguel; Izaguirre-Guajardo, Gerardo; Ramírez-Portillo, César Iván

    2016-01-01

    Right aortic arch with aberrant left subclavian artery from a Kommerell's diverticulum is a very rare variant of the incomplete vascular ring. Associated symptoms are caused due to tracheal or esophagus compression. Magnetic resonance is the gold standard for diagnosis. Surgical treatment is recommended for symptomatic patients or asymptomatic patients with a large diverticulum. We report three consecutive cases of patients with Kommerell's diverticulum, aberrant left subclavian artery, and right-sided aortic arch.

  4. Intussuscepting Ampullary Adenoma: An Unusual Cause of Gastric Outlet Obstruction Leading to Cavitating Lung Lesions

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    Simon J. McCluney

    2016-10-01

    Full Text Available Ampullary adenomas are a rare clinical entity, occurring at a rate of 0.04–0.12% in the general population. They are premalignant lesions which have the capability to progress to malignancy, and they should be excised if they are causing immediate symptoms and/or are likely to degenerate to carcinoma. Intestinal intussusception in adults is rare and, unlike in children, is often due to a structural pathology. Intussuscepting duodenal/ampullary adenomas have been reported in the literature on 13 previous occasions, however never before with this presentation. We report the case of a woman who presented with a 1-year history of recurrent chest infections. She was treated with numerous antibiotics, whilst intermittent symptoms of recurrent vomiting and weight loss were initially attributed to her lung infections. A chest CT demonstrated multiple cavitating lung lesions, whilst an obstructing polypoid mass was noted at D2 on dedicated abdominal imaging. Due to ongoing nutritional problems, she had a semi-urgent pancreaticoduodenectomy. Intraoperative findings demonstrated a large mass at D2 with a duodeno-duodenal intussusception. Histological analysis reported a duodenal, ampullary, low-grade tubular adenoma, 75 × 28 × 30 mm in size, with intussusception and complete resection margins. The patient recovered well and was discharged on postoperative day 10, with no complications to date. Ampullary adenomas may present with obstruction of the main gastrointestinal tract and/or biliary/pancreatic ducts. Common presentations include gastric outlet obstruction, gastrointestinal bleeding or acute pancreatitis. This unique presentation should remind clinicians of the need to investigate recurrent chest infections for a possible gastrointestinal cause.

  5. Angiodysplasia in gaint diverticulum of transverse duodenum causing massive gastrointestinal bleeding: a case report

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    Choi, Pil Yeob; Lee, Sang Wook; Kwon, Jae Soo; Sung, Young Soon; Rho, Myoung Ho; Hwon, Oh Joon [Sungkyunkwan Univ. College of Medicine, Seoul (Korea, Republic of)

    1998-12-01

    The incidence of duodenal diverticulum found incidentally during upper gastrointestinal roentgenographic examination varies between 2% and 5%. The majority of cases occur along the medial aspect of the second portion of the duodenum, within 2.5 cm of the ampulla of Vater. The majority of duodenal diverticual are asymptomatic, but in some cases, complications such as diverticulitis, hemorrhage, perforation, and fistula formation occur in the third and fourth portions of the duodenum. We describe a case of giant diverticulum of the transverse duodenum, revealed by UGI and angiography, massive gastrointestinal bleeding in a 80-year-old patient.=20.

  6. Common Bile Duct Obstruction Secondary to a Periampullary Diverticulum

    Directory of Open Access Journals (Sweden)

    Anastasios J. Karayiannakis

    2012-07-01

    Full Text Available Periampullary duodenal diverticula are not uncommon and are usually asymptomatic although complications may occasionally occur. Here, we report the case of a 72-year-old woman who presented with painless obstructive jaundice. Laboratory tests showed abnormally elevated serum concentrations of total and direct bilirubin, of alkaline phosphatase, of γ-glutamyl transpeptidase, and of aspartate and alanine aminotransferases. Serum concentrations of the tumor markers carbohydrate antigen 19-9 and carcinoembryonic antigen were normal. Abdominal ultrasonography showed dilatation of the common bile duct (CBD, but no gallstones were found either in the gallbladder or in the CBD. The gallbladder wall was normal. Computed tomography failed to detect the cause of CBD obstruction. Magnetic resonance imaging and magnetic resonance cholangiopancreatography revealed a periampullary diverticulum measuring 2 cm in diameter and compressing the CBD. The pancreatic duct was normal. Hypotonic duodenography demonstrated a periampullary diverticulum with a filling defect corresponding to the papilla. CBD compression by the diverticulum was considered as the cause of jaundice. The patient was successfully treated by surgical excision of the diverticulum. In conclusion, the presence of a periampullary diverticulum should be considered in elderly patients presenting with obstructive jaundice in the absence of CBD gallstones or of a tumor mass. Non-interventional imaging studies should be preferred for diagnosis of this condition, and surgical or endoscopic interventions should be used judiciously for the effective and safe treatment of these patients.

  7. MicroRNA expression profiles associated with pancreatic adenocarcinoma and ampullary adenocarcinoma

    DEFF Research Database (Denmark)

    Schultz, Nicolai A; Werner, Jens; Willenbrock, Hanni;

    2012-01-01

    MicroRNAs have potential as diagnostic cancer biomarkers. The aim of this study was (1) to define microRNA expression patterns in formalin-fixed parafin-embedded tissue from pancreatic ductal adenocarcinoma, ampullary adenocarcinoma, normal pancreas and chronic pancreatitis without using micro......, normal pancreas and duodenal adenocarcinoma. In all, 43 microRNAs had higher and 41 microRNAs reduced expression in pancreatic cancer compared with normal pancreas. In all, 32 microRNAs were differently expressed in pancreatic adenocarcinoma compared with chronic pancreatitis (17 higher; 15 reduced......-dissection and (2) to discover new diagnostic microRNAs and combinations of microRNAs in cancer tissue. The expression of 664 microRNAs in tissue from 170 pancreatic adenocarcinomas and 107 ampullary adenocarcinomas were analyzed using a commercial microRNA assay. Results were compared with chronic pancreatitis...

  8. Bone and brain metastases from ampullary adenocarcinoma

    Institute of Scientific and Technical Information of China (English)

    Ioannis A Voutsadakis; Stergios Doumas; Konstantinos Tsapakidis; Maria Papagianni; Christos N Papandreou

    2009-01-01

    Ampullary carcinoma is the second most common cancer of the peri-ampullary area after pancreatic carcinoma and metastasizes mostly intra-abdominally and to the liver. Extra-abdominal metastases are less frequent. In this report we describe the case of a patient with resected adenocarcinoma of the ampulla of Vater who developed skeletal metastases in the lower extremity and brain metastases. We briefly discuss aspects of this comparatively rare gastrointestinal malignancy.

  9. Duodenal obstruction following acute pancreatitis caused by a large duodenal diverticular bezoar

    Institute of Scientific and Technical Information of China (English)

    Ji Hun Kim; Jae Hyuck Chang; Sung Min Nam; Mi Jeong Lee; Il Ho Maeng; Jin Young Park; Yun Sun Im

    2012-01-01

    Bezoars are concretions of indigestible materials in the gastrointestinal tract.It generally develops in patients with previous gastric surgery or patients with delayed gastric emptying.Cases of periampullary duodenal divericular bezoar are rare.Clinical manifestations by a bezoar vary from no symptom to acute abdominal syndrome depending on the location of the bezoar.Biliary obstruction or acute pancreatitis caused by a bezoar has been rarely reported.Small bowel obstruction by a bezoar is also rare,but it is a complication that requires surgery.This is a case of acute pancreatitis and subsequent duodenal obstruction caused by a large duodenal bezoar migrating from a periampullary diverticulum to the duodenal lumen,which mimicked pancreatic abscess or microperforation on abdominal computerized tomography.The patient underwent surgical removal of the bezoar and recovered completely.

  10. Neonatal Duodenal Obstruction: A 15-Year Experience

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    Kamal Nain Rattan

    2016-04-01

    Full Text Available Background: Congenital duodenal obstruction is one of the commonest causes of neonatal intestinal obstruction. We are presenting our 15-year experience by analyzing clinical spectrum and outcome in neonates with duodenal obstruction admitted at our center. Material and Methods: The hospital records of all neonates admitted with duodenal obstruction from June 2000 to June 2015 were reviewed. The patient records were analyzed for antenatal diagnosis, age, sex, clinical presentation, diagnosis, associated anomalies, surgical procedures performed; postoperative morbidity and mortality. We excluded from our study malrotation of gut associated with congenital diaphragmatic hernia and abdominal wall defects. Results: A total of 81 patients were admitted, out of which 56 were males and 25 were females. Polyhydramnios was detected in 24 (30% pregnancies. Average birth weight was 2.1±1.0Kg and average gestational age was 38 (SD±1 weeks with 17 (21% preterm neonates. Presenting features were vomiting in 81(100% which was bilious in 81% and non bilious in 19%, epigastric fullness in 56 (69% and dehydration in 18 (22% and failure to thrive in 16 (19%. Most common cause of obstruction was duodenal atresia in 38 (46.9%, followed by malrotation of gut in 33 (40.7%, and annular pancreas in 4 cases. Depending upon site of location, infra-ampullary obstruction was the most common in 64 (79%, supra-ampullary in 9 (7.4% and ampullary 8 neonates. Both duodenal atresia and malrotation of gut was present in 4 cases. X-ray abdomen was most commonly used investigation to confirm the diagnosis. All cases were managed surgically by open laparotomy. Eleven (13.5% patients died due to sepsis and associated congenital anomalies. Conclusion: Congenital duodenal obstruction most commonly presents in early neonatal period with features of upper GIT obstruction like vomiting and epigastrium fullness as in our series. Early antenatal diagnosis and surgical interventions hold the

  11. Metastatic Ampullary Adenocarcinoma Presenting as a Hydrocele: A Case Report

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    Whitney O Lane

    2014-05-01

    Full Text Available Context Metastases from ampullary malignancies are common, but spread to the testicle and paratesticular tissue is exceedingly rare with only 2 reported cases in the literature. Case Report We report a case of a 70 year-old male with a history of ampullary adenocarcinoma status post pancreaticoduodenectomy who presented with a symptomatic right-sided hydrocele. Subsequent pathology revealed metastatic ampullary adenocarcinoma. Conclusions Metastasis to the testicle and paratesticular tissue from ampullary malignancies is rare, but must be considered in the evaluation of scrotal masses in patients with a history of ampullary malignancy.

  12. Primary duodenal neoplasms: A retrospective clinico-pathological analysis

    Science.gov (United States)

    Bal, Amanjit; Joshi, Kusum; Vaiphei, Kim; Wig, JD

    2007-01-01

    AIM: To analyze the clinico-pathological spectrum of primary duodenal neoplasms. METHODS: A total of 55 primary duodenal neoplasms reported in the last 10 years after excluding ampullary and periampullary tumors were included in the study. Clinical details were noted and routine hematoxylin and eosin stained paraffin sections were studied for histological subtyping of the tumors. RESULTS: On histopathological examination primary duodenal neoplasms were categorized as: epithelial tumor in 27 cases (49.0%) including 10 cases of adenoma, 15 cases of adenocarcinoma, and 2 cases of Brunner gland adenoma; mesenchymal tumor in 9 cases (16.3%) consisting of 4 cases of gastrointestinal stromal tumor, 4 cases of smooth muscle tumor and I case of neurofibroma; lymphoproliferative tumor in 12 cases (21.8%), and neuroendocrine tumor in 7 cases (12.7%). CONCLUSION: Although non-ampullary/periampullary duodenal adenocarcinomas are rare, they constitute the largest group. Histopathological examination of primary duodenal tumors is important for correct histological subtyping. PMID:17373748

  13. Primary duodenal neoplasms:A retrospective clinico-pathological analysis

    Institute of Scientific and Technical Information of China (English)

    Amanjit Bal; Kusum Joshi; Kim Vaiphei; JD Wig

    2007-01-01

    AIM:To analyze the clinico-pathological spectrum of primary duodenal neoplasms.METHODS:A total of 55 primary duodenal neoplasms reported in the last 10 years after excluding ampullary and periampullary tumors were included in the study.Clinical details were noted and routine hematoxylin and eosin stained paraffin sections were studied for histological subtyping of the tumors.RESULTS:On histopathological examination primary duodenal neoplasms were categorized as:epithelial tumor in 27 cases(49.0%)including 10 cases of adenoma,15 cases of adenocarcinoma,and 2 cases of Brunner gland adenoma;mesenchymal tumor in 9 cases (16.3%)consisting of 4 cases of gastrointestinal stromal tumor,4 cases of smooth muscle tumor and I case of neurofibroma;lymphoproliferative tumor in 12 cases (21.8%),and neuroendocrine tumor in 7 cases(12.7%).CONCLUSION:Although non-ampullary/periampullary duodenal adenocarcinomas are rare,they constitute the largest group.Histopathological examination of primary duodenal tumors is important for correct histological subtyping.

  14. Modeling data for pancreatitis in presence of a duodenal diverticula using logistic regression

    Science.gov (United States)

    Dineva, S.; Prodanova, K.; Mlachkova, D.

    2013-12-01

    The presence of a periampullary duodenal diverticulum (PDD) is often observed during upper digestive tract barium meal studies and endoscopic retrograde cholangiopancreatography (ERCP). A few papers reported that the diverticulum had something to do with the incidence of pancreatitis. The aim of this study is to investigate if the presence of duodenal diverticula predisposes to the development of a pancreatic disease. A total 3966 patients who had undergone ERCP were studied retrospectively. They were divided into 2 groups-with and without PDD. Patients with a duodenal diverticula had a higher rate of acute pancreatitis. The duodenal diverticula is a risk factor for acute idiopathic pancreatitis. A multiple logistic regression to obtain adjusted estimate of odds and to identify if a PDD is a predictor of acute or chronic pancreatitis was performed. The software package STATISTICA 10.0 was used for analyzing the real data.

  15. Duodenal lipoma associated with ectopic duodenal glands

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    Dianbo Cao

    2011-12-01

    Full Text Available Duodenal lipomas are relatively uncommon and are rarely responsible for clinical symptoms. Occasionally, searching for aetiology of gastrointestinal bleeding leads to the final diagnosis of duodenal lipomas. Here, we present the case of a 68-year-old woman who suffered with repeated melena and weight loss. Endoscopy, abdominal computed tomography (CT and histopathological outcomes are described in this case of duodenal lipoma with ectopic duodenal glands.

  16. PERICARDIAL DIVERTICULUM WITH UNUSUAL SYMPTOMATOLOGY

    NARCIS (Netherlands)

    WATERBOLK, TW; HENKENS, CAM; REMMERT, DG; VANDERJAGT, EJ; POSTMUS, PE

    1991-01-01

    A healthy 37 yr old female presented with recurrent right-sided chest pain which spontaneously disappeared. On a chest roentgenogram a lesion in the right cardiophrenic angle was found. Magnetic resonance imaging suggested a cystic structure. During thoracotomy a pericardial diverticulum was found.

  17. Diagnostic Accuracy of the Initial Endoscopy for Ampullary Tumors

    OpenAIRE

    Lee, Hee Seung; Jang, Jong Soon; Lee, Seungho; Yeon, Myeong Ho; Kim, Ki Bae; Park, Jae Geun; Lee, Joo Young; Kim, Mi Jin; HAN, JOUNG-HO; Sung, Rohyun; Park, Seon Mee

    2015-01-01

    Background/Aims Ampullary tumors come in a wide variety of malignant forms. We evaluated the diagnostic accuracy of endoscopy for ampullary tumors, and analyzed the causes of misdiagnosis. Methods We compared endoscopic imaging and biopsy results to final diagnoses. Types of endoscope, numbers of biopsy specimens taken, and final diagnoses were evaluated as possible factors influencing diagnostic accuracy. Results Final diagnoses were 19 adenocarcinomas, 18 normal or papillitis, 11 adenomas, ...

  18. Ampullary organ morphology of freshwater salmontail catfish, Arius graeffei.

    Science.gov (United States)

    Whitehead, D L; Tibbetts, I R; Daddow, L Y

    2000-11-01

    Two types of ampullary organs are present in the skin of the freshwater salmontail catfish, Arius graeffei, each consisting of a short canal (0.2-0.5 mm) oriented perpendicular to the basement membrane and ending in an ampulla. Histochemical staining techniques (Alcian blue and Lillie's allochrome) indicate that the ampullary canals contain an acidic mucopolysaccharide gel, which is uniform in its staining properties along the canals. Type II ampullary organs consist of a canal, the wall of which is lined with cuboidal epithelial cells. The canal opens into an ampulla with 50-60 receptor cells. Electron microscopy reveals that the pear-shaped receptor cells bear microvilli on their luminal surface and lie adjacent to an unmyelinated neuron. Type III ampullary organs differ from Type II in that the canal wall consists of cells that possess a protein-rich sac at the luminal apex and have a polymorphic nucleus. The canals of Type III ampullary organs open to an ampulla with 8-30 receptor cells similar in both staining properties and structure to those of the Type II organ. In both types of ampullary organs, supportive cells surround each receptor cell except at the apex of the receptor cell.

  19. Meckel′s diverticulum-Revisited

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    Malik Ajaz

    2010-01-01

    Full Text Available Meckel′s diverticulum is a true intestinal diverticulum that results from the failure of the vitelline duct to obliterate during the fifth week of fetal development. In about 50% cases, it contains ectopic or heterotopic tissue which can be the cause of complications. A systematic review of literature was undertaken to study the history, incidence, embryoanatomy, clinical presentation, complication and management of Meckel′s diverticulum. Although Meckel′s diverticulum is the most common congenital abnormality of the gastrointestinal tract, it is often difficult to diagnose. It may remain asymptomatic or it may mimic disorders such as Crohn′s disease, appendicitis and peptic ulcer disease.

  20. Nervous structure of Meckel's diverticulum in children.

    Science.gov (United States)

    Negrea, V; Gheban, D

    2012-01-01

    Meckel's diverticulum, being considered as the most frequent malformation of the digestive tract, has been largely presented in scientific papers, but a complete physiopathological mechanism for its natural history has not been yet described. We have studied the nervous system and the differences observed in eight Meckel's diverticulums with enteric or ectopic gastric mucosa, using specific immunohistochemical markers. It has been noted a significantly higher density of myenteric nerve fibers in areas with enteric mucosa compared with the areas with gastric heterotopias, while the transition zone had intermediate nerve fibers density. The ileal wall near the diverticulum had a myenteric plexus density similar to gastric mucosa intradiverticular area. The density of Meckel's diverticulum myenteric plexuses determines the local peristalsis. The enteric type mucosa diverticulums has more intense peristaltic activity which leads more frequent to intussusception or, in case of intraluminal obstruction, might be also involved in germ spreading and progression of infectious process. The lower density of Auerbach's plexus nerve fibers in cases with gastric heterotopia Meckel's diverticulum determines less effective drainage of diverticular content, favoring the contact of intradiverticular mucosa with acid secretion of gastric mucosa area. The gastric mucosa's defense mechanisms and the intense peristaltic activity in the zone with enteric mucosa offer a certain protection against the apparition of intradiverticular ulcerative lesions, which usually are observed on the ileum, near the diverticulum. The age related decreasing number of myenteric nerve fibers density explains the higher frequency of Meckel's diverticulum complications in children.

  1. ENDOSCOPIC TREATMENT OF THE HYPOPHARYNGEAL (ZENKERS) DIVERTICULUM

    NARCIS (Netherlands)

    WOUTERS, B; VANOVERBEEK, JJM

    1992-01-01

    Over the years the techniques for endoscopic treatment of Zenker's diverticulum have been improved. Initially, in 1964, we used the electrocoagulation technique as described by Dohlman, but currently we prefer to sever the tissue bridge between the diverticulum and esophagus with the CO2 laser under

  2. Management of duodenal trauma

    Institute of Scientific and Technical Information of China (English)

    CHEN Guo-qing; YANG Hua

    2011-01-01

    Duodenal trauma is uncommon but nowadays seen more and more frequently due to the increased automobile accidents and violent events. The management of duodenal trauma can be complicated, especially when massive injury to the pancreatic-duodenal-biliary complex occurs simultaneously. Even the patients receive surgeries in time, multiple postoperative complications and high mortality are common. To know and manage duodenal trauma better, we searched the recent related literature in PubMed by the keywords of duodenal trauma, therapy, diagnosis and abdomen. It shows that because the diagnosis and management are complicated and the mortality is high,duodenal trauma should be treated in time and tactfully.And application of new technology can help improve the management. In this review, we discussed the incidence,diagnosis, management, and complications as well as mortality of duodenal trauma.

  3. Juxtapapillary duodenal diverticula: MDCT findings in 1010 patients and proposal for a new classification.

    Science.gov (United States)

    Wiesner, W; Beglinger, Ch; Oertli, D; Steinbrich, W

    2009-01-01

    The aim of this study is to analyze the MDCT findings of juxtapapillary duodenal diverticula (JPDD) and to propose a new radiological classification. CT-examinations of 1010 consecutive patients, all examined by 16-row MDCT of the abdomen over a time period of 20 months were retrospectively analyzed. All study patients were examined by triple phase CT (native, arterial and portal venous CT scan) of the abdomen and all recieved positive oral contrast prior to the examination. Thirty-three patients showed a juxtapapillary duodenal diverticulum, which could be seen on all CT scans, but jusually was depicted most clearly on the thin collimated arterial phase CT images. Size of diverticula range from 4 mm to 4.5 cm (mean 1.7 cm). In 17 cases the diverticulum was located ventrally to the vaterian sphincter complex, extending less or more into the pancreas at the site where the dorsal and the ventral anlage of the pancreas have fused (type I). 12 diverticula were located dorsally to the sphincter complex (type II). Three patients presented with a bilobated juxtapapillary diverticulum extending to both sides, ventrally and dorsally (type III) and one patient showed a little diverticulum ventrally to the minor papilla (type IV).Three patients presented with food impaction in the diverticulum but only one of these patients with a large IPDD showed a Lemmel-syndrome, whereas the other three patients with non-calculous extrahepatic cholostasis showed larger diverticula without food impaction. MDCT allows to identify four different types of juxtapapillary duodenal diverticula and using the proposed classification may be helpful for a more exact, anatomy based radiological description of this CT finding.

  4. AN UNUSUALLY LONG MECKEL’S DIVERTICULUM

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    Sunil Kumar

    2013-05-01

    Full Text Available ABSTRACT: Meckel’s diverticulum is the most common congenita l abnormality of the gastrointestinal tract. It is the common differenti al diagnosis thought of in cases of lower abdomen pain especially in Appendicitis. When present, Meck el’s diverticulum is around 2-5cm and its lifetime risk of complications is approximately 4-6 %. Though an entity called ‘Giant Meckel’s diverticulum’ is described in some studies, there a re controversies about length or the width of the diverticulum to be considered for calling it a ‘gia nt’. Usually Meckel’s diverticulum is directed towards umbilicus or anterior abdominal wall due to its embryological origin. There are various ways of presentation of Meckel’s diverticulum and p re-operative diagnosis is difficult except when suspected in cases of bleeding, or when ectopic muc osa is present. Intra-operatively diagnosed Meckel’s diverticulum is treated mainly by resectio n, though the controversies arise for the treatment of co-incidentally found diverticula. We present a case of unusually long Meckel’s diverticulum with its tip attached to root of mesen tery and causing strangulation of ileal loops underneath it.

  5. Structural characteristics and development of ampullary organs in Acipenser naccarii.

    Science.gov (United States)

    Camacho, Susana; Ostos, Maria Del Valle; Llorente, José Ignacio; Sanz, Ana; García, Manuel; Domezain, Alberto; Carmona, Ramón

    2007-09-01

    Ampullary organs of Acipenser naccarii sturgeons were examined by optical and electronic microscopy (transmission electron microscopy and scanning electron microscopy) from hatching until 1 month later when the juvenile phase is completely established. It was observed that, when A. naccarii begins to feed actively, the ultrastructural characteristics of ampullary organs already correspond to those of adult animals. These organs may, therefore, be functional and, together with taste buds, facilitate food search after exhaustion of yolk sac food reserves. Mature ampullary organs of A. naccarii are formed by an ampulla that communicates with the exterior by means of a short channel. These ampullae correspond to the sensory portion of these receptors and are formed by two cell types: receptor cells and support cells. Receptor cells present a kinocilium on their free surface and establish ribbon synapses with axon nerve endings that arise from the underlying conjunctive tissue. Support cells enclose receptor cells, bear stereocilia and occasional cilia, and are of a secretory nature. The mucus associated with ampullary organs mainly comprises neutral mucopolysaccharides, whereas mucopolysaccharides are usually acid in other fish groups.

  6. A case of intussuscepted Meckel's diverticulum

    Institute of Scientific and Technical Information of China (English)

    Tae Hee Lee; Jin-Oh Kim; Jae Joon Kim; Seong Sook Hong; So Young Jin; Hyun Gun Kim; Joo Young Cho; Joon Seong Lee

    2009-01-01

    We report colonoscopic features of an intussuscepted Meckel's diverticulum, presenting with hematochezia.A 35-year-old woman presented to the emergency room with acute onset, transient, sharp, severe epigastric pain that began 6 h earlier. Colonoscopy revealed a reddish, soft, fist-sized polypoid lesion in the terminal ileum. The lesion was misinterpreted as a hematoma by an inexperienced endoscopist. The patient began to complain of intermittent, severe periumbilical pain following the colonoscopic examination.Subsequent computed tomography showed an enteric intussusception. An exploratory laparotomy revealed an intussuscepted Meckel's diverticulum, with transmural infarction. Colonoscopy was of little use in assessing the intussusception. However, colonoscopic examination may be performed initially, especially in an intussuscepted Meckel's diverticulum presenting with hematochezia. Endoscopists should note the endoscopic features of an intussuscepted Meckel's diverticulum.

  7. Giant colonic diverticulum: radiographic and MDCT characteristics.

    Science.gov (United States)

    Zeina, Abdel-Rauf; Mahamid, Ahmad; Nachtigal, Alicia; Ashkenazi, Itamar; Shapira-Rootman, Mika

    2015-12-01

    Giant colonic diverticulum (GCD), defined as a diverticulum larger than 4 cm, is a rare entity that is generally a manifestation of colonic diverticular disease. Because of its rarity and its variable and non-specific presentation, the diagnosis of GCD depends mainly on imaging findings. Knowledge of the spectrum of radiographic and CT features of the GCD is important in making the correct diagnosis and potentially preventing complications. This review focuses on imaging findings characteristic of GCD as well as its complications and radiographic mimics. Teaching points • Giant colonic diverticulum is a rare complication of diverticulosis.• The most common symptom is abdominal pain presenting in approximately 70 % of patients.• Diagnosis is based on imaging findings with plain abdominal radiographs and MDCT.• Treatment consists of en bloc resection of the diverticulum and affected adjacent colon.

  8. Case series: Congenital left ventricular diverticulum

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    Shah Dharita

    2010-01-01

    Full Text Available Congenital left ventricular diverticulum is a rare cardiac malformation characterized by a localized outpouching from the cardiac chamber. The patient is usually asymptomatic. However, complications like embolism, infective endocarditis, arrhythmia and, rarely, rupture can be the initial presentation. Diagnosis can be established by USG, echocardiography, CT angiography, and MRI. We report here two neonates with congenital left ventricular apical diverticulum associated with epigastric hernia.

  9. Parabronchial Diverticulum of Esophagus: Report of a Case

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    Bayram Altuntas

    2014-03-01

    Full Text Available Parabronchial or midesophageal diverticulum is a saclike bulging of the midesophageal wall into the periesophageal space. This bulging usually occur secondary to mediastinal inflammation. We report a case of a midesophageal diverticulum in a 21-year-old man. We discuss midesophageal diverticulum and review the literature findings.

  10. Togetherness of Achalasia, Paraesophageal Diverticulum and Dextrocardia

    Directory of Open Access Journals (Sweden)

    Hakan Demirci

    2013-08-01

    Full Text Available Achalasia is a disorder of motor function of the esophagus. Its treatment is the quite gratifying. Depending on increasing lower esophageal sphincter pressure, esophageal diverticula can occur in patients with achalasia. We report achalasia, paraesophageal diverticulum and also offer a patient with dextrocardia. 23 year old male patient was admitted to our outpatient clinic with following complaints; chest pain, palpitations and difficulty swallowing. The bird%u2019s beak appearance was observed to in the distal esophagus in contrast barium graphy. The diverticulum was viewed in the distal part of esophagus. Paraesophageal diverticulum situated in food scraps was viewed at 38 cm from the incisors on the endoscopy. It was diagnosed with achalasia and paraesophageal diverticulum to patient as a result of this examination. Cardiology consultation was requested for complaints of chest pain and palpitation. Dextrocardia was viewed in the transesophageal echocardiography. It was applied balloon dilation therapy to patient. The heart is usually structurally normal in the case of dextrocardia. This type of anomaly is not life-shortening effect on. They may be associated with other congenital malformations. Achalasia and paraesophageal diverticulum may be associated with dextrocardia. If congenital anomalies was detected, other possible structural diseases remind.

  11. Endoscopic retrograde cholangiopancreatography in periampullary diverticulum: The challenge of cannulation

    Institute of Scientific and Technical Information of China (English)

    Ahmed Youssef Altonbary; Monir Hussein Bahgat

    2016-01-01

    Periampullary diverticulum(PAD) is duodenal outpunching defined as herniation of the mucosa or submucosa that occurs via a defect in the muscle layer within an area of 2 to 3 cm around the papilla. Although PAD isusually asymptomatic and discovered incidentally during endoscopic retrograde cholangiopancreatography(ERCP), it is associated with different pathological conditions such as common bile duct obstruction, pancreatitis, perforation, bleeding, and rarely carcinoma. ERCP has a low rate of success in patients with PAD,suggesting that this condition may complicate the technical application of the ERCP procedure. Moreover, cannulation of PAD can be challenging, time consuming, and require the higher level of skill of more experienced endoscopists. A large portion of the failures of cannulation in patients with PAD can be attributed to inability of the endoscopist to detect the papilla. In cases where the papilla is identified but does not point in a suitable direction for cannulation, different techniques have been described. Endoscopists must be aware of papilla identification in the presence of PAD and of different cannulation techniques, including their technical feasibility and safety, to allow for an informed decision and ensure the best outcome. Herein, we review the literature on this practical topic and propose an algorithm to increase the success rate of biliary cannulation.

  12. Female urethral diverticulum presenting with acute urinary retention: Reporting the largest diverticulum with review of literature

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    Manas Ranjan Pradhan

    2012-01-01

    Full Text Available Female urethral diverticulum is a rare entity with diverse spectrum of clinical manifestations. It is a very rare cause of bladder outlet obstruction and should be considered as a differential diagnosis in females presenting with acute urinary retention associated with a vaginal mass. Strong clinical suspicion combined with thorough physical examination and focused radiological investigations are vital for its diagnosis. Herein we report a case of giant urethral diverticulum presenting with acute urinary retention in a young female. It was managed by excision and urethral closure, and is the largest urethral diverticulum reported till date in the literature.

  13. Laparoscopic resection for incidentally detected Meckel diverticulum

    Institute of Scientific and Technical Information of China (English)

    Davide Bona; Luigi Stefano Schipani; Marco Nencioni; Barbara Rubino; Luigi Bonavina

    2008-01-01

    The management of Meckel diverticulum found un-expectedly during an abdominal operation remains controversial.Most published reports have included only patients undergoing diverticulectomy or bowel resection through laparotomy.We report a case of a carcinoid tumor in a Meckel's diverticulum which was incidentally detected and removed during laparoscopic inguinal hernia repair.Although there is no compelling evidence in the literature to recommend prophylactic diverticulectomy,laparoscopic stapled resection represents a viable and safe approach in healthy individuals undergoing elective surgery for other purposes.

  14. Giant ascending colonic diverticulum presenting with intussusception.

    Science.gov (United States)

    Kim, Ho Jin; Kim, Jin Ha; Moon, Ok In; Kim, Kyung Jong

    2013-10-01

    Diverticular disease of the colon is a common disease, and its incidence is increasing gradually. A giant colonic diverticulum (GCD) is a rare entity and is defined as a diverticulum greater than 4 cm in size. It mainly arises from the sigmoid colon, and possible etiology is a ball-valve mechanism permitting progressive enlargement. A plain abdominal X-ray can be helpful to make a diagnosis initially, and a barium enema and abdominal computed tomography may confirm the diagnosis. Surgical intervention is a definite treatment for a GCD. We report a case of an ascending GCD presenting with intussusception in a young adult.

  15. Encountering Meckel's diverticulum in emergency surgery for ascaridial intestinal obstruction

    Directory of Open Access Journals (Sweden)

    Amin Abid

    2010-06-01

    Full Text Available Abstract Background Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract. In children with intestinal ascariasis, the diverticulum remains asymptomatic or rarely the Ascaris lumbricoides may lead to its complications in the presence of massive intestinal roundworm load. Given that preoperative diagnosis is seldom carried out, when Meckel's diverticulum is found at laparotomy for obstructive intestinal complications of roundworm, the diverticulum should be removed as complications may occur at any time. The aim of this study was to describe the findings of concomitant presence of Meckel's diverticulum who had surgical intervention in symptomatic intestinal ascariasis in children. Methods A retrospective case review study of 14 children who had surgical intervention for symptomatic intestinal ascariasis having the presence of concomitant Meckel's diverticulum was done. The study was done at SMHS Hospital Srinagar, Kashmir. Results A total of the 14 children who had ascaridial intestinal obstruction with concomitant presence of Meckel's diverticulum were studied. Age of children ranged from 4-12 years, male:female ratio was 1.8:1. Nine patients had asymptomatic Meckel's diverticulum, whereas 5 patients with symptomatic signs were found in the course of emergency surgery for ascaridial intestinal obstruction. Conclusion Meckel's diverticulum in intestinal ascariasis may pursue silent course or may be accompanied with complications of the diverticulitis, perforation or the gangrene. Incidental finding of the Meckel's diverticulum in the intestinal ascariasis should have removal.

  16. Dynamics of the ampullary-isthmic junction in rabbit oviduct.

    Science.gov (United States)

    Anand, S; Guha, S K

    1982-01-01

    A delay in the ovum transport at the ampullary-isthmic junction (AIJ) has been confirmed by various investigators, but the mechanism of retention and release at this junction is not yet well understood. Using a technique for monitoring unobstructed Fallopian tube motility with an impedance plethysmograph, an increase in luminal diameter was observed at the time when the ova are released from the AIJ. This enlargement persists till all ova emerge from the AIJ. Hence, it seems likely that the AU relaxation is a dominant factor contributing to ova release from the AIJ.

  17. Ampullary carcinoma: Effect of preoperative biliary drainage on surgical outcome

    Institute of Scientific and Technical Information of China (English)

    Sheikh Anwar Abdullah; Tarun Gupta; Khairul Azhar Jaafar; Yaw Fui Alexander Chung; London Lucien Peng Jin Ooi; Steven Joseph Mesenas

    2009-01-01

    AIM: To evaluate the influence of preoperative biliary drainage on morbidity and mortality after surgical resection for ampullary carcinoma. METHODS: We analyzed retrospectively data for 82 patients who underwent potentially curative surgery for ampullary carcinoma between September 1993 and July 2007 at the Singapore General Hospital, a tertiary referral hospital. Diagnosis of ampullary carcinoma was confirmed histologically. Thirty-five patients underwent preoperative biliary drainage (PBD group), and 47 were not drained (non-PBD group). The mode of biliary drainage was endoscopic retrograde cholangiopancreatography ( n = 33) or percutaneous biliary drainage ( n = 2). The following parameters were analyzed: wound infection, intra-abdominal abscess, intra-abdominal or gastrointestinal bleeding, septicemia, biliary or pancreatic leakage, pancreatitis, gastroparesis, and re-operation rate. Mortality was assessed at 30 d (hospital mortality) and also longterm. The statistical endpoint of this study was patient survival after surgery. RESULTS: The groups were wel l matched for demographic criteria, clinical presentation and operative characteristics, except for lower hemoglobin in the non- PBD group (10.9 ± 1.6 vs 11.8 ± 1.6 in the PBD group). group (10.9 ± 1.6 vs 11.8 ± 1.6 in the PBD group). Of the parameters assessing postoperative morbidity, incidence of wound infection was significantly less in the PBD than the non-PBD group [1 (2.9%) vs 12 (25.5%)]. However, the rest of the parameters did not differ significantly between the groups, i.e. sepsis [10 (28.6%) vs 14 (29.8%)], intra-abdominal bleeding [1 (2.9%) vs 5 (10.6%)], intra-abdominal abscess [1 (2.9%) vs 8 (17%)], gastrointestinal bleeding [3 (8.6%) vs 5 (10.6%)], pancreatic leakage [2 (5.7%) vs 3 (6.4%)], biliary leakage [2 (5.7%) vs 3 (6.4%)], pancreatitis [2 (5.7%) vs 2 (4.3%)], gastroparesis [6 (17.1%) vs 10 (21.3%)], need for blood transfusion [10 (28.6%) vs 17 (36.2%)] and re-operation rate [1 (2

  18. Anterior urethral diverticulum: A rare presentation

    Directory of Open Access Journals (Sweden)

    Annavarupu Gopalkrishna

    2016-01-01

    Full Text Available Congenital anomalies of the urogenital tract are the most common anomalies found in the foetus, neonates and infants, but anterior urethral valves and diverticula are rare. Here, we present a case with congenital anterior urethral diverticulum associated with patent ductus arteriosus and polydactyly.

  19. Zenker's Diverticulum: Diagnostic Approach and Surgical Management

    Science.gov (United States)

    Nuño-Guzmán, Carlos M.; García-Carrasco, Daniel; Haro, Miguel; Arróniz-Jáuregui, José; Corona, Jorge L.; Salcido, Macario

    2014-01-01

    Zenker's diverticulum (ZD), also known as cricopharyngeal, pharyngoesophageal or hypopharyngeal diverticulum, is a rare condition characterized by an acquired outpouching of the mucosal and submucosal layers originating from the pharyngoesophageal junction. This false and pulsion diverticulum occurs dorsally at the pharyngoesophageal wall between the inferior pharyngeal constrictor and the cricopharyngeus muscle. The pathophysiology of ZD involves altered compliance of the cricopharyngeus muscle and raised intrabolus pressure. Decreased compliance of the upper esophageal sphincter and failure to open completely for effective bolus clearance both lead to an increase in the hypopharyngeal pressure gradient. Different open surgical techniques and transoral endoscopic approaches have been described for the management of ZD, although there is no consensus about the best option. We report the case of a 61-year-old patient with a 7-year history of dysphagia and odynophagia for solid food, which after 2 months progressed to dysphagia for liquids and after 4 months to regurgitation 2–6 h after meals. The patient experienced a 12-kg weight loss. Diagnosis was established by esophagogram, which showed a diverticulum through the posterior pharyngeal wall, suggestive of a ZD. Esophagogastroduodenoscopy showed a pouch with erythematous mucosa. Under general anesthesia, diverticulectomy and myotomy were performed. After an uneventful recovery and adequate oral intake, the patient remains free of symptoms at 4 months of follow-up. PMID:25759630

  20. Zenker's Diverticulum: Diagnostic Approach and Surgical Management

    Directory of Open Access Journals (Sweden)

    Carlos M. Nuño-Guzmán

    2014-11-01

    Full Text Available Zenker's diverticulum (ZD, also known as cricopharyngeal, pharyngoesophageal or hypopharyngeal diverticulum, is a rare condition characterized by an acquired outpouching of the mucosal and submucosal layers originating from the pharyngoesophageal junction. This false and pulsion diverticulum occurs dorsally at the pharyngoesophageal wall between the inferior pharyngeal constrictor and the cricopharyngeus muscle. The pathophysiology of ZD involves altered compliance of the cricopharyngeus muscle and raised intrabolus pressure. Decreased compliance of the upper esophageal sphincter and failure to open completely for effective bolus clearance both lead to an increase in the hypopharyngeal pressure gradient. Different open surgical techniques and transoral endoscopic approaches have been described for the management of ZD, although there is no consensus about the best option. We report the case of a 61-year-old patient with a 7-year history of dysphagia and odynophagia for solid food, which after 2 months progressed to dysphagia for liquids and after 4 months to regurgitation 2-6 h after meals. The patient experienced a 12-kg weight loss. Diagnosis was established by esophagogram, which showed a diverticulum through the posterior pharyngeal wall, suggestive of a ZD. Esophagogastroduodenoscopy showed a pouch with erythematous mucosa. Under general anesthesia, diverticulectomy and myotomy were performed. After an uneventful recovery and adequate oral intake, the patient remains free of symptoms at 4 months of follow-up.

  1. CT features of the juxtapapillary duodenal diverticula%十二指肠乳头旁憩室的CT表现特征

    Institute of Scientific and Technical Information of China (English)

    张国华; 陈运奎; 郑辉

    2011-01-01

    Objective:To explore CT characteristics of the juxtapapiliary duodenal diverticulum so as to improve the diagnostic accuracy. Methods:CT findings of 23 cases with juxtapapiliary duodenal diverticulum. Which were found by abdominal CT scans and further confirmed by upper gastrointestinal examination, were analysed retrospectively. Results: In this group, the juxtapapiliary duodenal diverticulum was missed in 8 of 23 cases on CT by junior radiologists, the missed diag-nositic rate was 34. 8% ? And all were correctly diagnosed by senior radiologists. All of juxtapapiliary duodenal diverticulum on CT were showed as airbag shadow within duodenal loop posterior pancreatic head, protruding out of interior duodenal wall, with air-liquid level in it or reticular shadows when it contained residual contents. In 7 cases of oral positive contrast medium. 5 cases showed contrast medium directly getting into the capsule. Multiplanar reconstruction in 12 cases of this group more intuitively displayed the morphology of diverticulitis and the relationship between diverticulitis and intestine. The findings of CT were consistency with upper gastrointestinal examination in all cases. Conclusion: The findings of juxtapapiliary duodenal diverticulum on abdominal CT have some characteristics. As the disease suspected, upper gastrointestinal examination may be necessary to futher comfirm the diagnosis.%目的:探讨十二指肠乳头旁憩室的CT表现特点,提高诊断正确率.方法:回顾性分析上腹部CT检查中发现十二指肠乳头旁憩室23例,并进行上消化道造影进一步证实.结果:23例中低年资医生漏诊8例.高年资医生均诊断为十二指肠憩室.CT表现十二指肠框内圆形、半圆形囊袋状,突出于肠管小弯侧壁外,囊袋内可见气液平面.残留内容物较多时呈网状阴影,增强后囊壁强化与十二指肠壁强化一致.结论:十二指肠乳头旁憩室上腹部CT检查有一定的特征性,当疑为本病时,可进一

  2. Radiologic Imaging in Meckel Diverticulum Complications

    Directory of Open Access Journals (Sweden)

    Erin Leslee Dames

    2015-09-01

    Full Text Available In 1809, Johann Friedrich Meckel the Younger described the most common congenital small bowel anomaly, which was named after him; however, the radiologic manifestations and interventional guidelines related to this entity are still limited to a few large-scale case series as well as proposed therapeutic protocols for the general population. Despite the fact that this entity is more commonly found within the first decade of life, imaging and management protocols remain controversial in the pediatric population, particularly within the asymptomatic group. We present an article depicting the radiologic and histologic findings in a series of Meckel's diverticulum within the pediatric population seen within our institution. We present this series to underscore the importance of high clinical suspicion in the early diagnosis and management of Meckel's diverticulum and to examine further the radiologic and therapeutic protocols within the pediatric population based on our local experience.

  3. Severe halitosis as presentation of epiphrenic diverticulum

    Directory of Open Access Journals (Sweden)

    Elizabeth Montes-de-Oca-Megías

    Full Text Available Halitosis is a common condition, whose main etiology does not respond to diseases of the gastrointestinal system. Epiphrenic diverticula are a rare cause of this manifestation, thus they are not frequent and they are usually asymptomatic. However, they may produce symptoms with inability for patient. A patient with severe halitosis is presented. In his study, an epiphrenic diverticulum is diagnosed and the laparoscopic abdominal diverticulectomy is performed with a complete resolution of symptomatology.

  4. miR-215 overexpression distinguishes ampullary carcinomas from pancreatic carcinomas.

    Science.gov (United States)

    Choi, Dong Ho; Park, Sang Jae; Kim, Hark Kyun

    2015-06-01

    Distinguishing ampullary carcinoma from pancreatic carcinoma is important because of their different prognoses. microRNAs are differentially expressed according to the tissue of origin. However, there is rare research on the differential diagnosis between the two types of cancers by microRNA in periampullary cancers. The present study was undertaken to compare microRNA profiles between ampullary and pancreatic carcinomas using microarrays. miR-215 was most significantly overexpressed in ampullary carcinomas; whereas the expressions of miR-134 and miR-214 were significantly lower in ampullary carcinomas than in pancreatic carcinomas. When these discriminatory microRNAs were applied to liver metastases, they were correctly predicted for the tissue of origin. Although this study is limited by small sample size, striking difference in microRNA expression and concordant expression of discriminating microRNAs in primary tumors and metastases suggest that these novel discriminatory microRNAs warrant future validation.

  5. Roxatidine in duodenal ulcer.

    OpenAIRE

    1995-01-01

    Roxatidine acetate is a new H2-receptor antagonist. A randomized double-blind clinical trial in fifty-three patients with endoscopically proven duodenal ulcers > 5 mm in diameter was undertaken to compare safety and efficacy of roxatidine with that of ranitidine. Twenty-six patients received roxatidine (75 mg bid) while 27 patients received ranitidine (150 mg bid) for 4 weeks. One patient in each group did not come for follow up. Roxatidine and ranitidine had comparable ulcer healing rates...

  6. Diverticulum of the brachiocephalic trunk - angiography and embryological explanation

    Energy Technology Data Exchange (ETDEWEB)

    Pfefferkorn, J.R.; Lunkenheimer, A.; Loeser, H.; Hilgenberg, F.

    1983-03-01

    A diverticulum of the brachiocephalic trunk is described in 5 children with unilateral absence of the pulmonary artery, in a child with tetralogy of Fallot, and in an other child with Bland-White-Garland syndrome. The diverticulum is a remnant of a contralateral ductus arteriosus, which closed after birth and represents the origin of the distal part of the sixth aortic arch.

  7. Transurethral incision of urethral diverticulum in the female

    DEFF Research Database (Denmark)

    Miskowiak, J; Honnens de Lichtenberg, M

    1989-01-01

    A new technique of transurethral incision of urethral diverticulum was successfully used in two women. The method described is safe, simple and shortens operating time.......A new technique of transurethral incision of urethral diverticulum was successfully used in two women. The method described is safe, simple and shortens operating time....

  8. Meckel's diverticulum incarcerated in a transmesocolic internal hernia.

    Science.gov (United States)

    Wu, Si-Yuan; Ho, Meng-Hsing; Hsu, Sheng-Der

    2014-10-07

    Intestinal obstruction is a common complication associated with Meckel's diverticulum in adults. The diverticulum itself or its fibrous band can lead to an intestinal volvulus, intussusceptions, or closed-loop obstructions, which require surgery. The incarceration of Meckel's diverticulum in either inguinal or femoral hernia sacs (Littre's hernia) is another, less common, etiology underlying intestinal obstruction. This case report describes a 45-year-old man who had an obstruction associated with a Meckel's diverticulum that passed through a congenital defect in the mesocolon into the right subphrenic space. The patient, who had not undergone abdominal surgery previously, came to the emergency room with acute onset of intermittent epigastric pain and abdominal distention. Computed tomography images showed the presence of a segment of the small bowel and a diverticulum in the right subphrenic space and paracolic gutter. The twisted mesentery and the dilated loops of the proximal small bowel were indicative of an intestinal volvulus and obstruction. Meckel's diverticulum complicated by a transmesocolic internal hernia was diagnosed, and this condition was confirmed during emergency surgery. The patient's postoperative recovery was uneventful. This case report highlights another presentation of Meckel's diverticulum, that is, in combination with a transmesocolic internal hernia. This etiology may lead to an intestinal volvulus and necessitate early surgery.

  9. A case report of an ampullary tumor presenting with spontaneous perforation of an aberrant bile duct and treated with total laparoscopic pancreaticoduodenectomy

    Directory of Open Access Journals (Sweden)

    Kaplan Mehmet

    2012-07-01

    Full Text Available Abstract Background This case report discusses a patient who presented with bile peritonitis due to spontaneous perforation of an aberrant bile duct that originated in the triangular ligament of the liver. It was associated with an ampullary tumor and treated with total laparoscopic pancreaticoduodenectomy (TLPD. Case report A 58-year-old male patient was admitted to the emergency department of Medical Park Gaziantep Hospital in September 2009 with acute abdominal findings. He underwent an urgent laparoscopy, and, interestingly, bile peritonitis due to the rupture of an aberrant bile duct in the triangular ligament was noted. After laparoscopic treatment of the acute conditions, the follow-up examinations of the patient showed the finding of obstructive jaundice. Endoscopic retrograde cholangio-pancreatography revealed a 1-cm polypoid mass located at the ampulla of Vater (duodenal papilla with possible extension to the ampullary sphincter. A stent was inserted for temporary biliary drainage, and subsequent endoscopic biopsy showed the pathological finding of adenocarcinoma. After waiting for a 1-month period for the peritonitis to heal, the patient underwent pylorus-preserving TLPD and was discharged without any major complications on postoperative day 7. Conclusion In patients with bile peritonitis, it should be considered that the localization of the perforation may be in an aberrant bile duct localized at the triangular ligament and the etiology may be associated with an obstructing periampullary tumor. Laparoscopic pancreaticoduodenectomy is a feasible operative procedure in carefully selected patients. This technique can achieve adequate margins and follows oncological principles. Randomized comparative studies are needed to establish the superiority of minimally invasive surgery over traditional open surgery.

  10. Management of Duodenal Adenomas Involving the Ampulla of Vater – A Warning against Limited Resection

    Directory of Open Access Journals (Sweden)

    Jeremy Rossaak

    2008-03-01

    Full Text Available Duodenal adenomas are uncommon, however, when present a proportion have dysplasia associated with the adenoma and therefore require treatment. The options range from less invasive endoscopic treatments to a pancreaticoduodenectomy. This case report describes two patients with adenomas involving the ampulla of Vater. One patient had familial adenomatous polyposis, the other was a renal transplant patient with a large adenoma. Both patients’ adenomas contained high-grade dysplasia. Both patients underwent a pancreaticoduodenectomy. Histology of both specimens demonstrated that the adenoma had migrated up the bile duct for at least 7 mm, and the pancreatic duct for 8 mm in one patient. Limited resection of ampullary adenomas may leave residual adenomatous tissue in the bile duct with the risk of recurrent adenomatous disease and malignant transformation.

  11. Frequencies and prognostic role of KRAS and BRAF mutations in patients with localized pancreatic and ampullary adenocarcinomas

    DEFF Research Database (Denmark)

    Schultz, Nicolai Aagaard; Roslind, Anne; Christensen, Ib J

    2012-01-01

    The frequencies and prognostic role of KRAS and BRAF mutations in patients operated on for pancreatic ductal adenocarcinomas (PDACs) and ampullary adenocarcinomas (A-ACs) are scantily studied.......The frequencies and prognostic role of KRAS and BRAF mutations in patients operated on for pancreatic ductal adenocarcinomas (PDACs) and ampullary adenocarcinomas (A-ACs) are scantily studied....

  12. Paraganglioma gangliocítico duodenal Duodenal gangliocytic paraganglioma

    Directory of Open Access Journals (Sweden)

    C. Prieto

    2005-04-01

    Full Text Available Se presenta el caso de un varón de 85 años que ingresó por dolor abdominal e ictericia, por lo cual se le realizaron diversas exploraciones, apreciandose en 2ª porción duodenal una masa cuyo estudio histológico demostró que se trataba de un paraganglioma gangliocítico duodenal. Se describen las características clínicas de este infrecuente tumor y revisamos su diagnóstico y tratamiento.We present the case of an 85 year old male who was admitted to hospital with abdominal pain and jaundice. Different explorations were performed for this reason, with a mass observed in his 2nd duodenal portion. Histiological study showed that it was a duodenal gangliocytic paraganlioma. The clinical characteristics of this infrequent tumour are described and we review the diagnosis and treatment.

  13. Roxatidine in duodenal ulcer.

    Directory of Open Access Journals (Sweden)

    Habibullah C

    1995-07-01

    Full Text Available Roxatidine acetate is a new H2-receptor antagonist. A randomized double-blind clinical trial in fifty-three patients with endoscopically proven duodenal ulcers > 5 mm in diameter was undertaken to compare safety and efficacy of roxatidine with that of ranitidine. Twenty-six patients received roxatidine (75 mg bid while 27 patients received ranitidine (150 mg bid for 4 weeks. One patient in each group did not come for follow up. Roxatidine and ranitidine had comparable ulcer healing rates (22/25 vs 22/26; roxatidine, however, resulted in greater reduction in the number and severity of night time pain episodes (p < 0.05. No adverse event was reported during 4 weeks of treatment with roxatidine. Thus roxatidine achieves the primary therapeutic goal of relief of pain better than ranitidine.

  14. Roxatidine in duodenal ulcer.

    Science.gov (United States)

    Habibullah, C M; Habeeb, M A; Singh, S P

    1995-01-01

    Roxatidine acetate is a new H2-receptor antagonist. A randomized double-blind clinical trial in fifty-three patients with endoscopically proven duodenal ulcers > 5 mm in diameter was undertaken to compare safety and efficacy of roxatidine with that of ranitidine. Twenty-six patients received roxatidine (75 mg bid) while 27 patients received ranitidine (150 mg bid) for 4 weeks. One patient in each group did not come for follow up. Roxatidine and ranitidine had comparable ulcer healing rates (22/25 vs 22/26); roxatidine, however, resulted in greater reduction in the number and severity of night time pain episodes (p roxatidine. Thus roxatidine achieves the primary therapeutic goal of relief of pain better than ranitidine.

  15. A large incarcerated Meckel's diverticulum in an inguinal hernia

    Directory of Open Access Journals (Sweden)

    Michael J. Horkoff

    2014-01-01

    CONCLUSION: Littre's hernia, although rare, should be a consideration at the time of repair for any abdominal hernia involving small bowel as resection of the Meckel's diverticulum is critical in avoiding recurrent complications.

  16. Extrahepatic right hepatic duct diverticulum:a rare entity

    Institute of Scientific and Technical Information of China (English)

    Eduardo SM Fernandes; Raquel L Bernardo; Moacir M Fernandes; Rogério MC Araújo; Renato Sebbe; Asterio Monte; José F Coelho; Antonio AP Souza; Joaquim Ribeiro Filho

    2010-01-01

    BACKGROUND: Douglas described choledochal cysts in 1852 and Todani proposed an anatomy-based classiifcation in 1977. The classiifcation is the most extensively used, but does not include some rare variations. We present a case of hepatic duct diverticulum, one of the variations, and discuss its diagnosis and treatment. METHODS: A 57-year-old woman presented with upper abdominal pain and discomfort associated with nausea and vomiting. She was ifnally diagnosed with cholelithiasis and right hepatic duct diverticulum. RESULT: The patient underwent resection of the hepatic duct diverticulum and cholecystectomy, and was asymptomatic 26 months after surgery. CONCLUSIONS: Hepatic duct diverticulum is a rare form of choledochal cyst, not included in Todani's classiifcation. Todani's classiifcation including this and other uncommon variations of choledochal cysts must be reviewed. The best diagnostic imaging methods and treatment for choledochal cysts must be deifned.

  17. An unusual case of cardiac tamponade: ruptured subaortic diverticulum.

    Science.gov (United States)

    Salemi, Arash; Lee, Ben; Ivascu, Natalia; Webber, Geoffrey; Paul, Subroto

    2010-05-01

    Cardiac diverticula are rare congenital anomalies found as outpouchings from various chambers of the heart. We present a case of a diverticulum arising from the membranous septum with free rupture into the pericardial space and tamponade.

  18. Zenker's diverticulum - diagnosis and therapy

    Energy Technology Data Exchange (ETDEWEB)

    Heindel, W.; Raab, M.

    1987-08-01

    Clinical, X-ray and endoscopic follow-up of patients operated on for Zenker's diverticulum (pharyngo-oesophageal diverticulum) via myotomy and diverticulectomy permits conclusions in respect of functional results of this therapeutic concept and the preoperative diagnosis that our study has proved to be necessary. Usually the diagnosis can be made on the basis of the characteristic anamnesis. It is confirmed by means of an oesophagogram, if necessary with a gastrointestinal passage. Besides visualisation of Zenker's diverticulum, attention must be paid especially to associated neuromuscular functional disturbances of the oesophagus. Preoperative endoscopy is necessary in individual cases only. In respect of therapy, it appears mandatory to perform a sufficiently extended (3-5 cm) myotomy of the pars transversa musculi cricopharyngei because of the frequently seen disturbance of coordination of the pharyngo-oesophageal sphincter, besides removing the diverticulum.

  19. Tracheal diverticulum: case report; Diverticulo traqueal: relato de caso

    Energy Technology Data Exchange (ETDEWEB)

    Feldman, Carlos Jader; Hoffmann, Luciano Lerch [Fundacao Universitaria de Cardiologia, Porto Alegre, RS (Brazil). Inst. de Cardiologia. Servico de Radiologia

    2003-03-01

    A case of incidental finding of a tracheal diverticulum in a patient submitted to computed tomography of the chest is reported. The computed tomography features of this lesion area discussed and the literature is reviewed (author)

  20. PEANUT AS A CAUSE OF TORSION MECKEL'S DIVERTICULUM

    Directory of Open Access Journals (Sweden)

    Sekulić Stojan

    2015-07-01

    Full Text Available Meckel's diverticulum is a rest of omphalenteric's channel. It is a congenital anomaly of the small intestine. It can be found in about 2% of the population.The diagnosis of Meckel's diverticulum is generally applied randomly during surgical intervention. 22 year old girl, admitted to the clinic with the clinical picture of acute appendicitis. After 20 hours observation, intestinal permanence -- ileus, was diagnosed. After a brief reanimation and anesthetic preparation, the girl was operated. Operationally we found a normal appendix. Exploration of the abdomen fortified Meckel's diverticulum at a distance of 75 cm from the ileocaecal mouth of the ileum. Diverticulum was completely filled with peanuts, and torsio around its axis which caused the ileus.We performed diverticulectomy and appendectomy. The patient had a rapid and successful postoperative course.

  1. A Rare Case Presentation of a Perforated Giant Sigmoid Diverticulum

    Directory of Open Access Journals (Sweden)

    Jennifer C. Kam

    2013-01-01

    Full Text Available Giant sigmoid diverticulum (GSD is a rare complication of diverticulosis. These lesions arise from herniations of the mucosa through the muscle wall which progressively enlarge with colonic gas to become large air-filled cysts evident on plain X-ray and CT scans. We present a rare case of a 72-year-old female presenting with abdominal distention, abdominal tenderness, and fever who developed a type 1 giant sigmoid diverticulum (pseudodiverticulum that subsequently formed an intra-abdominal abscess and an accompanying type 2 diverticulum as well. The patient was treated with surgical resection of the diverticulum with a primary anastomosis and abscess drainage. The patient’s postoperative course was uneventful. This case helps to support the need for the consideration of GSD in patients aged 60 and older with a history of diverticulosis and presenting with abdominal discomfort and distension.

  2. 胆胰肠结合部的解剖与损伤发生机制%Surgical anatomy and occurrence of injury in choledocho-pancreatico-duodenal junction

    Institute of Scientific and Technical Information of China (English)

    王钦尧; 朱黎庆

    2009-01-01

    The choledocho-pancreatico-duodenal junc-tion is located at the central part of choledocho-pancreatico-duodenal region. During early embryogenetic stage, the primary duodenum develops from the end of foregut and the beginning part of the midgut. The dorsal pancreas, hepatic diverticulum and the ventral pancreas which arises from the basic part of hepatic diverticulum are growing and rotating following the duodenum. During the course, the formations of the choledocho-pancreatico-duodenal region and the central part of choledocho-pancreatico-duodenal junction are complete. The injuries in cho-ledocho-pancreatico-duedenal junction may be caused by metal probe or lithotomy forceps for exploring, dilatating the distal bile duct or taking out the stones from the bile duct. Even if the injuries of choledocho-pancreatico-duodenal junction are deve-loped in a limited scope of several centimeters, several adjacent organs may be involved. Injuries in choledocho-pancreatico-duo-denal junction are hard to be identified during operation and may develop into serious pathological procedures.

  3. Esophageal epiphrenic diverticulum associated with diffuse esophageal spasm

    Science.gov (United States)

    Matsumoto, Hideo; Kubota, Hisako; Higashida, Masaharu; Manabe, Noriaki; Haruma, Ken; Hirai, Toshihiro

    2015-01-01

    Introduction Esophageal diverticulum, a relatively rare condition, has been considered to be associated with motor abnormalities such as conditions that cause a lack of coordination between the distal esophagus and lower esophageal sphincter. Presentation of case We herein report a case of esophageal epiphrenic diverticulum associated with diffuse esophageal spasm. A 73-year-old woman presented with dysphagia and regurgitation. Imaging examinations revealed a right-sided esophageal diverticulum located about 10 cm above the esophagogastric junction. High-resolution manometry revealed normal esophageal motility. However, 24-h pH monitoring revealed continuous acidity due to pooling of residue in the diverticulum. An esophageal epiphrenic diverticulum was diagnosed and resected thoracoscopically. Her dysphagia recurred 2 years later. High-resolution manometry revealed diffuse esophageal spasm. Discussion The diverticulum in the present case was considered to have been associated with diffuse esophageal spasm. The motility disorder was likely not identified at the first evaluation. Conclusion In this case, the patient’s symptoms spontaneously resolved without any treatment; however, longer-term follow-up is needed. PMID:26143577

  4. The organization of ampullary sense organs in the electric fish, Gymnarchus niloticus.

    Science.gov (United States)

    Mullinger, A M

    1969-01-01

    Three types (A, B, and C) of ampullary sense organs occur in the skin of Gymnarchus niloticus. In type A the ampulla is connected to the surface of the skin by an open duct whereas in B and C organs it is closed, though overlain by specialized epidermal cells. In each case the receptor cell surface in contact with the ampullary lumen bears microvilli; these are more highly developed in B and C organs than in type A. Fine structural observations are consistent with the view that the organs are electric receptors of three different types.

  5. Diverticulum of the mitral valve, a rare cause of mitral regurgitation.

    LENUS (Irish Health Repository)

    Soo, Alan

    2010-12-01

    Non-infective mitral valve diverticulum is extremely rare. We present a case of intraoperatively diagnosed mitral valve diverticulum of a 69-year-old man presenting with mitral regurgitation who was successfully treated with mitral valve replacement.

  6. CT of gastro-duodenal obstruction.

    Science.gov (United States)

    Millet, I; Doyon, F Curros; Pages, E; Faget, C; Zins, M; Taourel, P

    2015-10-01

    Gastro-duodenal obstruction encompasses a spectrum of benign and malignant disease. Historically, chronic peptic ulcer disease was the main cause of gastro-duodenal obstruction, whereas now malignant cause with gastric carcinomas for gastric obstruction and pancreatic tumors for duodenal obstruction predominate. This paper reviews the role of CT in diagnosing gastro-duodenal obstruction, its level, its cause by identifying intraluminal, parietal, or extrinsic process, and the presence of complication.

  7. Duodenal duplication cyst identified with MRCP

    Energy Technology Data Exchange (ETDEWEB)

    Carbognin, G.; Guarise, A.; Biasiutti, C.; Pagnotta, N.; Procacci, C. [Department of Radiology, University Hospital ' G.B. Rossi' , Verona (Italy)

    2000-08-01

    We report a case of a stalked cystic duodenal duplication. The lesion, hyperintense on T2-weighted GRE images, maintained the signal intensity after oral administration of a negative contrast agent (Lumirem, Guerbet, Aulnay-Sous-Bois, France), confirming its independence from the duodenal lumen. To our knowledge, this is the first demonstration of duodenal duplication by means of MR cholangiopancreatography. (orig.)

  8. Cholecystokinin-like activity in the duodenal mucosa of duodenal ulcer patients.

    OpenAIRE

    Kataoka, S

    1982-01-01

    Cholecystokinin-like activity in the duodenal mucosa was measured by the bioassay method described by Ljungberg to elucidate its significance in 14 duodenal ulcer patients as well as in 13 normal subjects with no evidence of gastrointestinal diseases. The stage of duodenal ulceration was determined endoscopically according to the criterion of the Japanese Gastroenterological Endoscopic Society. The cholecystokinin-like activity in the duodenal mucosa of duodenal ulcer patients in active stage...

  9. Multiple giant duodenal ulcers associated with duodenal gastrinoma.

    Science.gov (United States)

    Fujihara, Shintaro; Mori, Hirohito; Nishiyama, Noriko; Kobayashi, Mitsuyoshi; Kobara, Hideki; Masaki, Tsutomu

    2012-02-01

    A 59-year-old Japanese man with a history of chronic hepatitis C and cirrhosis was admitted to hospital because of severe abdominal pain and diarrhea. His discomfort had begun 2 months earlier and was localized to the upper abdomen. Upper gastrointestinal endoscopy showed multiple ulcerative lesions from the duodenal bulb to the descending part of the duodenum, one of which was a giant ulcer that filled half of the intestinal lumen. Despite continuous intravenous lansoprazole therapy, his abdominal symptoms did not improve. Upper gastrointestinal endoscopy was again performed to detect the tumor, but it was difficult to observe the tumor with a conventional endoscope. We then inverted a transnasal endoscope into the duodenum, and this enabled us to detect a 15-mm submucosal tumor in the upper wall of the duodenal bulb. Examination of specimens from endoscopic ultrasonography fine-needle aspiration biopsy of the tumor revealed gastrinoma in the duodenal bulb. We decided to perform an operative resection. The patient's symptoms resolved after surgery, and he remained asymptomatic at follow-up 18 months later. Therefore, when it is difficult to detect the tumor directly by conventional endoscopy, we recommend that attempts be made to detect the tumor by inverting a transnasal endoscope into the duodenal bulb.

  10. Huge uterine-cervical diverticulum mimicking as a cyst

    Directory of Open Access Journals (Sweden)

    S Chufal

    2012-01-01

    Full Text Available Here we report an incidental huge uterine-cervical diverticulum from a total abdominal hysterectomy specimen in a perimenopausal woman who presented with acute abdominal pain. The diverticulum was mimicking with various cysts present in the lateral side of the female genital tract. Histopathological examination confirmed this to be a cervical diverticulum with communication to uterine cavity through two different openings. They can attain huge size if left ignored for long duration and present a diagnostic challenge to clinicians, radiologists, as well as pathologists because of its extreme rarity. Therefore, diverticula should also be included as a differential diagnosis. Its histopathological confirmation also highlights that diverticula can present as an acute abdomen, requiring early diagnosis with appropriate timely intervention. Immunohistochemistry CD 10 has also been used to differentiate it from a mesonephric cyst.

  11. Huge uterine-cervical diverticulum mimicking as a cyst.

    Science.gov (United States)

    Chufal, S; Thapliyal, Naveen; Gupta, Manoj; Pangtey, Nirmal

    2012-01-01

    Here we report an incidental huge uterine-cervical diverticulum from a total abdominal hysterectomy specimen in a perimenopausal woman who presented with acute abdominal pain. The diverticulum was mimicking with various cysts present in the lateral side of the female genital tract. Histopathological examination confirmed this to be a cervical diverticulum with communication to uterine cavity through two different openings. They can attain huge size if left ignored for long duration and present a diagnostic challenge to clinicians, radiologists, as well as pathologists because of its extreme rarity. Therefore, diverticula should also be included as a differential diagnosis. Its histopathological confirmation also highlights that diverticula can present as an acute abdomen, requiring early diagnosis with appropriate timely intervention. Immunohistochemistry CD 10 has also been used to differentiate it from a mesonephric cyst.

  12. Meckel's diverticulitis: a rare entity of Meckel's diverticulum

    Science.gov (United States)

    Wong, Chee S.; Dupley, Leanne; Varia, Haren N.; Golka, Darek; Linn, Thu

    2017-01-01

    Meckel's diverticulum is the most common congenital abnormality of the small intestine that results from incomplete closure of the vitelline (omphalo-mesenteric) duct. This true diverticulum, ~2 ft from the ileocecal valve commonly found on the anti-mesenteric border of the ileum, is benign and majority asymptomatic. Diagnosis challenges arise when it became inflamed or presented in following ways, for example, haemorrhage (caused by ectopic pepsin—and hydrochloric acid—secreting gastric mucosa), intestinal obstruction (secondary to intussusception or volvulus) or the presence of diverticulum in the hernia sac (Littre's hernia). We report a case of a 59-year-old male who was admitted under the surgical service at Blackpool Victoria Hospital with suspected appendicitis that turned out to be a Meckel's diverticulitis, a rare presentation of an acute abdomen. We discuss the issues involved in his investigation and management as well as perform a literature review comparing different surgical approaches. PMID:28064243

  13. Perforated jejunal diverticulum in the use of mycophenolate mofetil

    Directory of Open Access Journals (Sweden)

    Charat Thongprayoon

    2014-01-01

    Full Text Available Context: Jejunal diverticulosis is a rare disease. Common acute complications include diverticulitis, intestinal obstruction, bleeding and perforation. Gastrointestinal tract perorations have also been rarely observed in the use of mycophenolate mofetil. Case Report: We report a 44-year-old man with end-stage renal disease post failed kidney transplant on low-dose mycophenolate mofetil who presented with acute onset of abdominal pain. He was successfully given the diagnosis of perforated jejunal diverticulum. The patient successfully underwent a segmental jejunal resection and anastomosis. He unfortunately developed a recurrent jejunal perforation a month later and again had the second segmental jejunal resection operation. Mycophenolate mofetil then was discontinued. Conclusion: The present case illustrates jejunal diverticulum perforation in the use of mycophenolate mofetil. Physicians should increase the awareness of this association of perforated jejunal diverticulum in patients using mycophenolate mofetil.

  14. Giant vesical diverticulum: A rare cause of defecation disturbance

    Institute of Scientific and Technical Information of China (English)

    Sami Akbulut; Bahri Cakabay; Arsenal Sezgin; Kenan Isen; Ayhan Senol

    2009-01-01

    Vesical diverticula frequently result from bladder outlet obstructions. However, giant vesical diverticula which cause acute abdomen or intestinal obstruction are very rare. Our review of the English medical literature found 3 cases of bladder diverticula which caused gastrointestinal symptoms. Here, we present a 57-yearold man with a giant diverticulum of the urinary bladder who complained of abdominal pain, nausea and vomiting,constipation, no passage of gas or feces, and abdominal distension for 3 d. A 20 cm × 15 cm diverticulum was observed upon laparotomy. The colonic obstruction was secondary to external compression of the rectum against the sacrum by a distended vesical diverticulum.We performed a diverticulectomy and primary closure.Twelve months postoperatively, the patient had no difficulty with voiding or defecation.

  15. Iatrogenic Uterine Diverticulum in Pregnancy After Robotic-assisted Myomectomy.

    Science.gov (United States)

    DeStephano, Christopher C; Jernigan, Amelia M; Szymanski, Linda M

    2015-01-01

    Uterine diverticula are rare outpouchings of the uterus associated with abnormal uterine bleeding, pelvic pain, dysmenorrhea, and adverse obstetric events. At the time of cesarean delivery at 36 5/7 weeks' gestation during the patient's first pregnancy and 36 6/7 weeks during the second pregnancy, a fundal iatrogenic uterine diverticulum at the site of a prior robotic-assisted myomectomy was noted. The outpouching communicated with the endometrial cavity and was extremely attenuated, palpably 2 to 3 mm thick. Further research is needed to determine the incidence of iatrogenic uterine diverticulum after robotic myomectomy and whether these malformations increase the risk of adverse obstetric outcomes.

  16. Meckel′s diverticulum strangulated in an umbilical hernia

    Directory of Open Access Journals (Sweden)

    Komlatse Akakpo-Numado

    2009-01-01

    Full Text Available Background: Strangulated Meckel′s diverticulum (MD in an umbilical hernia (UH is a rare event. We present herein a case of strangulated MD in UH in a child. Case Report: An 18-month girl was admitted with clinical features suggesting upper intestinal strangulation since seven days. Many attempts of reduction were done before admission. She was resuscitated and had exploratory laparotomy, which revealed the hernia sac containing a completely gangrenous MD. She had bowel resection and had an uneventful postoperative period. Conclusion: An MD may be the content of a strangulated UH. Bowel resection of the segment bearing the diverticulum is advisable if the latter is gangrenous.

  17. CLINICAL STUDY OF DUODENAL PERFORATION

    Directory of Open Access Journals (Sweden)

    Sambasiva Rao

    2016-04-01

    Full Text Available BACKGROUND The duodenal injury can pose a formidable challenge to the surgeon and failure to manage it properly may have devastating results. Over the centuries, there was little to offer the patient of acute abdomen beyond cupping, purgation and enemas, all of which did more harm than good. It was not until 1884 that Mikulicz made an attempt to repair a perforation. Recent statistics indicate roughly 10% of population develop gastric or duodenal ulcer in life time. Roughly 1-3% of population above the age of 20 years have some degree of peptic ulcer activity during any annual period. A detailed history with regards to the signs and symptoms of the patient, a meticulous examination, radiological and biochemical investigations help to arrive at a correct preoperative diagnosis. In this study, a sincere effort has been put to understand the demographic patterns, to understand the underlying aetiology and to understand the effectiveness of the standard methods of investigation and treatment in use today. METHODS This is a 24 months prospective study i.e., from September 2011 to September 2013 carried out at Dr. Pinnamaneni Siddhartha Institute of Medical Sciences & Research Foundation. The study included the patients presenting to Dr. Pinnamaneni Siddhartha Institute of Medical Sciences & Research Foundation to emergency ward with signs and symptoms of hollow viscus perforation. The sample size included 30 cases of duodenal perforation. RESULTS Duodenal ulcer perforation commonly occurs in the age group of 30-60 years, but it can occur in any age group. Majority of the patients were male. Smoking and alcohol consumption were risk factors in most cases (53.3% for the causation of duodenal ulcer perforation. Sudden onset of abdominal pain, situated at epigastrium and right hypochondrium was a constant symptom (100%. Vomiting, constipation and fever were not so common. CONCLUSION The emergency surgical management for perforated duodenal ulcer is by

  18. Gall bladder carcinoma with ampullary carcinoma: A rare case of double malignancy

    Directory of Open Access Journals (Sweden)

    Praveer Rai

    2013-01-01

    Full Text Available Simultaneous double cancers in the biliary system are rare. Most are associated with pancreaticobiliary maljunction (PBM. However, it can occur in patients without PBM. Differentiation between these events is important since these two mechanistic origins imply different stages of disease, as well as different subsequent treatments and prognoses. Herein, we report a case of ampullary carcinoma associated with gall bladder carcinoma diagnosed nonoperatively and palliated with biliary metal stenting.

  19. Sodium pertechnetate scintigraphy in detection of Meckel's diverticulum

    DEFF Research Database (Denmark)

    Poulsen, K A; Qvist, N

    2000-01-01

    OBJECTIVE: To evaluate the results of 99mTc-Na-pertechnetate scintigraphy in children presenting with symptoms suspicious of Meckel's diverticulum (MD). METHOD: Retrospective study. A total of 55 99mTc-Na-pertechnetate scintigraphies in 53 patients were compared with the results from surgery and ...

  20. Giant Meckel’s diverticulum torsion that mimics adnexal pathology

    Directory of Open Access Journals (Sweden)

    Serdar Kirmizi

    2016-01-01

    Full Text Available Meckel’s diverticulum is a real diverticulum located at the antimesenteric portion of intestinal loops and including all layers of the intestinal wall. It is the most common congenital anomaly of the gastrointestinal tract, and its incidence is 1–3%. Many asymptomatic cases are diagnosed when complications occur. A 23-year-old female patient applied to gynaecology emergency clinic with pelvic pain complaint. Laparotomy was performed with the diagnosis of acute abdomen because the physical examination and imaging studies did not exclude tuboovary pathology. Giant Meckel’s diverticulitis and ischemic bowel loops that had been torsion were observed. Obstruction is the most common complication and generally originates from inflammation, adhesions, intussusception and omphalo-mesenteric band. In this case, it was seen that mobilized diverticulitis can be complicated without any fibrous band or adhesion to adjacent organs. This case supports that there can be torsion of bowel in free Meckel’s diverticulum. Meckel’s diverticulum settled in the pelvic region can make a clinical manifestation that is difficult to distinguish from adnexal diseases. It should be kept in mind for cases that start with pelvic pain, form adnexal pathology suspicion and cause an acute abdomen.

  1. Cardiac diverticulum and omphalocele: Cantrell's pentalogy or syndrome.

    NARCIS (Netherlands)

    Halbertsma, F.J.; Oort, A.M. van; Staak, F.H.J.M. van der

    2002-01-01

    Omphaloceles and left ventricular diverticulums are rare disorders. Although either is known to occur on its own, the combination is highly suggestive of the so-called pentalogy of Cantrell. This syndrome is a combination of deformities involving midline structures, with exteriorisation of the heart

  2. Syncope with Surprise: An Unexpected Finding of Huge Gastric Diverticulum

    Directory of Open Access Journals (Sweden)

    Mauro Podda

    2016-01-01

    Full Text Available A gastric diverticulum is a pouch protruding from the gastric wall. The vague long clinical history ranging between dyspepsia, postprandial fullness, and upper gastrointestinal bleeding makes this condition a diagnostic challenge. We present a case of large gastric diverticulum that has been diagnosed during clinical investigations for suspected cardiovascular issues in a patient admitted at the medical ward for syncope. A 51-year-old man presented to the medical department due to a syncopal episode occurring while he was resting on the beach after having his lunch, with concomitant vague epimesogastric gravative pain without any other symptom. A diagnosis of neuromediated syncopal episode was made by the cardiologist. Due to the referred epimesogastric pain, an abdominal ultrasound scan was carried out, showing perisplenic fluid. A CT scan of the abdomen was performed to exclude splenic lesions. The CT scan revealed a large diverticulum protruding from the gastric fundus. The upper gastrointestinal endoscopy visualized a large diverticular neck situated in the posterior wall of the gastric fundus, partially filled by undigested food. The patient underwent surgery, with an uneventful postoperative course. Histologic examination showed a full-thickness stomach specimen, indicative of a congenital diverticulum. At the 2nd month of follow-up, the patient was asymptomatic.

  3. Minute ampullary carcinoid tumor with lymph node metastases: a case report and review of literature

    Directory of Open Access Journals (Sweden)

    Sakano Shigeru

    2009-01-01

    Full Text Available Abstract Background Carcinoid tumors are usually considered to have a low degree of malignancy and show slow progression. One of the factors indicating the malignancy of these tumors is their size, and small ampullary carcinoid tumors have been sometimes treated by endoscopic resection. Case presentation We report a case of a 63-year-old woman with a minute ampullary carcinoid tumor that was 7 mm in diameter, but was associated with 2 peripancreatic lymph node metastases. Mild elevation of liver enzymes was found at her regular medical check-up. Computed tomography (CT revealed a markedly dilated common bile duct (CBD and two enlarged peripancreatic lymph nodes. Endoscopy showed that the ampulla was slightly enlarged by a submucosal tumor. The biopsy specimen revealed tumor cells that showed monotonous proliferation suggestive of a carcinoid tumor. She underwent a pylorus-preserving whipple resection with lymph node dissection. The resected lesion was a small submucosal tumor (7 mm in diameter at the ampulla, with metastasis to 2 peripancreatic lymph nodes, and it was diagnosed as a malignant carcinoid tumor. Conclusion Recently there have been some reports of endoscopic ampullectomy for small carcinoid tumors. However, this case suggests that attention should be paid to the possibility of lymph node metastases as well as that of regional infiltration of the tumor even for minute ampullary carcinoid tumors to provide the best chance for cure.

  4. Jugular bulb diverticulum combined with high jugular bulb: a case report with CT and MRA findings

    Energy Technology Data Exchange (ETDEWEB)

    Ko, Seog Wan [College of Medicine, Chonbuk National Univ., Jeonju (Korea, Republic of)

    2004-12-01

    Jugular bulb diverticulum is a rare condition that is characterized by the outpouching of the jugular bulb, and this can lead to hearing loss, tinnitus and vertigo. A few reports have revealed the radiologic findings about jugular bulb diverticulum, but none of them have described the MRA findings concerning this lesion. We present here the CT and MR venography findings in regards to a large high jugular blub and diverticulum we observed in a 47-year-old woman.

  5. Isolated perforation of Meckel′s diverticulum following blunt trauma abdomen: A rare case report

    OpenAIRE

    Syeda Siddiqua Banu; Joshi, Sanjeev B; Vidyadhar A Kinhal; Desai, Mahesh S.

    2015-01-01

    Meckel′s diverticulum is the most common congenital anomaly of the gastrointestinal tract, occurring in about 2% of the population and, in most cases, incidentally being discovered during autopsy, laparotomy, or barium studies. Hemorrhage, obstruction, and inflammation are the complications that can occur in a Meckel′s diverticulum. Perforation in a Meckel′s diverticulum can occur in the presence of ectopic mucosa which is rare, but perforation following blunt abdominal injury is very rare an...

  6. Female urethral diverticulum containing a giant calculus: a CARE-compliant case report.

    Science.gov (United States)

    Dong, ZhiLong; Wang, Hanzhang; Zuo, LinJun; Hou, MingLi

    2015-05-01

    Urethral diverticula with calculi have a low incidence as reported in the literature. Diverticulum of female urethra is rare, often discovered due to associated complications. We report a case of diverticulum of the female urethra containing giant calculi in a 62-year-old multiparous woman. She consulted with our office due to dysuria and a hard, painful periurethral mass in the anterior vagina wall. The diverticulum was approached surgically by a vaginal route, and local extraction of the calculi and subsequent diverticulectomy successfully treated the condition.Diagnosis of a complicated diverticulum can be easily achieved if one possesses a high degree of clinical symptoms.

  7. Acquired Tracheal Diverticulum as an Unexpected Cause of Endotracheal Tube Cuff Leak

    Directory of Open Access Journals (Sweden)

    Flores-Franco René Agustin

    2015-10-01

    Full Text Available Introduction: Tracheal diverticulum has been associated with problems during endotracheal intubation but there are no reports concerning air leakage around an endotracheal tube (ETT.

  8. Surgical Treatment of Epiphrenic Diverticulum: Technique and Controversies.

    Science.gov (United States)

    Andolfi, Ciro; Wiesel, Ory; Fisichella, P Marco

    2016-11-01

    The goal of this article is to illustrate the current minimal invasive approaches to patients with epiphrenic diverticulum in terms of preoperative evaluation, surgical technique, and outcomes. Two techniques will be presented: a laparoscopic and a video-assisted thoracic repair. Indications for each technique will be discussed as well as proper patient selection and management. Current controversies in the treatment of patients with this rare disease will be addressed.

  9. Perforated jejunal diverticulum: a rare presentation of acute abdomen.

    Science.gov (United States)

    Kavanagh, Crystal; Kaoutzanis, Christodoulos; Spoor, Kristen; Friedman, Paul F

    2014-03-22

    Jejunal diverticulosis is a rare entity with a reported clinical incidence of 0.5%. However, symptoms relating to its presence are non-specific, which does not only delay diagnosis, but also increases the risk of serious complications approaching 15%. We report a case of perforated jejunal diverticulum presented with a 6-month history of significant weight loss and acute abdominal pain. We discuss clinical presentation in both simple and complex cases, diagnostic pitfalls and management strategies.

  10. Giant mid-esophageal diverticulum. Conservative treatment of postoperative leakage.

    Science.gov (United States)

    Dallatomasina, S; Casaccia, M; Chessa, M; Serrano, J; Nardi, I; Troilo, B; Miggino, M; Valente, U

    2009-01-01

    Mid-esophageal diverticula are rare entities. Only symptomatic patients usually receive surgical treatment. Esophageal leakage is one of the most common complications after these procedures. Though in literature, operative management is the preferred treatment for esophageal fistula, conservative approach is described in case of small leaks. We report a case of an operated giant mid-esophageal diverticulum complicated with an esophageal fistula. The patient underwent a surgical treatment and recovered completely.

  11. Aortic aneurysm and diverticulum of Kommerell: a dreadful concomitance

    Directory of Open Access Journals (Sweden)

    Fernando Peixoto Ferraz de Campos

    2012-12-01

    Full Text Available First described in 1936, the diverticulum of Kommerell (DOK is a dilatation of the proximal segment of an aberrant subclavian artery. Appearing more frequently in the left-sided aortic arch, the aberrant right subclavian artery passes behind the esophagus toward the right arm, causing symptoms in the minority of cases. Diagnosis is generally incidental with this pattern. When symptomatic, dysphagia, respiratory symptoms, hoarseness, chest pain, and upper limb ischemia are the most common complaints. Although debatable, the origin of DOK is accepted as being degenerative or congenital. The degenerative condition is normally associated with atherosclerosis and occurs more frequently after the age of 50 years with no gender predominance. Complications may be life threatening and are more commonly related to the diverticulum aneurysm or when associated with aortic diseases such as aneurysms or dissection. The authors present a case of a 67-year-old male with a history of acute chest pain, neurological disturbances, and hypertensive crisis. The diagnostic workup revealed an aortic arch aneurysm with intramural hematoma and a diverticulum aneurysm of Kommerell. Treatment was conservative at first. The patient presented a satisfactory outcome and was referred to an outpatient clinic for follow up and further therapeutic consolidation.

  12. Duodenal polyposis secondary to portal hypertensive duodenopathy

    Institute of Scientific and Technical Information of China (English)

    Ananta; Gurung; Philip; E; Jaffe; Xuchen; Zhang

    2015-01-01

    Portal hypertensive duodenopathy(PHD) is a recognized, but uncommon finding of portal hypertension in cirrhotic patients. Lesions associated with PHD include erythema, erosions, ulcers, telangiectasia, exaggerated villous pattern and duodenal varices. However, duodenal polyposis as a manifestation of PHD is rare. We report a case of a 52-year-old man who underwent esophagogastroduodenoscopy and was found with multiple small duodenal polyps ranging in size from 1-8 mm. Biopsy of the representative polyps revealed polypoid fragments of duodenal mucosa with villiform hyperplasia lined by reactive duodenal/gastric foveolar epithelium and underlying lamina propria showed proliferating ectatic and congested capillaries. The features were diagnostic of polyps arising in the setting of PHD.

  13. Endoscopic resection of an ampullary carcinoid presenting with upper gastrointestinal bleeding: A case report and review of the literature

    Institute of Scientific and Technical Information of China (English)

    Nooman Gilani; Francisco C Ramirez

    2007-01-01

    Ampullary carcinoid is a rare tumor that can present with gastrointestinal bleeding, obstructive jaundice or pancreatitis. Some of these tumors are associated with Von Recklinghausen disease. The usual surgical options are a biliary-enteric anastomosis, Whipple procedure or rarely a local resection. The mean survival dges not appear to be much different after a pancreaticoduodenectomy versus local surgical excision.We report a very rare case of a non-metastatic ampullary carcinoid causing upper gastrointestinal bleeding, which was managed by endoscopic ampullectomy.

  14. Fertility following microsurgical removal of the ampullary-isthmic junction in rabbits.

    Science.gov (United States)

    Eddy, C A; Antonini, R; Pauerstein, C J

    1977-10-01

    The role of the ampullary-isthmic junction (AIJ) in fertility was investigated in the rabbit by using microsurgical tuboplastic techniques. Microsurgical transection or resection of the AIJ failed to alter fertility significantly. Nine of ten rabbits which underwent unilateral transection of the AIJ became pregnant on the operated side and eight of the ten became pregnant on the unoperated control side. Of the ten rabbits which underwent unilateral AIJ resection, all became pregnant bilaterally. The results of this study indicate that the AIJ is not necessary for normal fertility in the rabbit.

  15. Perforated duodenal ulcer: Emerging pattern

    Directory of Open Access Journals (Sweden)

    Murtaza Ali Asger Calcuttawala

    2014-01-01

    Full Text Available Background: A total of 27 patients of perforated duodenal ulcer admitted in our institution between December 2010 and November 2012 were treated and studied. Materials and Methods: All patients were diagnosed on the basis of clinical and radiological findings, exploratory laparotomy was performed and simple closure of perforation with placement of Graham′s omental patch was carried out. This was followed by triple regimen for Helicobacter pylori eradication. Results: All patients were male, maximum incidence (61.54% was noted in the age group of 21-30, ′O′ +ve blood group was most commonly observed in our patients. Eight patients had history suggestive of acute acid peptic disease. Mean time interval between the start of symptoms and surgery was 43 h. No morbidity except minimal pleural effusion was seen in one case. There was no mortality in our series. Conclusion: We conclude that although a number of definitive surgeries have been described for acid peptic disease, but the requirement of such procedures has come down due to increasing use of H. pylori eradication therapy and proton pump inhibitors. However, surgery for complications especially for duodenal ulcer perforation has not reduced concomitantly. Incidence is greater in young males.

  16. Giant sigmoid diverticulum with coexisting metastatic rectal carcinoma: a case report.

    LENUS (Irish Health Repository)

    Sasi, Walid

    2010-01-01

    Giant diverticulum of the colon is a rare but clinically significant condition, usually regarded as a complication of an already existing colonic diverticular disease. This is the first report of a giant diverticulum of the colon with a co-existing rectal carcinoma.

  17. 先天性十二指肠梗阻63例治疗经验%Congenital Duodenal Obstruction

    Institute of Scientific and Technical Information of China (English)

    韩茂棠; 李彩霞; 胡银莲

    1985-01-01

    @@ 先天性十二指肠部位梗阻是新生儿期常见急症之一,其中不全梗阻者可在新生儿期或其后的任何时期出现症状,本文总结我院1970年以来经手术治疗的63例,并对治疗中的经验教训作些探讨.%A survey is made of 63 cases of congenital duodenal obstruction which were surgically corrected in the years from 1970 to 1983.53 cases were duodenal atresia or stenosis,and 10 were noticed as annular pancreas combined with congenital duodenal stenosis. The patients aged 1-13. Pathologlcally,they can be classified into 4 types:diaphragm or wind Sock (31 cases),intrinsic stenosis (16),annular pancreas plus stenosis or atresia (10-and atresic duodenum with blind end (6).Concommitent abnormalities were noted in 28 cases,including Down's syndrome (3),midgut malrotation (16),inperforate anus (2),congenital heart disease(2),hypospadia(1),omphalocele (1),diverticulum (2) and esophageal atresia (1). Retrocolic duodenojejunostomy,was performed on 40 patients and diaphragm resection combined with transverse suture of the duodenal opening on 10.In blind end type,an end-to-end duodenojejunostomy is suggested. In 16 cases of midgut malrotation,simultaneous Ladd's operation was also performed.The authors cmphasize the importance of catheteric exploration through the anastomosis to rule out a bulging diaphragmatic membrane or wind sock lesions. Diaphragmatic resection has been abandoned because of the risk of damaging the opening of bile duct or pancreatic duct. 14 patients died after operation,mortality rate being 23%. 3 re-operatlons were also reviewed.

  18. Spontaneous Hemoperitoneum With Meckel's Diverticulum Associated, Presentation of an Uncommon Case

    Directory of Open Access Journals (Sweden)

    Cobian JI

    2016-06-01

    Full Text Available Common complications of Meckel’s diverticulum includes gastrointestinal hemorrhage, intestinal obstruction and diverticulitis. Hemoperitoneum in association with a perforated diverticulum is rare. Actually,with an unscathed one, is even rarer. A 37-year-old-man with hemoperitoneum and an unscathed Meckel´s diverticulum with a hematoma in the mesentery of its intestinal segment with non-active bleeding is presented. An enterectomy including Meckel`s diverticulum was performed with successful outcome. The pathological diagnosis results in multiple hypotheses in reference to the pathogenesis related to our case. A Meckel´s diverticulum associated with arteriovenous disorder might be considered as a cause of spontaneous hemoperitoneum in adults.

  19. KRAS mutation as a prognostic factor in ampullary adenocarcinoma: a meta-analysis and review

    Science.gov (United States)

    Kim, Bum Jun; Jang, Hyun Joo; Kim, Jung Han; Kim, Hyeong Su; Lee, Jin

    2016-01-01

    Ampullary adenocarcinoma (A-AC) is a rare malignancy arising from the ampulla of Vater. KRAS mutation is detected in 30–40% of patients with A-AC, but its clinical implication and prognostic value are not well described. We conducted this meta-analysis to investigate the association between KRAS mutation and prognosis in patients with A-AC. We searched Pubmed, MEDLINE, EMBASE, and the Cochrane Library databases for articles including following terms in their titles, abstracts, or keywords: ‘ampullary or periampullary or ampulla of vater’, ‘cancer or carcinoma’, and ‘KRAS’. There were five studies with survival data of patients. A total of 388 patients with A-AC from the 5 studies were included in the overall survival (OS) analysis, and 169 patients from 2 studies were eligible for the relapse-free-survival (RFS) analysis. Out of 388 patients, 175 (45%) had KRAS mutation. There was no association between KRAS mutation and OS (HR = 1.06, 95% CI: 0.87–1.29, P = 0.58). However, there was a significant correlation between KRAS mutation and worse RFS (HR = 2.74, 95% CI: 1.52–4.92, P = 0.0008). In conclusion, this meta-analysis indicates that KRAS mutation is associated with poor RFS, but not with OS in patients with A-AC. PMID:27517148

  20. Adenocarcinoma of the Minor Duodenal Papilla: Report of a Case

    Directory of Open Access Journals (Sweden)

    Kazuhiro Takami

    2011-04-01

    Full Text Available An 81-year-old male was found to have a duodenal tumor by screening upper gastrointestinal endoscopy. The tumor was located in the minor duodenal papilla. Pathological examination of the biopsy specimen revealed adenocarcinoma, and endoscopic ultrasound showed an elevated hypoechoic mass in the minor duodenal papilla. The preoperative diagnosis was therefore considered to be either adenocarcinoma of the minor duodenal papilla or duodenal cancer. We performed a subtotal stomach-preserving pancreaticoduodenectomy. Histopathological examination of the resected specimen showed the tumor cells to be primarily located in the submucosa of the minor duodenal papilla, with slight invasion into the pancreatic parenchyma through the accessory pancreatic duct. We therefore diagnosed a primary adenocarcima of the minor duodenal papilla. Adenocarcinoma of the minor duodenal papilla is considered to be a rare disease, but it may be underestimated because of the difficulty in distinguishing advanced adenocarcinoma of the minor duodenal papilla from primary duodenal cancer and cancer of the pancreatic head.

  1. Duodenal Perforation Precipitated by Scrub Typhus.

    Science.gov (United States)

    Rajat, Raghunath; Deepu, David; Jonathan, Arul Jeevan; Prabhakar, Abhilash Kundavaram Paul

    2015-01-01

    Scrub typhus is an acute febrile illness usually presenting with fever, myalgia, headache, and a pathognomonic eschar. Severe infection may lead to multiple organ failure and death. Gastrointestinal tract involvement in the form of gastric mucosal erosions and ulcerations owing to vasculitis resulting in gastrointestinal bleeding is common. This process may worsen a pre-existent asymptomatic peptic ulcer, causing duodenal perforation, and present as an acute abdomen requiring surgical exploration. We report the case of a patient with no previous symptoms or risk factors for a duodenal ulcer, who presented with an acute duodenal perforation, probably precipitated by scrub typhus infection.

  2. Duodenal perforation precipitated by scrub typhus

    Directory of Open Access Journals (Sweden)

    Raghunath Rajat

    2015-01-01

    Full Text Available Scrub typhus is an acute febrile illness usually presenting with fever, myalgia, headache, and a pathognomonic eschar. Severe infection may lead to multiple organ failure and death. Gastrointestinal tract involvement in the form of gastric mucosal erosions and ulcerations owing to vasculitis resulting in gastrointestinal bleeding is common. This process may worsen a pre-existent asymptomatic peptic ulcer, causing duodenal perforation, and present as an acute abdomen requiring surgical exploration. We report the case of a patient with no previous symptoms or risk factors for a duodenal ulcer, who presented with an acute duodenal perforation, probably precipitated by scrub typhus infection.

  3. Acute Necrotizing Esophagitis Followed by Duodenal Necrosis.

    Science.gov (United States)

    Del Hierro, Piedad Magdalena

    2011-12-01

    Acute Necrotizing Esophagitis is an uncommon pathology, characterized by endoscopic finding of diffuse black coloration in esophageal mucosa and histological presence of necrosis in patients with upper gastrointestinal bleeding. The first case of acute necrotizing esophagitis followed by duodenal necrosis, in 81 years old woman with a positive history of Type 2 Diabetes Mellitus, Hypertension, and usual intake of Nonsteroidal Anti-inflammatory drugs, is reported. Although its etiology remains unknown, the duodenal necrosis suggests that ischemia could be the main cause given that the branches off the celiac axis provide common blood supply to the distal esophageal and duodenal tissue. The massive gastroesophagic reflux and NSAID intake could be involved.

  4. Whipple's operation for carcinoma of the pancreatic head and the ampullary region. Short-and long-term results

    DEFF Research Database (Denmark)

    Sørensen, M B; Banner, Jytte; Rokkjaer, M;

    1998-01-01

    In this retrospective review short- and long-term perspectives have been evaluated for 108 patients who, during 1982 through 1992, had Whipple's operation performed for carcinoma of the pancreatic head (PC, n=63) or the ampullary region (AC, n=45). In 24 patients the operation was not radical (21...

  5. Endoscopic duodenal biopsy in children

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    El Mouzan Mohammad

    2006-01-01

    Full Text Available Background: Biopsy of the small bowel is frequently obtained by endoscopic forceps instead of the classical suction capsule, yet reports from developing countries are scarce. Aim of the study: to report our experience on the diagnostic value of this procedure in our community. Patients and methods: A retrospective analysis of all endoscopic duodenal biopsies (EDB, performed on all patients below 18 years of age. Data retrieved from the records included age, gender, nationality, indication for biopsy, the endoscopic findings, and the results of histopathology. Results: From 1993 to 2002, 241 endoscopic biopsies were performed on 241 consecutive children. Most of the children (96% were Saudi nationals, the age range between six weeks to 18 years, and male to female ratio was 0.7: 1. All of the biopsy material was adequate for routine histopathology. The commonest indications for biopsy were short stature and chronic diarrhea in 116/241 (48% and 102/241 (43% of the children respectively. Refractory rickets accounted for 11/241 (5% of the indications. The prevalence of villous atrophy was highest in children presenting with chronic diarrhea (40%, compared to short stature (22%. Other less common, but important findings were villous atrophy in three unusual conditions (one refractory rickets, one unexplained anemia, and one polyendocrinopathy, two cases of intestinal Giardia lamblia infestation, three cases of intestinal lymphangiectasis and one case of Mycobacterium avium intracellulare. Unexpected endoscopic findings were documented in 34/241 (14% of the children. Conclusions: Endoscopic duodenal biopsy is adequate not only for the diagnosis of villous atrophy, but also for the detection of other gastroenteropathies. Accordingly, when expertise and equipments are available, EDB should be the procedure of choice not only in industrialized but also in developing countries.

  6. Duodenal diverticulitis. computed tomography findings; Diverticulities duodenal. Hallazgos en la TC

    Energy Technology Data Exchange (ETDEWEB)

    Sanchez, E.; Martin, S.; Garcia, J.; Dominguez, A. [Hospital Ramon y Cajal. Madrid (Spain)

    2001-07-01

    Duodenal diverticular occur very frequently among the general public. However, duodenal diverticulitis is a very uncommon clinical entity, the diagnosis of which requires radiological studies since the clinical signs cam mimic a great number of disease processes with different treatments. We present a case of duodenal diverticulitis in which the diagnosis according to ultrasound and computed tomography (CT) studies was confirmed intraoperatively. We also review the few cases of this entity reported in the literature. The CT findings are highly suggestive of duodenal diverticulitis given their similarity to those associated with diverticulitis at other sites. (Author) 5 refs,.

  7. [Persistent duodenal septum in an adult].

    Science.gov (United States)

    Helwing, E; Echtermeyer, V; Otten, G

    1977-02-01

    A case of duodenal obstruction by a congenital duodenal web in a 34-year-old woman is presented. A mucosal diaphragm obstructed the duodenum. It showed an excentric opening of 0.8 cm diameter, but the dilated diaphragm caused a total stop during the last months. Despite a typical history, exact X-ray, and endoscopic examination, the correct preoperative diagnosis was not found, because nobody thought it possible, that a mucosal diapharm of the duodenum could persist for 34 years.

  8. Giant small bowel diverticulum presenting after percutaneous gastrostomy: case report

    Energy Technology Data Exchange (ETDEWEB)

    Robinson, G.J.; Clark, J.A.; Pugash, R.A. [St. Michael' s Hospital, Wellesley Central Site, Dept. of Medical Imaging, Toronto, Ontario (Canada)

    2000-10-01

    The standard technique for percutaneous gastrostomy requires insufflation of air into the stomach via a nasogastric tube before percutaneous gastric puncture. We present a previously undescribed complication in which the insertion of a percutaneous gastrostomy tube resulted in the distention of a previously undiagnosed giant small bowel diverticulum. This led to discomfort for the patient, further radiologic investigation and a delay in discharge. Symptoms resolved with conservative management. We suggest a strategy for avoiding this complication, as well as for reducing the incidence of post-procedure ileus. (author)

  9. Computed tomography of complicated Meckel's diverticulum in adults: a pictorial review.

    Science.gov (United States)

    Platon, Alexandra; Gervaz, Pascal; Becker, Christoph D; Morel, Philippe; Poletti, Pierre-Alexandre

    2010-05-01

    OBJECTIVE: To show various CT aspects of complicated Meckel's diverticulum in adult patients to facilitate the preoperative diagnosis of this rare pathology in emergency settings. METHODS: A computer search of medical records over a 15 year period identified 23 adult patients who underwent surgery for acute abdomen generated by a complicated Meckel's diverticulum. CT images available for review were analyzed, and some specific patterns leading to the diagnosis of complicated Meckel's diverticulum are presented in this review. RESULTS: Complications were related to inflammation (14 patients), bleeding (5 patients), intestinal obstruction (3 patients), and penetrating foreign body (1 patient). The presence of a Meckel's diverticulum was usually suggested at CT scan by an abnormal outpouching, blind-ending digestive structure connected to the terminal ileum by a neck of variable caliber. Depending on the type of complications, the diverticulum was surrounded by mesenteric inflammatory changes, or presented as a localized fluid or air-fluid collection contiguous with the terminal ileum. The diverticulum was also the source of active bleeding or acted as the lead point to intestinal obstruction or intussusception. CONCLUSION: CT findings of complicated Meckel's diverticulum are polymorphic and should be considered in the evaluation of adult patients with acute abdomen.

  10. Multiple early gastric cancer with duodenal invasion

    Directory of Open Access Journals (Sweden)

    Okino Tetsuya

    2007-10-01

    Full Text Available Abstract Background Early gastric cancers with duodenal invasion are rare, and no previous case of multiple early gastric cancer, one invading the duodenal bulb, has been reported. Case presentation A 79-year-old woman was investigated for upper abdominal discomfort. Endoscopic examination revealed an irregular nodulated lesion in the antrum area, and a reddish aggregated-type semi-circumferential nodulated lesion extending from the prepyloric area to the duodenal bulb through the normal mucosa with the antrum lesion. Biopsy revealed a tubular adenoma for the antrum lesion and a well-differentiated tubular adenocarcinoma for the prepyloric lesion. Distal gastrectomy with sufficient duodenal resection was performed. Microscopically, the antrum lesion appeared as a papillary adenocarcinoma, and the prepyloric lesion as a mainly papillary adenocarcinoma which partially invaded the submucosa without any sequential elongation for endoscopic findings. The lesion extended into the duodenal bulb, and was 12 mm in length from the oral end of Brunner's gland's area and limited within the duodenal mucosa. Conclusion Here, we present an unusual case of multiple early gastric cancer, one of which invaded the duodenum with relative wide mucosal spreading. This case illustrates that even early stage cancers located in the gastric antrum, particularly in the prepyloric area can invade the duodenum directly.

  11. Unusual case of a large midoesophageal diverticulum mimicking unstable angina pectoris.

    Science.gov (United States)

    Hoffmann, J C; Pistorius, G; Müller, P; Zeitz, M

    2002-04-01

    We describe a 77-year-old lady who presented with progressive retrosternal pain radiating to the left arm and the back. After exclusion of cardiac causes a large midoesophageal diverticulum was found on oesophago-gastro-duodenoscopy. Importantly, the retrosternal pain completely disappeared after endoscopic removal of impacted food from the diverticulum. After the surgical resection the patient became fully asymptomatic. This is the first example of angina-like chest pain which definitively resulted from a midoesophageal diverticulum. Therefore, midoesophageal diverticula should be considered as a rare differential diagnosis of exercise-induced retrosternal pain.

  12. Delayed Failure after Endoscopic Staple Repair of an Anterior Spine Surgery Related Pharyngeal Diverticulum

    Directory of Open Access Journals (Sweden)

    Samer Al-Khudari

    2013-01-01

    Full Text Available We present a rare complication of endoscopic staple repair of a pharyngeal diverticulum related to prior anterior cervical spine surgery. A 70-year-old male developed a symptomatic pharyngeal diverticulum 2 years after an anterior cervical fusion that was repaired via endoscopic stapler-assisted diverticulectomy. He initially had improvement of his symptoms after the stapler-assisted approach. Three years later, the patient presented with dysphagia and was found to have erosion of the cervical hardware into the pharyngeal lumen at the site of the prior repair. We present the first reported case of late hardware erosion into a pharyngeal diverticulum after endoscopic stapler repair.

  13. Congenital left ventricular diverticulum, a rare chest fluoroscopy finding: a case report

    Institute of Scientific and Technical Information of China (English)

    WANG Zhi-wei; WU Hong-bing; MAO Zhi-fu; HU Xiao-ping

    2011-01-01

    Congenital left ventricular diverticulum is a very rare cardiac abnormality and it is not completely understood about its etiology, clinical manifestation, diagnosis, treatment and prognosis. This article presents a case of large congenital diverticulum of the left ventricle. The clinical manifestation included paroxysmal supraventricular tachycardia. The diagnosis was made by chest fluoroscopy observation and confirmed by 64-slice CT-angiography. The arrhythmia alleviated instead of antiarrhythmic drugs but by radiofrequency catheter ablation. Due to the rapid growth of the diverticulum, the patient underwent surgical resection finally. Owing to the fatal risks, clinicians should improve the understanding of this disease by deeply studying more cases, in order to standardize the treatment.

  14. Formation of the cupula cristae ampullaris: development in vivo and in vitro.

    Science.gov (United States)

    Anniko, M; Nordemar, H

    1982-01-01

    The development of the cupula cristae ampullaris in the mouse starts on the 14th gestational day and occurs mainly during the 15th and 16th gestational days. Subsequently the secretory activity of the epithelial cells diminishes. The cupula is formed from the underlying epithelium when there are only a small number of differentiated hair cells present. Secretion of cytoplasmic material occurs mainly from supporting cells. The surface of the epithelium at a location corresponding to the planum semilunatum in the adult organ has a thick layer of microvilli and demonstrates a particularly high secretory activity on the 15th gestational day. After the 16th gestational day there are few morphologic signs of secretion. The cupula also develops in inner ear anlages that have been explanted at the otocyst stage on the 12th or 13th gestational day and cultured for eight days in vitro.

  15. Electrical Resistivity of an Elasmobranch's Ampullary Jelly in Varying Electric and Magnetic Fields

    Science.gov (United States)

    Brown, Brandon; Hughes, Mary E.

    2001-03-01

    The ampullae of Lorenzini are believed to function as the electroreceptive organs in elasmobranch fishes. Though the entire excised organs have been the subject of electrical transport measurements, the jelly that fills the ampullae -- composed primarily of glycoproteins with proteins and dissolved salts -- has received less scrutiny. The specific electromagnetic properties of the jelly contribute to electroreception, and we hope to supply useful parameters to modeling efforts via precise electrical characterization. We report preliminary resistivity measurements from ampullary jelly removed, post mortem, from an adult triaenodon obesus (white-tip reef shark). We present data over a broad range of applied electrical currents. We also present data of the resistivity as a function of applied magnetic field strength.

  16. Medical image of the week: killian-jamieson diverticulum

    Directory of Open Access Journals (Sweden)

    Meenakshisundaram C

    2014-11-01

    Full Text Available No abstract available. Article truncated after 150 words. An 89 year old female nursing home resident with a past medical history of hypertension and coronary artery disease was admitted with generalized weakness and vomiting for two days. Chest x-ray revealed consolidation in the left lung suggestive of pneumonia and she was started on broad spectrum antibiotics. Due to worsening consolidation in both lung fields (Figure 1 a video swallow was done for possible aspiration, which revealed contrast retained within the proximal esophagus within a diverticula in the anterior aspect (Figure 2. After excision of the diverticulum her pneumonia resolved and she was discharged back to the nursing home. Killian-Jamieson diverticulum is a mucosal protrusion through a muscular gap in the anterolateral wall of the cervical esophagus; inferior to the cricopharyngeus and lateral to the longitudinal muscle of the esophagus just below its insertion on the posterior lamina of cricoid cartilage (gap also known as Killian-Jamieson space. This differentiates ...

  17. Type 4 appendiceal diverticulum within a de Garengeot hernia.

    Science.gov (United States)

    Rossi, S H; Coveney, E

    2016-09-01

    A de Garengeot hernia is defined as an incarcerated femoral hernia containing the vermiform appendix. We describe the case of a patient with a type 4 appendiceal diverticulum within a de Garengeot hernia and delineate valuable learning points. A 76-year-old woman presented with a 2-week history of a non-reducible painless femoral mass. Outpatient ultrasonography demonstrated a 36mm × 20mm smooth walled, multiloculated, partially cystic lesion anterior to the right inguinal ligament in keeping with an incarcerated femoral hernia. Intraoperatively, the appendix was found to be incarcerated in the sac of the femoral hernia and appendicectomy was performed. Histopathology demonstrated no evidence of inflammation in the appendix. However, an incidental appendiceal diverticulum was identified. It is widely recognised that a de Garengeot hernia may present with concomitant appendicitis, secondary to raised intraluminal pressure in the incarcerated appendix. Appendiceal diverticulosis is also believed to develop in response to raised pressure in the appendix and may therefore develop secondary to incarceration in a de Garengeot hernia. To our knowledge, only one such case has been described in the literature. A de Garengeot hernia is a rare entity, which poses significant diagnostic challenges. A high index of clinical suspicion is necessary as these hernias are at particularly high risk of perforation and so prompt surgical management is paramount.

  18. Endoscopic versus surgical treatment of ampullary adenomas: a systematic review and meta-analysis.

    Science.gov (United States)

    Mendonça, Ernesto Quaresma; Bernardo, Wanderley Marques; Moura, Eduardo Guimarães Hourneaux de; Chaves, Dalton Marques; Kondo, André; Pu, Leonardo Zorrón Cheng Tao; Baracat, Felipe Iankelevich

    2016-01-01

    The aim of this study is to address the outcomes of endoscopic resection compared with surgery in the treatment of ampullary adenomas. A systematic review and meta-analysis were performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. For this purpose, the Medline, Embase, Cochrane, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Scopus and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were scanned. Studies included patients with ampullary adenomas and data considering endoscopic treatment compared with surgery. The entire analysis was based on a fixed-effects model. Five retrospective cohort studies were selected (466 patients). All five studies (466 patients) had complete primary resection data available and showed a difference that favored surgical treatment (risk difference [RD] = -0.24, 95% confidence interval [CI] = -0.44 to -0.04). Primary success data were identified in all five studies as well. Analysis showed that the surgical approach outperformed endoscopic treatment for this outcome (RD = -0.37, 95% CI = -0.50 to -0.24). Recurrence data were found in all studies (466 patients), with a benefit indicated for surgical treatment (RD = 0.10, 95% CI = -0.01 to 0.19). Three studies (252 patients) presented complication data, but analysis showed no difference between the approaches for this parameter (RD = -0.15, 95% CI = -0.53 to 0.23). Considering complete primary resection, primary success and recurrence outcomes, the surgical approach achieves significantly better results. Regarding complication data, this systematic review concludes that rates are not significantly different.

  19. Ultrastructural changes in non-specific duodenitis

    Institute of Scientific and Technical Information of China (English)

    Cheng-Xin Wang; Li-Jiang Liu; Jing Guan; Xiao-Ling Zhao

    2005-01-01

    AIM: To investigate the ultrastructural and morphological changes of non-specific duodenitis (NSD) in an attempt to grade them according to the extent of the lesions.METHODS: Biopsies were taken from the mucosa of duodenal bulb of 44 patients selected from the patients undergoing upper gastrointestinal endoscopy for epigastric discomforts. From each patient, two pinch biopsies on the same area were obtained from duodenal bulb. One was for scanning electron microscopy and the other was stained with hematoxylin-eosin, Warthin-Starry silver and both were then examined under light microscope. A total of 12 specimens (three from each degree of the normal and Ⅰ-Ⅲ of NSD diagnosed and graded by histology) selected from the 44patients were dehydrated, critical point dried, coated with gold palladium and examined under a JEOL JSM-30 scanning electron microscope (SEM) at 20 kV.RESULTS: According to the ultrastructural morphologic changes, non-specific duodenitis was divided into normal (as control group), mild, moderate and severe degrees according to results of SEM. The normal villi of duodenal bulb were less than 0.2 mm. There were inflammation cells,occasionally red blood cells and macrophages on the mucosal epithelial surface. Erosion and desquamation of epithelium could be seen. Three cases (25%, 3/12) had gastric metaplasia and Helicobacter pylori(H pylori) infection could be found in 5 cases (41.67%, 5/12) in duodenal bulb mucosa. The most distinctive feature was the ulcer-like defect on the surface of epithelial cells.CONCLUSION: Non-specific duodenitis is a separate entity disease caused by different factors. SEM is of value as an aid in the diagnosis of mucosal diseases of duodenum.

  20. Perforated Meckel’s Diverticulum Lithiasis: An Unusual Cause of Peritonitis

    Directory of Open Access Journals (Sweden)

    Umasankar Mathuram Thiyagarajan

    2013-01-01

    Full Text Available Meckel’s diverticulum is the commonest congenital malformation of gastrointestinal tract and represents a persistent remnant of the omphalomesenteric duct. Although it mostly remains silent, it can present as bleeding, perforation, intestinal obstruction, intussusception, and tumours. These complications, especially bleeding, tend to be more common in the paediatric group and intestinal obstruction in adults. Stone formation (lithiasis in Meckel’s diverticulum is rare. We report a case of Meckel’s diverticulum lithiasis which presented as an acute abdomen in an otherwise healthy individual. The patient underwent an exploratory laparotomy which revealed a perforated Meckel’s diverticulum with lithiasis; a segmental resection with end-to-end anastomosis of small bowel was performed. Patient recovery was delayed due to pneumonia, discharged on day 20 with no further complications at 6 months following surgery.

  1. Isolated perforation of Meckel′s diverticulum following blunt trauma abdomen: A rare case report

    Directory of Open Access Journals (Sweden)

    Syeda Siddiqua Banu

    2015-01-01

    Full Text Available Meckel′s diverticulum is the most common congenital anomaly of the gastrointestinal tract, occurring in about 2% of the population and, in most cases, incidentally being discovered during autopsy, laparotomy, or barium studies. Hemorrhage, obstruction, and inflammation are the complications that can occur in a Meckel′s diverticulum. Perforation in a Meckel′s diverticulum can occur in the presence of ectopic mucosa which is rare, but perforation following blunt abdominal injury is very rare and only few cases have been reported so far. We report a case of perforation of Meckel′s diverticulum in an 8-year-old boy following a blunt abdominal trauma due to fall from a bicycle.

  2. Right aortic arch with aberrant left innominate artery arising from Kommerell's diverticulum*

    Science.gov (United States)

    Faistauer, Ângela; Torres, Felipe Soares; Faccin, Carlo Sasso

    2016-01-01

    We report a case of an uncommon thoracic aorta anomaly-right aortic arch with aberrant left innominate artery arising from Kommerell's diverticulum-that went undiagnosed until adulthood. PMID:27777481

  3. A massive bleeding from a gastrointestinal stromal tumor of a Meckel’s diverticulum

    Directory of Open Access Journals (Sweden)

    Chabowski Mariusz

    2016-01-01

    Full Text Available Introduction. Meckel’s diverticulum is the most common congenital anomaly of the gastro intestinal tract, present in about 2% of population. Case Outline. The article presents the case of a 44-year-old otherwise healthy man with anemia, who was diagnosed lower gastrointestinal bleeding. An abdominal CT scan revealed a clearly demarcated solid tumor in hypogastric region, measuring 65 Ч 45 mm. A laparotomy through lower midline incision was performed. A surgical resection of a lesion of a Meckel’s diverticulum was carried out and a final diagnosis of gastrointestinal stromal tumor was made. The patient made an uneventful recovery. Conclusion. The preoperative diagnosis of a complicated Meckel’s diverticulum may be challenging. CT is usually an adequate method to diagnose tumors arising from Meckel’s diverticulum.

  4. Radiological features of Meckel's diverticulum and its complications

    Energy Technology Data Exchange (ETDEWEB)

    Thurley, P.D. [Departments of Radiology Queens Medical Centre, Nottingham University Hospitals, Nottingham (United Kingdom)], E-mail: pthurley@doctors.org.uk; Halliday, K.E.; Somers, J.M. [Departments of Radiology Queens Medical Centre, Nottingham University Hospitals, Nottingham (United Kingdom); Al-Daraji, W.I.; Ilyas, M. [Histopathology, Queens Medical Centre, Nottingham University Hospitals, Nottingham (United Kingdom); Broderick, N.J. [Departments of Radiology Queens Medical Centre, Nottingham University Hospitals, Nottingham (United Kingdom)

    2009-02-15

    Meckel's diverticulum is the most common congenital abnormality of the small bowel. The majority of patients with this anomaly will remain asymptomatic; however, several complications may occur, including obstruction, intussusception, perforation, diverticulitis, and gastrointestinal haemorrhage. These complications may produce a variety of different clinical features and radiological appearances. The purpose of this article is to review the potential imaging manifestations of Meckel's diverticulum and its complications and discuss the advantages and disadvantages of the imaging techniques available.

  5. A Rare Cardiac Malformation in a Patient Presenting with Transient Ischemic Attack: Isolated Left Ventricular Diverticulum

    Directory of Open Access Journals (Sweden)

    Haldun Müderrisoğlu1

    2012-12-01

    Full Text Available Left ventricular diverticulum is a rare congenital malformation consisting of a localized protrusion of the endocardium and myocardium from the free wall of the left ventricle (LV. The prevalence of the disease is 0.26% in nonselected patients who underwent cardiac catheterization. It is believed that the etiology is an intrinsic abnormality developing during embryogenesis. It often does not cause any symptoms. We report a case of isolated left ventricular diverticulum with complaints of transient ischemic attack.

  6. Isolated rectal diverticulum complicating with rectal prolapse and outlet obstruction: Case report

    Institute of Scientific and Technical Information of China (English)

    Chuang-Wei Chen; Shu-Wen Jao; Huang-Jen Lai; Ying-Chun Chiu; Jung-Cheng Kang

    2005-01-01

    The occurrence of rectal diverticula is very rare, with only sporadic reports in the literature since 1911. Symptomatic rectal diverticula are encountered even less frequently.Treatments of these complicated events range from conservative treatments to major surgical interventions.We present a hitherto unreported occurrence of isolated rectal diverticulum complicated with rectal prolapse and outlet obstruction. Delorme's procedure resulted in subsidence of symptoms and resolution of the diverticulum. It provides a minimal invasive surgical technique to successfully address the reported malady.

  7. [Isolated left ventricular muscular diverticulum in an adult. Value of non-invasive examinations].

    Science.gov (United States)

    Holeman, A; Bellorini, M; Lefevre, T; Lévy, M; Loiret, J; Huerta, F; Thébault, B; Funck, F

    1997-10-01

    The authors report a case of ventriculum in a 45 year old women investigated for chest pain. This was a congenital muscular left ventricular diverticulum confirmed by a complete imaging series including echocardiography, magnetic resonance imaging, angio-scintigraphy and conventional angiography. This diverticulum was unusual due to the fact that there was no associated congenital disease and that it was discovered in an adult. The authors review the literature and discuss the value of non-invasive imaging procedures.

  8. Complete Resection of Ampullary Paragangliomas Confined to the Submucosa on Endoscopic Ultrasound May Be Best Achieved by Radical Surgical Resection

    Directory of Open Access Journals (Sweden)

    Kevin A. Ghassemi

    2009-06-01

    Full Text Available Paragangliomas of the gastrointestinal tract generally are benign tumors usually found in the second portion of the duodenum. We present a case of paraganglioma of the ampulla of Vater confined to the submucosa on endoscopic ultrasound examination. This was initially treated by endoscopic resection, followed by pancreaticoduodenectomy after local resection margins were positive. Histopathology showed a well-differentiated ampullary paraganglioma confined to the submucosa, but with involvement of one regional lymph node. Only 25 prior cases of paraganglioma at the ampulla of Vater have been reported, and nine of these have demonstrated local or distant metastases. Because of their malignant potential, ampullary paragangliomas should be treated with radical resection if the goal is to achieve complete resection, even if preoperative imaging shows local confinement.

  9. Meckel's diverticulum bleeding diagnosed with magnetic resonance enterography: a case report.

    Science.gov (United States)

    Zhou, Fu-Run; Huang, Liu-Ye; Xie, Hai-Zhu

    2013-05-07

    Although the introduction of double-balloon enteroscopy has greatly improved the diagnostic rate, definite diagnosis of Meckel's diverticulum far from the ileocecal valve is still impossible in most cases. We explored the role of magnetic resonance (MR) enterography in detecting bleeding from Meckel's diverticulum that can not be confirmed via double-balloon enteroscopy. This study describes a case of male patient with bleeding from Meckel's diverticulum diagnosed with MR enterography of the small intestine. No bleeding lesion was found via colonoscopy, anal enteroscopy, or oral colonoscopy. MR enterography of the small intestine revealed an occupying lesion of 3.0 cm in the lower segment of the ileum. The patient was transferred to the Department of Abdominal Surgery of our hospital for surgical treatment. During surgery, a mass of 3 cm × 2 cm was found 150 cm from the ileocecal valve, in conjunction with congestion and edema of the corresponding mesangium. Intraoperative diagnosis was small bowel diverticulum with bleeding. The patient underwent partial resection of the small intestine. Postoperative pathology showed Meckel's diverticulum containing pancreatic tissues. He was cured and discharged 7 d after operation. We conclude that MR enterography of the small intestine has greatly improved the diagnosis rate of Meckel's diverticulum, particularly in those patients with the disease which can not be confirmed via double-balloon enteroscopy.

  10. Westernblottinginthediagnosisof duodenal-biliary and pancreaticobiliary relfuxesinbiliarydiseases

    Institute of Scientific and Technical Information of China (English)

    Guo-Zhe Xian; Shuo-Dong Wu; Chun-Chih Chen; Yang Su

    2009-01-01

    BACKGROUND: Currently adopted diagnostic methods for duodenal-biliary and pancreaticobiliary relfuxes carry many lfaws, so the incidence of the two relfuxes demands further larger sample size studies. This study aimed to evaluate Western blotting for the diagnosis of relfuxes in biliary diseases. METHODS: An oral radionuclide 99mTc-DTPA test (radio-nuclide, RN) was conducted for the observation of duodenal-biliary relfux prior to measuring bile radioactivity and Western blotting for detecting bile enterokinase (EK). Pancreaticobiliary relfux was assessed by biochemical and Western blotting tests for biliary amylase activity and trypsin-1, respectively. In accordance with bile sample origin, our samples were classiifed into ductal bile and gall bile groups;based on each individual biliary disease, we further classiifed the ductal bile group into ifve sub-groups, and the gall bile group into four sub-groups. Western blotting was conducted to assess the two relfuxes in biliary diseases. RESULTS: Consistencies were noted between EK and RN tests when diagnosing duodenal-biliary relfux (P0.05); in the common bile duct cyst group, the EK positive rate was signiifcantly lower than the trypsin-1 positive rate (P CONCLUSIONS: Western blotting can accurately relfect duodenal-biliary and pancreaticobiliary relfuxes. EK has greater sensitivity than RN for duodenal-biliary relfux. The majority of biliary amylase and lipase comes from the pancreas in all biliary diseases;pancreaticobiliary relfux is the predominant source in the common bile duct cyst group and duodenal-biliary relfux is responsible for the ductal pigment stone group.

  11. Lubiprostone Stimulates Duodenal Bicarbonate Secretion in Rats

    OpenAIRE

    Mizumori, Misa; Akiba, Yasutada; Kaunitz, Jonathan D.

    2009-01-01

    Background Lubiprostone, a bicyclic fatty acid, is used for the treatment of chronic constipation. No published study has addressed the effect of lubiprostone on intestinal ion secretion in vivo. Aim The aim of this study was to test the hypothesis that lubiprostone augments duodenal HCO3 − secretion (DBS). Methods Rat proximal duodenal loops were perfused with pH 7.0 Krebs, control vehicle (medium-chain triglycerides), or lubiprostone (0.1–10 μM). We measured DBS with flow-through pH and CO2...

  12. Current status of minimally invasive endoscopicmanagement for Zenker diverticulum

    Institute of Scientific and Technical Information of China (English)

    Alberto Aiolfi; Federica Scolari; Greta Saino; Luigi Bonavina

    2015-01-01

    Surgical resection has been the mainstay of treatment ofpharyngoesophageal (Zenker) diverticula over the pastcentury. Developments in minimally invasive surgeryand new endoscopic devices have led to a paradigmchange. The concept of dividing the septum betweenthe esophagus and the pouch rather than resecting thepouch itself has been revisited during the last threedecades and new technologies have been investigatedto make the transoral operation safe and effective. Theinternal pharyngoesophageal myotomy accomplished through the transoral stapling approach has been shown to effectively relieve outflow obstruction and restore physiological bolus transit in patients with medium size diverticula. Transoral techniques, either through a rigid device or by flexible endoscopy, are gaining popularity over the open surgical approach due the low morbidity, the fast recovery time and the fact that the procedure can be safely repeated. We provide an analysis of the the current status of minimally invasive endoscopic management of Zenker diverticulum.

  13. Asymptomatic Meckel′s diverticulum in adults: Is diverticulectomy indicated?

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    Tauro Leo

    2010-01-01

    Full Text Available Background/Aim: The objective of this study was to estimate the incidence of the Meckel′s diverticulum (MD and to study its clinical profile and surgical outcome, as well as to check whether diverticulectomy is indicated for asymptomatic MD in adults. Materials and Methods: This is a prospective study of 1332 patients who were operated upon for acute abdomen during the period August 1999 to July 2009 in a single surgical unit. Preoperative abdominal ultrasonography and plain x-ray abdomen (erect were done depending on the necessity. These patients were subjected to laparotomy/ appendicectomy depending on the case. A search for MD was done, and if found, surgical resection and analysis by histopathological confirmation of the resected MD were performed. Results: During the operation, this study detected 15 (1.13% patients with MD. In none of these cases, preoperative diagnosis of Meckel′s diverticulitis was made. The age of the patients ranged from 18 to 68 years (mean age, 32.9 years. Out of 15 patients, 9 (60% were males; 6 (40% were females. Seven (46.7% cases were symptomatic due to MD and 8 (53.3% were asymptomatic. One patient presented with hematochezia; 2, with intestinal obstruction due to gangrene of the MD; and 4, with Meckel′s diverticulitis. One patient had duplication of (double Meckel′s diverticulum without any inflammation in both the diverticulae. Histopathological examination of these specimens confirmed 4 cases with inflammation; 2, with gangrene; and 1, with ulcerated gastric mucosa in the MD. Among these, in 2 (13.3% cases there was heterotopic epithelium (ulcerated gastric mucosa- 1, colonic mucosa- 1. Conclusion: We recommend that a search for MD in every case of appendicectomy/ laparotomy done for acute abdomen should be conducted, and if found, Meckel′s diverticulectomy or resection should be performed to avoid secondary complications arising from it.

  14. Anatomohistological characteristics of Meckel's diverticulum in human fetuses

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    Pavlović Snežana

    2008-01-01

    Full Text Available Background/Aim. Meckel's diverticulum (MD is the most frequent anomaly of the small intestine. It appears after incomplete obliteration of the omphalomesenteric or viteline duct which normally obliterates and disappears by the 9th week of gestation. The majority of MD do not give rise to any clinical symptoms and are encounted either incidentally, at examination or intervention, or due to complications which may occur (obstruction, hemorrhagy, rupture, and are described in many clinical reports. The aim of the study was to find out the incidence of MD in fetuses when the development of the alimentary tract is already finished. Methods. The investigation was performed on 150 human fetuses of different sex and gastational age, using microdissection method. The cases with MD were photographed, described, their positions and dimensions were registered. The samples of MD taken for histological investigation were dyed with hematoksilin eosin method. Results. Meckel's diverticulum was found in five fetuses (three male and two female; in one case the fibrous band was found. All of them were located on animesenteric margine of the small intestine at the average distance of 92.5 mm from the ileocecal junction. They were of different shape and dimensions, but of the normal constitution of the small intestine. Conclusion. The incidence of MD was 3.3%, and 4% of all the anomalies of the intestines connected to the disappearance of the viteline duct. It was more frequent in the male, located on antimesenteric margine of the small intestine, at the destination which highly correlated to the age of the fetus. Meckel's diverticule were of different shapes and dimensions but of the typical constitution of the small intestine. .

  15. Duodenal Neoplasms of Gastric Phenotype: An Immunohistochemical and Genetic Study With a Practical Approach to the Classification.

    Science.gov (United States)

    Hida, Risa; Yamamoto, Hidetaka; Hirahashi, Minako; Kumagai, Reiko; Nishiyama, Kenichi; Gi, Toshihiro; Esaki, Motohiro; Kitazono, Takanari; Oda, Yoshinao

    2017-03-01

    Duodenal neoplasm of gastric phenotype (DNGP) is very rare, and details of its histopathologic, genetic, and biological features are still unclear. Frequent gene mutations in GNAS, KRAS, and APC have been reported in pyloric gland adenomas and fundic gland-type neoplasms (initially reported as low-grade adenocarcinomas) of the stomach. Here we retrospectively analyzed 16 cases of extra-ampullary DNGP (benign to malignant), and we examined the mucin immunoprofile and oncogene mutations (GNAS, KRAS, APC, BRAF, and CTNNB1). The 16 DNGPs were histologically classified into adenomas (5 pyloric gland adenomas and 2 foveolar-type adenomas), neoplasms of uncertain malignant potential (NUMPs, n=6), and invasive adenocarcinomas (n=3). NUMPs consisted of slightly atypical epithelial cells with pale, eosinophilic, or basophilic cytoplasm growing in an anastomosing or branching glandular pattern, often with expansive submucosal extension. In contrast to invasive adenocarcinomas, NUMPs lacked significant nuclear irregularity, desmoplastic stromal reaction, lymphovascular invasion, and metastasis; their features were reminiscent of fundic gland-type neoplasms of the stomach. Immunophenotypically, most of NUMPs were predominantly positive for MUC6 with variable expressions of pepsinogen-I, HKATPase, human gastric mucin, and MUC5AC. Molecular analyses revealed the gene mutations of GNAS in 6 (38%) of 16 DNGPs (4 [57%] adenomas, 1 [16%] NUMP, and 1 [33%] invasive adenocarcinoma) and APC in 4 of 15 (27%) DNGPs: no adenomas, 2 (33%) NUMPs, and 2 (67%) invasive adenocarcinomas. BRAF mutation was present in only 1 (16%) NUMP, and KRAS and CTNNB1 mutations were absent. In conclusion, gastric-phenotype adenomas and NUMPs of the duodenum are similar to their counterparts of the stomach, in terms of histologic, genetic, and clinicopathologic features. We propose the term "NUMP" as an intermediate category between adenoma and definitely invasive adenocarcinoma. Our findings may provide novel

  16. Sigmoid colon cancer arising in a diverticulum of the colon with involvement of the urinary bladder: a case report and review of the literature

    OpenAIRE

    Yagi, Yasumichi; Shoji, Yasuhiro; Sasaki, Shozo; Yoshikawa, Akemi; Tsukioka, Yuji; Fukushima, Wataru; Hirosawa, Hisashi; Izumi, Ryohei; Saito, Katsuhiko

    2014-01-01

    Background Colon cancer can arise from the mucosa in a colonic diverticulum. Although colon diverticulum is a common disease, few cases have been previously reported on colon cancer associated with a diverticulum. We report a rare case of sigmoid colon cancer arising in a diverticulum with involvement of the urinary bladder, which presented characteristic radiographic images. Case presentation A 73-year-old man was admitted to our hospital for macroscopic hematuria. Computed tomography and ma...

  17. Duodenal Intracellular Bicarbonate and the 'CF Paradox'

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    Kaunitz JD

    2001-07-01

    Full Text Available HCO(3(- secretion, which is believed to neutralize acid within the mucus gel, is the most studied duodenal defense mechanism. In general, HCO(3(- secretion rate and mucosal injury susceptibility correlate closely. Recent studies suggest that luminal acid can lower intracellular pH (pH(i of duodenal epithelial cells and that HCO(3(- secretion is unchanged during acid stress. Furthermore, peptic ulcers are rare in cystic fibrosis (CF, although, with impaired HCO(3(- secretion, increased ulcer prevalence is predicted, giving rise to the 'CF Paradox'. We thus tested the hypothesis that duodenal epithelial cell protection occurs as the result of pH(i regulation rather than by neutralization of acid by HCO(3(- in the pre-epithelial mucus. Cellular acidification during luminal acid perfusion, and unchanged HCO(3(- secretion during acid stress are inconsistent with pre-epithelial acid neutralization by secreted HCO(3(-. Furthermore, inhibition of HCO(3(- secretion by 5-nitro-2-(3-phenylpropylamino benzoic acid (NPPB despite preservation of pH(i and protection from acid-induced injury further question the pre-epithelial acid neutralization hypothesis. This decoupling of HCO(3(- secretion and injury susceptibility by NPPB (and possibly by CF further suggest that cellular buffering, rather than HCO(3(- exit into the mucus, is of primary importance for duodenal mucosal protection, and may account for the lack of peptic ulceration in CF patients.

  18. Duodenal organ injury severity (OIS) and outcome.

    Science.gov (United States)

    Kline, G; Lucas, C E; Ledgerwood, A M; Saxe, J M

    1994-07-01

    The effect of organ injury severity on outcome was assessed in 101 patients treated for duodenal trauma. Most patients were men (89%) and victims of penetrating wounds (93%). Grade I is minor hematoma or incomplete perforation; Grade II is major hematoma or small complete perforation; Grade III is large perforation excluding ampulla; Grade IV is large perforation at ampulla; Grade V is duodenopancreatic crunch. The injuries were as follows: Grade I (5 patients), Grade II (31), Grade III (40), Grade IV (12), and Grade V (13). Fourteen patients exsanguinated from associated vessel injury; each had Grade IV or Grade V injury. All 36 patients with Grade I and Grade II injury had primary repair; the single death was due to liver necrosis. Most (31 patients) Grade III injuries and three Grade IV injuries were treated by primary repair alone; the three deaths were unrelated to the duodenal injury. Other major injuries were treated by duodenal exclusion (4 patients), duodenal diverticulization (6), or resection (4); the single death was unrelated to the duodenum. Primary closure is favored for minor injuries and most Grade III injuries. Severe injuries may require exclusion, diverticulization, or resection.

  19. Endoscopic biopsy: Duodenal ulcer penetrating into liver

    Institute of Scientific and Technical Information of China (English)

    Baybora Kircali; Tülay Saricam; Aysegul Ozakyol; Eser Vardareli

    2005-01-01

    @@ TO THE EDITOR We have read with interest the recent report by E Kayacetin and S Kayacetin of Gastric ulcer penetrating to liver diagnosed by endoscopic biopsy[1] since we diagnosed the duodenal ulcer which penetrated into liver similarly. This is a rather unusual case because of the fifth case in the literature and responding to medical therapy.

  20. Duodenal Amyloidosis Masquerading as Iron Deficiency Anemia

    Science.gov (United States)

    Hurairah, Abu

    2016-01-01

    The present study is a unique illustration of duodenal amyloidosis initially manifesting with iron deficiency anemia. It underscores the importance of clinical suspicion of amyloidosis while performing upper gastrointestinal endoscopy with a biopsy to establish the definite diagnosis in patients with unexplained iron deficiency anemia. PMID:27625911

  1. A giant colonic diverticulum presenting as a 'phantom mass': a case report

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    Abdelrazeq Ayman S

    2009-01-01

    Full Text Available Abstract Introduction Diverticulosis coli is the most common disease of the colon in Western countries. Giant colonic diverticulum, defined as a colonic diverticulum measuring 4 cm in size or larger, represents an unusual manifestation of this common clinical entity. Case presentation A 68-year-old Caucasian British woman with a history of intermittent lower abdominal mass, leg swelling and focal neurological symptoms underwent extensive non-diagnostic investigations over a significant period under a number of disciplines. The reason for a diagnosis being elusive in part related to the fact that the mass was never found on clinical and ultrasound examination. As a result, the patient's validity was questioned. Ultimately, this 'phantom-mass' was diagnosed as a giant colonic diverticulum causing intermittent compression of the iliac vein and obturator nerve. Conclusion Intermittent compression of the iliac vein and the obturator nerve by a colonic diverticulum has not previously been reported. A giant colonic diverticulum presenting as an intermittent mass is very rare. This case also illustrates two factors. First, the patient is often right. Second, the optimal mode of investigation for any proven or described abdominal mass with referred symptoms is cross-sectional imaging, typically a computed tomography scan, irrespective whether the mass or symptoms are constant or intermittent.

  2. Urethral Diverticulum Masquerading as Anterior Vaginal Wall Cyst: A Diagnostic Dilemma

    Science.gov (United States)

    Kaur, Gurpreet; Sharma, Abha; Suneja, Amita; Guleria, Kiran

    2015-01-01

    Urethral diverticulum (UD) is a condition in which a variably sized outpouching forms, next to the urethra. Because it connects to the urethra, this outpouching repeatedly gets filled with urine during micturition, thus causing symptoms. In females, it presents as a bulge in anterior vagina, mimicking a vaginal wall cyst. Various aetiologies proposed attributing to urethral diverticulum formation is repeated infection of the periurethral gland, childbirth trauma, iatrogenic and urethral instrumentation. Patients of UD present with non specific irritative lower urinary tract symptoms such as increased frequency, urgency and dysuria; symptoms may not correlate with the size of the diverticulum. Recurrent cystitis or urinary tract infection is seen in one-third of patients. Pain, hematuria, post-void dribbling, dyspareunia, urinary retention or incontinence is other symptoms. In some cases, there may be associated urethral calculi or carcinoma. Magnetic resonance imaging (MRI) is highly sensitive and specific for the diagnosis of UD, although non invasive sonography may be the first line investigation. Treatment is by transvaginal diverticulectomy or marsupialization. A 60-year-old P9L6 postmenopausal lady, presented with a tender, hard suburethral anterior vaginal wall mass. Cystourethroscopy revealed a small opening in posterior urethra, with stone visible through it. With the final diagnosis of suburethral diverticulum with retained multiple calculi, excision of the diverticulum and repair of urethra was done vaginally. Correct evaluation and treatment of this condition can lead to avoidance of urinary tract injury. PMID:26557574

  3. Metastatic Pulmonary Adenocarcinoma 6 Years After Curative Resection for Ampullary Adenocarcinoma. Metastatic Disease from Initial Primary or Metachronous Tumour?

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    Alexandros Giakoustidis

    2011-01-01

    Full Text Available Context With patients surviving longer after pancreatic resection, the challenges now is the management of the unresolved longerterm issues. Case report A 53-year-old woman with painless obstructive jaundice, underwent a pylorous preserving pancreaticoduodenectomy for a pT3N0M0 ampullary adenocarcinoma in 2001 (patchy chronic pancreatitis with mucinous metaplasia of background pancreatic duct epithelium and acinar atrophy were noted. Despite adjuvant chemotherapy, at month 54 she required a pulmonary wedge resection for metastatic adenocarcinoma, followed by a pulmonary relapse at 76 months when she underwent 6 neoadjuvant cycles of gemcitabine/capecitabine and a left pneumonectomy. Finally 7 years after the initial Whipple’s, a single 18F fluorodeoxyglucose (FDG avid pancreatic tail lesion led to completion pancreatectomy for a well-differentiated ductal adenocarcinoma with clear resection margins albeit peripancreatic adipose tissue infiltration. On review all resected tumour cells had identical immunophenotype (CK7+/CK20-/MUC1+/MUC2- as that of the primary. She is currently asymptomatic on follow-up. Conclusions These findings suggest that in selected cases even in the presence of pulmonary metastasis, repeat resections could result in long-term survival of patients with metachronous ampullary cancer. Second, even ampullary tumours maybe should be regarded as index tumors in the presence of ductal precursor lesions in the resection specimen. Three distant metastases, particularly if long after the initial tumour, should instigate a search for metachronous tumour, especially in the presence of field change in the initial specimen. Risk-adapted follow-up protocols with recognition of such factors could result in cost-effective surveillance and potentially improved outcomes.

  4. Endoscopic treatment of duodenal varices with cyanoacrylate

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    Ana Mora-Soler

    2013-12-01

    Full Text Available Background: the duodenum is the most common location for ectopic varices. Bleeding is rare, but when it appears, it is massive and difficult to control. Material and methods: retrospective description of five clinical cases of digestive bleeding secondary to duodenal varices that we observed between the years 2011 and 2012, together with their clinical characteristics, endoscopic diagnosis, endoscopic treatment with cyanoacrylate injection and the posterior follow-up and assessment of new bleeding. Results: all five patients were treated with an endoscopic cyanoacrylate injection and two of the patients experienced a digestive rebleeding. Three of the patients died during the follow-up period, only one due to cause digestive bleeding. Conclusion: in conclusion we can state that endoscopic treatment of duodenal varices with cyanoacrylate is technically possible, and it permits us to control the first bleeding before doing other definitive treatments, if the patient condition allows it.

  5. ArterioVenous Malformation within Jejunal Diverticulum: An Unusual Cause of Massive Gastrointestinal Bleeding

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    Jeffrey K. Lee

    2009-01-01

    Full Text Available Massive gastrointestinal (GI bleeding can occur with multiple jejunal diverticulosis. However, significant bleeding in the setting of few diverticulae is very unusual and rare. We report a case of massive gastrointestinal bleeding from an arteriovenous malformation (AVM within a jejunal diverticulum to underscore the significance of such coexisting pathologies. Mesenteric angiogram was chosen to help identify the source of bleeding and to offer an intervention. Despite endovascular coiling, emergent intestinal resection of the bleeding jejunal segment was warranted to ensure definitive treatment. However several reports have shown jejunal diverticulosis as a rare cause of massive GI bleeding. The coexistence of jejunal diverticulum and AVM is rare and massive bleeding from an acquired Dieulafoy-like AVM within a diverticulum has never previously been described. Awareness of Dieulafoy-like AVM within jejunoileal diverticulosis is useful in preventing delay in treatment.

  6. Congenital Left Ventricular Diverticulum Associated with ASD, VSD, and Epigastric Hernia

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    Seyed Mohammad Dalili

    2008-12-01

    Full Text Available Congenital left ventricular diverticulum is a rare cardiac malformation. Two categories of congenital ventricular diverticulum have been identified with regard to their localization: apical and non-apical. Apical diverticula are always associated with midline thoraco-abdominal defects and other heart malformations. Non-apical diverticula are always isolated defects. Diagnosis is established by imaging studies such as echocardiography, magnetic resonance imaging, or left ventricular angiography. Mode of treatment has to be individually tailored and depends on clinical presentation, accompanying abnormalities, and possible complications. We report a 10-month-old girl with left ventricular apical diverticulum, large atrial septal defect, two small muscular ventricular septal defects, and pulmonary hypertension, associated with epigastric hernia. This patient underwent total surgical repair for intra-cardiac defects as well as diverticular resection.

  7. Sigmoid Resection with Primary Anastomosis for Uncomplicated Giant Colonic Diverticulum : a Report of two Cases.

    Science.gov (United States)

    Mahieu, J; Mansvelt, B; Veys, E

    2014-01-01

    Giant colonic diverticulum (GCD) is a rare complication of colonic diverticulosis. A small number of cases has been reported in the literature. Patients with GCD have often few non-specific symptoms. Unfortunately, severe complications exist and may lead to surgical acute abdomen. Therefore, this complication of the diverticular disease must be known and properly treated. There is no gold standard diagnostic test, but an air-fluid or air-filled, rounded, pseudocystic image in relation with the colonic wall in a patient with colonic diverticula should suggest this diagnosis to the clinician. We report two cases of a 70-year-old male patient and a 44-year-old female patient having a giant sigmoid diverticulum. The treatment of choice of an uncomplicated GCD is an elective colonic resection, including the giant -diverticulum, with primary anastomosis ; while in case of complicated GCD (peritonitis, abscess or complex fistula), a two-stage resection should be considered.

  8. Presumed appendiceal abscess discovered to be ruptured Meckel diverticulum following percutaneous drainage

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Jeannie C.; Ostlie, Daniel J. [Children' s Mercy Hospital, Department of Surgery, Kansas City, MO (United States); Rivard, Douglas C.; Morello, Frank P. [Children' s Mercy Hospital, Department of Radiology, Kansas City, MO (United States)

    2008-08-15

    A Meckel diverticulum is an embryonic remnant of the omphalomesenteric duct that occurs in approximately 2% of the population. Most are asymptomatic; however, they are vulnerable to inflammation with subsequent consequences including diverticulitis and perforation. We report an 11-year-old boy who underwent laparoscopic appendectomy for perforated appendicitis at an outside institution. During his convalescence he underwent percutaneous drainage of a presumed postoperative abscess. A follow-up drain study demonstrated an enteric fistula. The drain was slowly removed from the abdomen over a period of 1 week. Three weeks following drain removal the patient reported recurrent nausea and abdominal pain. A CT scan demonstrated a 3.7-cm rim-enhancing air-fluid level with dependent contrast consistent with persistent enteric fistula and abscess. Exploratory laparoscopy was performed, at which time a Meckel diverticulum was identified and resected. This case highlights the diagnostic challenge and limitations of conventional radiology in complicated Meckel diverticulum. (orig.)

  9. Intussusception obstruction secondary for Meckel’s diverticulum invaginated. Case report.

    Directory of Open Access Journals (Sweden)

    Paola Muñoz H.

    2013-04-01

    Full Text Available INTRODUCTION: Intestinal intussusception occurs when a segment of bowel and mesentery invaginate in the light of an adjacent intestinal segment. Intussusception accounts for 1% of all cases of intestinal obstruction in adults. Most intussusceptions occurs in children, occurring only 5% in the adult. Meckel’s diverticulum is considered the most common congenital anomalies of the intestinal tract affecting 2% to 3% of the general population to be even rarer intussusception resulting from it. CASE REPORT: We report a case of an 8 years old children with a bowel obstruction secondary to complicated Meckel’s diverticulum, surgical repair with preoperative diagnosis. DISCUSSION: The ileo-ileal intussusception by an invaginated Meckel’s diverticulum is also something very uncommon for the patient’s age”.

  10. Obscure Gastrointestinal Bleeding from an Ampullary Tumour in a Patient with a Remote History of Renal Cell Carcinoma: A Diagnostic Conundrum

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    Rhonda M Janzen

    1998-01-01

    Full Text Available Metastasis of renal cell carcinoma to the ampulla of Vater is a rare occurrence. The outlined case, which presented as an upper gastrointestinal bleed, is only the eighth such reported case in the English-language literature. This case is the longest reported time interval between surgical nephrectomy to presentation with ampullary metastasis at 17.5 years. The ampullary source of bleeding in this case was initially obscure and missed by conventional gastroscopy. Diagnosis was made with a side-viewing endoscope, emphasizing the usefulness of this instrument in the investigation of active bleeding from a small bowel source.

  11. Duodenal Perforation Precipitated by Scrub Typhus

    OpenAIRE

    Raghunath Rajat; David Deepu; Arul Jeevan Jonathan; Abhilash Kundavaram Paul Prabhakar

    2015-01-01

    Scrub typhus is an acute febrile illness usually presenting with fever, myalgia, headache, and a pathognomonic eschar. Severe infection may lead to multiple organ failure and death. Gastrointestinal tract involvement in the form of gastric mucosal erosions and ulcerations owing to vasculitis resulting in gastrointestinal bleeding is common. This process may worsen a pre-existent asymptomatic peptic ulcer, causing duodenal perforation, and present as an acute abdomen requiring surgical explora...

  12. Duodenal damage complicating percutaneous access to kidney

    OpenAIRE

    Antonio Corrêa Lopes Neto; Marcos Tobias-Machado; Roberto Vaz Juliano; Marco Aurélio Lipay; Milton Borrelli; Eric Roger Wroclawski

    2000-01-01

    CONTEXT: Since the first percutaneous nephrostomy performed by Goodwin in 1954, technical advances in accessing the kidneys via percutaneous puncture have increased the use of this procedure and thus the complications too. Among these complications, digestive tract damage is not common. DESIGN: Case report. CASE REPORT: We report a duodenal lesion that was corrected using surgical exploration and we touch on the therapeutic options, which may be conservative or interventionist. We chose conse...

  13. Portal hypertensive duodenal polyp: A case report

    Institute of Scientific and Technical Information of China (English)

    Jean-David Zeitoun; Ariane Chryssostalis; Benoit Terris; Frederic Prat; Marianne Gaudric; Stanislas Chaussade

    2007-01-01

    Abnormalities of gastric mucosa in patients with portal hypertension are well documented. Manifestations of portal hypertension in small bowel and colon are less common. Colonic polypoid lesions microscopically consisting of a normal mucosa, with dilatation of submucosal vessels, have been described. We here report the first case of portal hypertensive duodenal polyp, responsible for gastro-intestinal bleeding.Endoscopic treatment turned out to be successful.

  14. An experimental study on a function of the cupula. Effect of cupula removal on the ampullary nerve action potential.

    Science.gov (United States)

    Suzuki, M; Harada, Y; Sugata, Y

    1984-01-01

    We used a posterior semicircular canal that had been isolated from a frog. From the utricular side the ampulla was cut open at a position one third of the way along the long axis. The cupula was removed through this opening using a glass micropipette. The action potential from the posterior ampullary nerve was recorded before and after removal of the cupula. After removal, the action potential disappeared almost completely. When the cupula was put back on the crista, the action potential was restored. When the cupula was put back upside down, the action potential recovered, but to a lesser extent.

  15. Concentrations and contractile effects of substance P in the human ampullary-isthmic junction.

    Science.gov (United States)

    Forman, A; Andersson, K E; Maigaard, S; Ulmsten, U

    1985-05-01

    From 20 women undergoing hysterectomy, strip preparations were isolated from the outer, longitudinal and the inner, circular smooth muscle layer of the ampullary-isthmic junction (AIJ), together with small arterial segments dissected as ring preparations from the root of the mesosalpinx. The specimens were mounted in organ baths and isometric tension was recorded. In addition, tissue concentrations of substance P (SP) in the ampulla, AIJ and utero-tubal junction were determined by radioimmunoassay. Tissue concentrations of SP expressed as pmol X g tissue-1 (wet weight, +/- SE) amounted to 3.09 +/- 1.40 in the utero-tubal junction, 1.08 +/- 0.299 in the AIJ and 0.742 +/- 0.299 in the ampulla. In strips of circular muscle, SP at concentrations of 10(-7) -3 X 10(-6) mol X l-1 elicited a combined phasic and tonic response and in longitudinal muscle a mainly tonic contraction was produced. In both tissues, contractions elicited by SP were rapidly abolished in calcium-free medium. Nifedipine abolished the phasic contraction elicited in circular muscle by SP while the tonic response was resistant. The contraction in longitudinal muscle was reduced by 20-30%. Vasoactive intestinal polypeptide (VIP) decreased tension in preparations contracted by SP, prostaglandin F2 alpha and K+-depolarization (124 mmol X l(-1). In unstimulated oviductal arterial preparations, SP had no effect, while the peptide induced a transient relaxation of noradrenaline contracted preparations, and slightly decreased tension of K+-depolarized vessels. The results suggest that SP may be involved in the control of motility of the human AIJ.

  16. Crista egregia: a geometrical model of the crista ampullaris, a sensory surface that detects head rotations.

    Science.gov (United States)

    Marianelli, Prisca; Berthoz, Alain; Bennequin, Daniel

    2015-02-01

    The crista ampullaris is the epithelium at the end of the semicircular canals in the inner ear of vertebrates, which contains the sensory cells involved in the transduction of the rotational head movements into neuronal activity. The crista surface has the form of a saddle, or a pair of saddles separated by a crux, depending on the species and the canal considered. In birds, it was described as a catenoid by Landolt et al. (J Comp Neurol 159(2):257-287, doi: 10.1002/cne.901590207 , 1972). In the present work, we establish that this particular form results from principles of invariance maximization and energy minimization. The formulation of the invariance principle was inspired by Takumida (Biol Sci Space 15(4):356-358, 2001). More precisely, we suppose that in functional conditions, the equations of linear elasticity are valid, and we assume that in a certain domain of the cupula, in proximity of the crista surface, (1) the stress tensor of the deformed cupula is invariant under the gradient of the pressure, (2) the dissipation of energy is minimum. Then, we deduce that in this domain the crista surface is a minimal surface and that it must be either a planar, or helicoidal Scherk surface, or a piece of catenoid, which is the unique minimal surface of revolution. If we add the hypothesis that the direction of invariance of the stress tensor is unique and that a bilateral symmetry of the crista exists, only the catenoid subsists. This finding has important consequences for further functional modeling of the role of the vestibular system in head motion detection and spatial orientation.

  17. Severe Hemoperitoneum Following Rupture of Uterine Diverticulum due to Pregnancy: a Case Report

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    Yaghmaei Minoo

    2009-06-01

    Full Text Available Uterovaginal malformations, occur in 0.16% of women and contribute to the problems of infertility, recurrent pregnancy loss, dysmenorrhea, dyspareunia, amenorrhea and a poor outcome in pregnancy. True diverticulum is an exceedingly rare anomaly and is like a tubular formation connected to uterine cavity that ends in a cul-de sac and It is not classified as any of mullerian duct anomalies. In this article a case of uterine diverticulum rupture due to pregnancy in a 19 years old woman with nausea, vomiting and abdominal pain is reported. Although rare, in complicated pregnancy we should think to genital tract anomalies.

  18. Early colon cancer within a diverticulum treated by magnifying chromoendoscopy and laparoscopy

    Institute of Scientific and Technical Information of China (English)

    Kuang; I; Fu; Yukihiro; Hamahata; Yasunobu; Tsujinaka

    2010-01-01

    We report a unique case of intramucosal carcinoma in a tubulovillous adenoma arising from a single diverticulum.Endoscopic mucosal resection(EMR)was carried out successfully and completely with the assistance of laparoscopy.A 71-year-old man was admitted to our hospital because of melena and anemia.Emergent colonoscopy showed diverticulosis in the right-sided colon.However,endoscopy could not exactly detect the bleeding site.A flat elevated polyp was found within a single diverticulum located in the descend...

  19. Isolated congenital cardiac diverticulum originating from the left ventricular apex: Report of a pediatric case

    Directory of Open Access Journals (Sweden)

    Fahrettin Uysal

    2016-01-01

    Full Text Available Congenital ventricular diverticulum is a rare cardiac anomaly defined as a localized protrusion of the ventricular free wall. Although, it is usually asymptomatic, complications such as embolism, infective endocarditis, and arrhythmias can occur. The diagnosis can be made by echocardiography, cardiac magnetic resonance imaging, or catheter angiography. Surgical resection is the treatment of choice in symptomatic patients, whereas the management of asymptomatic patients often represents a therapeutic dilemma. We report here, a 9-month-old patient with asymptomatic congenital left ventricular (LV diverticulum associated with epigastric hernia.

  20. Giant bladder diverticulum: A rare cause of bladder outlet obstruction in children

    Directory of Open Access Journals (Sweden)

    William Appeadu-Mensah

    2012-01-01

    Full Text Available Giant bladder diverticula are rare causes of bladder outlet obstruction in children and have rarely been reported. [1] In this paper, we present three children with giant bladder diverticula who presented with bladder outlet obstruction within a year. Micturating cystourethrogram is important for investigating bladder outlet obstruction in children and was used to confirm the diagnosis in all the patients. The relationship between the diverticula and ureters varied, with the ureters running either through the wall of the diverticulum and opening directly into the bladder, or opening into the diverticulum. In one patient, there was a recurrence, which was excised successfully. Excision is important to reduce the risk of recurrence.

  1. DRAGSTEDT, GASTRIC-ACID AND DUODENAL-ULCER

    OpenAIRE

    Hobsley, M.

    1994-01-01

    Dragstedt believed that basal hypersecretion of gastric acid was the root cause of duodenal ulcer, that the hypersecretion was due to an increased vagal stimulation, and that vagotomy would therefore cure duodenal ulcer. He introduced vagotomy and demonstrated that the operation was successful in curing most patients of their duodenal ulcers. This article reviews how further research in the succeeding half century has demonstrated that it is the effect of vagotomy on stimulated, rather than u...

  2. Russell body duodenitis with immunoglobulin kappa lightchain restriction

    Institute of Scientific and Technical Information of China (English)

    William R Munday; Lucy Harn Kapur; Mina Xu; Xuchen Zhang

    2015-01-01

    Russell bodies are eosinophilic intracytoplasmicglobules which are likely the result of disturbedsecretion of immunoglobulins that accumulate withinthe plasma cell. Russell body collections have beenidentified within the stomach, known as Russellbody gastritis. Similar lesions within the duodenumare referred to as Russell body duodenitis, whichis rare. Several Russell body gastritis case reportsare associated with Helicobacter pylori . However,the etiology of Russell body duodenitis remainsunclear. Here we report the first case of Russell bodyduodenitis with immunoglobulin light chain restrictionin a background of peptic duodenitis.

  3. [Piracetam in combined pathogenetic therapy of recurrent duodenal ulcer].

    Science.gov (United States)

    Tsimmerman, Ia S; Shchetkin, D I

    2002-01-01

    Duodenal ulcer cure, as a systemic gastroenterologic disease, can be achieved in some patients by the addition of the nootropic drug piracetam to current antisecretory and antihelicobacter therapy. Piracetam corrects vegetative and psychoemotional disorders in duodenal ulcer, normalizes gastric motility, has an antioxidant effect and improves cerebral circulation. An optimal effect on clinico-endoscopic manifestations of recurrent duodenal ulcer was achieved in combination of piracetam with current antisecretory (omeprazole) and antihelicobacter (de-nol, amoxicillin, metronidazole) medicines. Such combination improves both short- and long-term outcomes of duodenal ulcer treatment.

  4. Diagnosis and treatment of 34 cases of blunt duodenal injuries

    Institute of Scientific and Technical Information of China (English)

    BAO Shi-ting; WANG San-ming

    2007-01-01

    Objective: To summarize the experience on diagnosis and treatment of blunt duodenal injuries, and thus to improve the therapeutic skills. Methods: Clinical data of 34 cases of blunt duodenal injuries admitted to our hospital from 1990 to 2006 were retrospectively analyzed. Results: Among them, 28 cases were cured, 20 cases presented with complications, and 6 cases died. The causes of death were: duodenal or pancreatic fistula in 2 cases, intra- and retroperitoneal infection complicating septicopyemia in 2, disseminated intravascular coagulation in 1 and multiple organ failure in 1. Conclusions: Misdiagnosis and missed diagnosis predispose to happen for blunt duodenal injuries. Early recognition and surgical intervention are critical to a successful rescue.

  5. An experimental study on the physical properties of the cupula. Effect of cupular sectioning on the ampullary nerve action potential.

    Science.gov (United States)

    Suzuki, M; Harada, Y; Kishimoto, A

    1985-01-01

    The frog posterior semicircular canal (PSC) was isolated and a part of the ampullary wall was cut to allow removal of the cupula from the crista. The cupula was replaced on the crista and the PSC ampullary action potential was recorded. The cupula was again removed and was sectioned in half, either in the plane vertical to the crista (vertical sectioning), or in the plane parallel to the crista (horizontal sectioning). The sectioned half of the cupula was then replaced on the crista. The action potentials after replacement of the vertical or horizontal segments of the cupula were compared to those achieved when the entire cupula was replaced. After vertical sectioning, the action potentials were significantly reduced; they were 50.3% of the completely replaced cupula when a small stimulus was used and 79.1% when a large stimulus was used. A reduced attachment surface between the cupular base and the crista is possibly responsible for the decreased action potential in the vertically sectioned specimen. After horizontal sectioning, the action potentials were 64.5% for the small stimulus and 108.2% for the large stimulus. These results indicate that elicited responses are related to the height of the cupula and the deflection angle. This further suggests that the movement of the cupula is represented by that of the elastic system.

  6. Total Pancreatectomy and Islet Auto-Transplantation as Treatment for Ampullary Adenocarcinoma in the Setting of Pancreatic Ductal Disruption Secondary to Acute Necrotizing Pancreatitis. A Case Report

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    Uroghupatei P Iyegha

    2012-03-01

    Full Text Available Context Ampullary adenocarcinoma is the third most common periampullary malignancy. Obstruction of the main pancreatic duct is linked with an increased incidence of acute pancreatitis. Acute necrotizing pancreatitis leading to pancreatic duct disruption carries significant morbidity. When these conditions occur in combination, the treatment can be drastically limited as pancreaticoduodenectomy is not a viable option in the setting of friable ductal tissue, which precludes pancreatic ductal anastomosis and can lead to the complications of leak or stricture. Case report Our patient is a 72-year-old woman who developed pancreatic ductal disruption and splenic vein thrombosis as a result of acute necrotizing pancreatitis. Concurrently, she was found to have an ampullary adenoma with high-grade dysplasia. Her treatment options were limited, as she was neither a candidate for pancreaticoduodenectomy given the ductal disruption nor total pancreatectomy, which would render her a brittle diabetic. She was successfully treated with total pancreatectomy and islet auto-transplantation thereby resecting her ampullary lesion while both avoiding a pancreatic anastomosis and preserving pancreatic endocrine beta-cell function. Conclusion We report a case where total pancreatectomy and islet auto-transplantation can be considered as a viable option for treatment of ampullary lesions in a setting where standard surgical options are suboptimal.

  7. [Acute retention of urine secondary to a congenital diverticulum of the bladder].

    Science.gov (United States)

    Azahouani, A; Hida, M; Lasseri, A; Lahfaoui, M; Zaari, N; Belahcen, M; Elazzouzi, D; Benhaddou, H

    2016-10-01

    Bladder diverticula in children are mostly congenital, frequently associated with vesicoureteral reflux. Their positive diagnosis is based primarily on retrograde urethrocystography. One complication of this condition is acute urinary retention. We report the case of a 4-month-old infant who presented acute retention of urine secondary to bilateral congenital bladder diverticulum and review the literature on this subject.

  8. Helicobacter species and gut bacterial DNA in Meckel's diverticulum and the appendix

    Institute of Scientific and Technical Information of China (English)

    Peren H Karagin; Unne Stenram; Torkel Wadstr(o)m; (A)sa Ljungh

    2011-01-01

    AIM: To analyse the possible association of various Helicobacter species and certain common gut bacteria in patients with Meckel's diverticulum and appendicitis. METHODS: A nested-polymerase chain reaction (PCR), specific to 16S rRNA of the Helicobacter genus, was performed on paraffin embedded samples, 50 with acute appendicitis, 50 normal appendixes, and 33 Meckel's diverticulum with gastric heterotopia and/or ulcer. Helicobacter genus positive samples were sequenced for species identification. All samples were also analysed for certain gut bacteria by PCR. RESULTS: Helicobacter pullorum DNA was found in one out of 33 cases and Enterobacteria in two cases of Meckel's diverticulum. Helicobacter pylori (H. pylori ) was found in three, Enterobacter in 18, and Bacteroides in 19 out of 100 appendix samples by PCR. Enterococcus was not found in any MD or appendix samples. All H. pylori positive cases were from normal appendixes. CONCLUSION: Helicobacter is not an etiological agent in the pathogenesis of symptomatic Meckel's diverticulum or in acute appendicitis.

  9. A Rare Cause of Recurrent Urinary Tract Infections, Female Urethral Diverticulum: A Case Report

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    Taha Numan Yikilmaz

    2014-02-01

    Full Text Available A female urethral diverticulum is an uncommon pathologic entity. The most presentation of urethral diverticule has been described as lower urinary tract symptoms and dyspareunia. The case of female is presented, who consult with a vaginal mass and dyspareunia and current literature was reviewed.

  10. Mesonephroid adenocarcinoma in urethral diverticulum treated with diverticulectomy. Case report and review of the literature

    DEFF Research Database (Denmark)

    Jacobsen, F; Sørensen, Flemming Brandt; Nielsen, J B;

    1989-01-01

    A case of mesonephroid adenocarcinoma in an urethral diverticulum treated with diverticulectomy in a 53 year old female is reported. To our knowledge 26 cases of similar tumours have been reported in the literature. A review of symptoms, management and possible relationship to nephroid metaplasia...

  11. Feasibility of transapical aortic valve replacement through a left ventricular apical diverticulum

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    Ferrari Enrico

    2013-01-01

    Full Text Available Abstract Transapical aortic valve replacement is an established technique performed in high-risk patients with symptomatic aortic valve stenosis and vascular disease contraindicating trans-vascular and trans-aortic procedures. The presence of a left ventricular apical diverticulum is a rare event and the treatment depends on dimensions and estimated risk of embolisation, rupture, or onset of ventricular arrhythmias. The diagnosis is based on standard cardiac imaging and symptoms are very rare. In this case report we illustrate our experience with a 81 years old female patient suffering from symptomatic aortic valve stenosis, respiratory disease, chronic renal failure and severe peripheral vascular disease (logistic euroscore: 42%, who successfully underwent a transapical 23 mm balloon-expandable stent-valve implantation through an apical diverticulum of the left ventricle. Intra-luminal thrombi were absent and during the same procedure were able to treat the valve disease and to successfully exclude the apical diverticulum without complications and through a mini thoracotomy. To the best of our knowledge, this is the first time that a transapical procedure is successfully performed through an apical diverticulum.

  12. [Duodenal complications of rheumatoid purpura. Endoscopic aspects].

    Science.gov (United States)

    Chapoy, P; Guidon, M J; Louchet, E

    1984-01-01

    The aim of this work was to describe the endoscopic features and clinical outcome of the duodenal complications in anaphylactoid purpura. Over a 3-year period, 20 patients were hospitalized in our unit because of purpura rheumatica. Duodenal complications occurred in 5 cases warranting endoscopic assessment. All patients had bilious vomiting and epigastric pain, constantly associated with low-grade purpuric rash. Plasma factor XIII concentrations were always decreased. The duodenal complication was suspected radiologically in 2 cases when "thumbprint" impressions were seen. Petechiae, oedema and intramural hematoma with superficial erosions were present endoscopically in 3 cases. The lesions were severe and extensive, involving the entire duodenum in 3 cases and the jejunum in one case. In one patient, there was a stricture of the upper part of the second duodenum. Treatment consisted of parenteral nutrition (using a central catheter: 3 cases, or a peripheral vein: 2 cases) and cimetidine (30 mg/kg.bw). The clinical outcome was favorable in 4 patients; the symptoms vanished and the endoscopic lesions were reversible (including the stricture) with restitutio ad integrum after 10 days. The last patient died the 8th day of treatment, 3 days after digestive improvement; the cause of death was probably iatrogenic and related to accidental migration of the central catheter. These results suggest that endoscopic examination should be performed in all patients with anaphylactoid purpura presenting with bilious vomiting. Endoscopy seems to be of great value in deciding if parenteral nutrition is indicated--or not--and perhaps in order to contraindicate the use of steroid therapy in the case of ulcerated hematomas.

  13. Unusual duodenal perforation following endoscopic retrograde cholangiopancreatography

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    Martin Kobborg

    2011-02-01

    Full Text Available Perforation is a known but rare complication to Endoscopic retrograde cholangiopancreatography (ERCP with endoscopic sphincterotomy (ES. Most of the perforations are located in the periampullary area due to ES. This report presents an unusual perforation in the third part of the duodenum following ES. The patient an eigthy-sixt-year-old man underwent ERCP with ES. The patient had Magnetic Resonance Cholangio-pancreatography (MRCP and Computerized Tomography (CT verified cholelithiasis and intra- and extrahepatic cholestasis. The perforation was not found under the ERCP procedure but was clinically revealed when the patient developed pneumoscrotum after the procedure. A CT-scan with oral contrast later confirmed the duodenal perforation.

  14. Duodenal adenocarcinoma in a 10-year-old boy.

    Science.gov (United States)

    Mohamed, Zouari; Habib, Bouthour; Rabia, Ben Abdallah; Youssef, Hlel; Riath, Ben Malek; Youssef, Gharbi; Nejib, Kaabar

    2014-01-01

    Gastrointestinal malignancies are extremely rare in the paediatric population and duodenal cancers represent an even more unusual entity. It represents 0.3-1% of all gastrointestinal tumours. A case report of a 10-year-old boy with duodenal adenocarcinoma is reported and the difficulties of diagnosing and treating this rare tumour are discussed.

  15. Duodenal adenocarcinoma in a 10-year-old boy

    Directory of Open Access Journals (Sweden)

    Zouari Mohamed

    2014-01-01

    Full Text Available Gastrointestinal malignancies are extremely rare in the paediatric population and duodenal cancers represent an even more unusual entity. It represents 0.3-1% of all gastrointestinal tumours. A case report of a 10-year-old boy with duodenal adenocarcinoma is reported and the difficulties of diagnosing and treating this rare tumour are discussed.

  16. Duodenal pseudolymphoma: A case report and review of literature

    Institute of Scientific and Technical Information of China (English)

    Yong-Heng Huang; Tian-Zhu Long; Zhi-Yu Xiao; Hua Ye; Yun-Le Wan; Jie Wang

    2011-01-01

    We report a rare case of duodenal pseudolymphoma without any symptoms. The lesion located in front of the head of the pancreas was found accidentally during a medical examination. The findings of computed tomography and positron emission tomography-computed tomography suggested a stromal tumor or malignant lymphoma. Surgical resection was performed. The lesions were pathologically diagnosed as duodenal pseudolymphoma.

  17. Presentation and Surgical Management of Duodenal Duplication in Adults

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    Caroline C. Jadlowiec

    2015-01-01

    Full Text Available Duodenal duplications in adults are exceedingly rare and their diagnosis remains difficult as symptoms are largely nonspecific. Clinical presentations include pancreatitis, biliary obstruction, gastrointestinal bleeding from ectopic gastric mucosa, and malignancy. A case of duodenal duplication in a 59-year-old female is presented, and her treatment course is reviewed with description of combined surgical and endoscopic approach to repair, along with a review of historic and current recommendations for management. Traditionally, gastrointestinal duplications have been treated with surgical resection; however, for duodenal duplications, the anatomic proximity to the biliopancreatic ampulla makes surgical management challenging. Recently, advances in endoscopy have improved the clinical success of cystic intraluminal duodenal duplications. Despite these advances, surgical resection is still recommended for extraluminal tubular duplications although combined techniques may be necessary for long tubular duplications. For duodenal duplications, a combined approach of partial excision combined with mucosal stripping may offer advantage.

  18. Retrospective analysis of duodenal injuries: A comprehensive overview

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    Sanjay Pandey

    2011-01-01

    Full Text Available Background/Aim: Duodenal injury is an uncommon finding, accounting for about about 3 - 5% of abdominal trauma, mainly resulting from both penetrating and blunt trauma, and is associated with significant mortality (6 - 25% and morbidity (30 - 60%. Patients and Methods : Retrospective analysis was performed in terms of presentation, management, morbidity and mortality on 14 patients of duodenal injuries out of a total of 172 patients of abdominal trauma attending Subharti Medical College. Results: Epigastric pain (100% along with vomiting (100% is the usual presentation of duodenal injuries in blunt abdominal trauma, especially to the upper abdomen. Computed tomography (CT was diagnostic in all cases. Isolated duodenal injury is a rare finding and the second part is mostly affected. Conclusion: Duodenal injury should always be suspected in blunt upper abdominal trauma, especially in those presenting with epigastric pain and vomiting. Investigation by CT and early surgical intervention in these patients are valuable tools to reduce the morbidity and mortality.

  19. Crouzon’s Syndrome with Life-Threatening Ear Bleed: Ruptured Jugular Vein Diverticulum Treated by Endovascular Embolization

    Energy Technology Data Exchange (ETDEWEB)

    Mondel, Prabath Kumar, E-mail: prabathmondel@gmail.com; Anand, Sunanda, E-mail: sunandaanand@gmail.com; Limaye, Uday S., E-mail: uslkem@gmail.com [Lilavati Hospital and Research Centre, Department of Interventional Neuroradiology (India)

    2015-08-15

    Crouzon’s syndrome is the commonest variety of syndromic craniosynostosis. Life-threatening ear bleed due to ruptured jugular venous diverticulum in Crouzon’s syndrome has not been described previously. In patients with syndromic craniosynostosis, definitive repair of jugular diverticulum by open surgery is fraught with high risk of bleeding, poor functional outcomes, and even death. A 24-year-old woman with Crouzon’s syndrome presented with conductive hearing loss and recurrent episodes of torrential bleeding from her left ear. On computed tomography, a defect in the roof of jugular fossa containing jugular venous diverticulum immediately inferior to the bony external auditory canal was seen. The clinical presentation, imaging features, and endovascular management of Crouzon’s syndrome due to a ruptured jugular venous diverticulum is described.

  20. An unusual case of intraabdominal abscess and acute abdomen caused by axial torsion of a Meckel's diverticulum

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    İhsan Yıldız

    2016-03-01

    Conclusion: Although MD is known as a pediatric disease, it is likely to occur in adults as well. Axial torsion of Meckel's diverticulum should be kept in mind the adults presenting with symptoms of acute abdomen.

  1. Incidental finding of Meckel’s diverticulum in an umbilical hernia in a 60-year-old man

    Directory of Open Access Journals (Sweden)

    Naveed F

    2012-11-01

    Full Text Available Filza Naveed, Daniel Passeri, Aaron IlanoDepartment of Surgery, St Vincent’s Medical Center, Bridgeport, CT, USAAbstract: Meckel’s diverticulum is an outpouching in the wall of the intestine. Although it is the most common congenital abnormality of the gastrointestinal tract, diagnosing and deciding on intervention is often a matter of debate when it presents asymptomatically. A 60-year-old man with an umbilical hernia presented to our institution for elective surgery. A Meckel’s diverticulum was incidentally discovered perioperatively and removed. Although the mortality and risk of complications are low, the surgical team in this case decided to remove the diverticulum to prevent any possible complications from occurring in the future due to its presence.Keywords: Meckel’s diverticulum, umbilical hernia, surgery

  2. Axial torsion as a rare and unusual complication of a Meckel's diverticulum: a case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Seth Jai

    2011-03-01

    Full Text Available Abstract Introduction In 1809, Johann Friedrich Meckel described the embryology of a small bowel diverticulum, which now bears his name. Meckel's diverticulum is the most common congenital abnormality of the gastrointestinal tract, with a prevalence ranging from 1% to 4% of the population. The majority are clinically silent and are incidentally identified at surgery or at autopsy. The lifetime risk of complications is estimated at 4%, with most of these complications occurring in adults. It is these cases that can cause problems for the clinician, as the diagnosis can be elusive and the consequences extremely serious. Case presentation We present the case of a 68-year-old Caucasian man with axial torsion of a Meckel's diverticulum around its base, a rare complication. He presented with acute, severe abdominal pain, and a clinical diagnosis of perforated acute appendicitis was made. Laparotomy revealed a torted Meckel's diverticulum with distal necrosis and perforation, which was resected. His recovery was uncomplicated, and he was discharged to home six days post-operatively. Conclusion Torsion is an extremely rare complication of Meckel's diverticulum. Its presentation can be elusive, and it can mimic a number of different, more common intra-abdominal pathologies. Imaging appears to be an unreliable diagnostic tool, and the diagnosis is usually made intra-operatively. Factors pre-disposing these patients to axial torsion of Meckel's diverticulum include the presence of mesodiverticular bands, a narrow base, excessive length, and associated neoplastic growth or inflammation of the diverticulum. The importance of searching for a diseased Meckel's diverticulum at laparotomy in appropriate circumstances is highlighted. Once identified, prompt surgical excision generally leads to an uncomplicated recovery.

  3. Proton therapy with concomitant capecitabine for pancreatic and ampullary cancers is associated with a low incidence of gastrointestinal toxicity

    Energy Technology Data Exchange (ETDEWEB)

    Nichols, R. Charles Jr.; Huh, Soon; Ho, Meng Wei; Mendenhall, Nancy P.; Morris, Christopher G.; Hoppe, Bradford S. [Univ. of Florida Proton Therapy Inst., Jacksonville (United States)], e-mail: rnichols@floridaproton.org; George, Thomas J.; Zaiden, Robert A. Jr. [Dept. of Hematology and Medical Oncology, Univ. of Florida, Gainesville and Jacksonville (United States); Awad, Ziad T. [Dept. of Surgery, Univ. of Florida, Jacksonville (United States); Asbun, Horacio J. [Dept. of Surgery, Mayo Clinic, Jacksonville (United States)

    2013-04-15

    Background: To review treatment toxicity for patients with pancreatic and ampullary cancer treated with proton therapy at our institution. Material and methods: From March 2009 through April 2012, 22 patients were treated with proton therapy and concomitant capecitabine (1000 mg PO twice daily) for resected (n = 5); marginally resectable (n = 5); and unresectable/inoperable (n = 12) biopsy-proven pancreatic and ampullary adenocarcinoma. Two patients with unresectable disease were excluded from the analysis for reasons unrelated to treatment. Proton doses ranged from 50.40 cobalt gray equivalent (CGE) to 59.40 CGE. Results: Median follow-up for all patients was 11 (range 5-36) months. No patient demonstrated any grade 3 toxicity during treatment or during the follow-up period. Grade 2 gastrointestinal toxicities occurred in three patients, consisting of vomiting (n = 3); and diarrhea (n = 2). Median weight loss during treatment was 1.3 kg (1.75% of body weight). Chemotherapy was well-tolerated with a median 99% of the prescribed doses delivered. Percentage weight loss was reduced (p = 0.0390) and grade 2 gastrointestinal toxicity was eliminated (p = 0.0009) in patients treated with plans that avoided anterior and left lateral fields which were associated with reduced small bowel and gastric exposure. Discussion: Proton therapy may allow for significant sparing of the small bowel and stomach and is associated with a low rate of gastrointestinal toxicity. Although long-term follow-up will be needed to assess efficacy, we believe that the favorable toxicity profile associated with proton therapy may allow for radiotherapy dose escalation, chemotherapy intensification, and possibly increased acceptance of preoperative radiotherapy for patients with resectable or marginally resectable disease.

  4. Duodenal obstruction due to a preduodenal portal vein

    Directory of Open Access Journals (Sweden)

    MNC Vilakazi

    2014-01-01

    Full Text Available An infant presented with clinical signs and symptoms suggestive of a pyloric stenosis. On abdominal ultrasound, pyloric stenosis was excluded, and other causes for proximal duodenal obstruction, such as a duodenal web or annular pancreas, were suspected. At surgery, the cause was found to be due to an anterior portal vein or preduodenal portal vein, compressing the duodenum. There were no associated findings such as midgut malrotation, duodenal web and congenital anomalies. The treatment was a diamond-shaped duodeno-duodenostomy anterior to the portal vein. The patient improved after surgery.

  5. Duodenal bleeding from metastatic renal cell carcinoma.

    Science.gov (United States)

    Rustagi, Tarun; Rangasamy, Priya; Versland, Mark

    2011-04-20

    Massive upper gastrointestinal bleeding due to malignancy is relatively uncommon and the duodenum is the least frequently involved site. Duodenal metastasis is rare in renal cell carcinoma (RCC) and early detection, especially in case of a solitary mass, helps in planning further therapy. We report a case of intractable upper gastrointestinal bleeding from metastatic RCC to the duodenum. The patient presented with melena and anemia, 13 years after nephrectomy for RCC. On esophagogastroduodenoscopy, a submucosal mass was noted in the duodenum, biopsies of which revealed metastatic RCC. In conclusion, metastasis from RCC should be considered in nephrectomized patients presenting with gastrointestinal symptoms and a complete evaluation, especially endoscopic examination followed by biopsy, is suggested.

  6. Thyroid Storm Precipitated by Duodenal Ulcer Perforation

    Directory of Open Access Journals (Sweden)

    Shoko Natsuda

    2015-01-01

    Full Text Available Thyroid storm is a rare and life-threatening complication of thyrotoxicosis that requires prompt treatment. Thyroid storm is also known to be associated with precipitating events. The simultaneous treatment of thyroid storm and its precipitant, when they are recognized, in a patient is recommended; otherwise such disorders, including thyroid storm, can exacerbate each other. Here we report the case of a thyroid storm patient (a 55-year-old Japanese male complicated with a perforated duodenal ulcer. The patient was successfully treated with intensive treatment for thyroid storm and a prompt operation. Although it is believed that peptic ulcer rarely coexists with hyperthyroidism, among patients with thyroid storm, perforation of a peptic ulcer has been reported as one of the causes of fatal outcome. We determined that surgical intervention was required in this patient, reported despite ongoing severe thyrotoxicosis, and reported herein a successful outcome.

  7. Duodenal Bleeding from Metastatic Renal Cell Carcinoma

    Science.gov (United States)

    Rustagi, Tarun; Rangasamy, Priya; Versland, Mark

    2011-01-01

    Massive upper gastrointestinal bleeding due to malignancy is relatively uncommon and the duodenum is the least frequently involved site. Duodenal metastasis is rare in renal cell carcinoma (RCC) and early detection, especially in case of a solitary mass, helps in planning further therapy. We report a case of intractable upper gastrointestinal bleeding from metastatic RCC to the duodenum. The patient presented with melena and anemia, 13 years after nephrectomy for RCC. On esophagogastroduodenoscopy, a submucosal mass was noted in the duodenum, biopsies of which revealed metastatic RCC. In conclusion, metastasis from RCC should be considered in nephrectomized patients presenting with gastrointestinal symptoms and a complete evaluation, especially endoscopic examination followed by biopsy, is suggested. PMID:21577373

  8. Duodenal Bleeding from Metastatic Renal Cell Carcinoma

    Directory of Open Access Journals (Sweden)

    Tarun Rustagi

    2011-04-01

    Full Text Available Massive upper gastrointestinal bleeding due to malignancy is relatively uncommon and the duodenum is the least frequently involved site. Duodenal metastasis is rare in renal cell carcinoma (RCC and early detection, especially in case of a solitary mass, helps in planning further therapy. We report a case of intractable upper gastrointestinal bleeding from metastatic RCC to the duodenum. The patient presented with melena and anemia, 13 years after nephrectomy for RCC. On esophagogastroduodenoscopy, a submucosal mass was noted in the duodenum, biopsies of which revealed metastatic RCC. In conclusion, metastasis from RCC should be considered in nephrectomized patients presenting with gastrointestinal symptoms and a complete evaluation, especially endoscopic examination followed by biopsy, is suggested.

  9. Unusual association of Meckel's diverticulum with double appendix – A rare finding

    Science.gov (United States)

    Panda, Sangram Keshari; Prasad, C.; Tirkey, Roshni; Rajesh, V.; Mishra, Jagadananda; Dora, Rajesh Kumar

    2014-01-01

    INTRODUCTION Appendix duplication is an extremely rare congenital anomaly that is seen in 0.004–0.009% of appendectomy specimens. Duplicated appendix may be associated with number of congenital anomalies. PRESENTATION OF CASE In this case report, we are presenting a rare case of duplicated vermiform appendix with a co-existing Meckel's diverticulum. DISCUSSION Anomalies of appendix are rare and duplication of vermiform appendix is extremely rare. In 1936, Cave classified appendiceal duplication for the first time which was modified by Wallbridge in 1963 into three types. Concomitant malformations or duplications of the large intestine or the genitourinary system may be present, especially in types B1 and C probably due to their similar embryological origin. Here we are presenting a very rare case report of type B1 appendix anomaly associated with Meckel's diverticulum. CONCLUSION Surgeons should be aware of these conditions because of the possible clinical implications. PMID:25462057

  10. Stercoral colonic diverticulum perforation with jejunal diverticulitis mimicking upper gastrointestinal perforation

    Institute of Scientific and Technical Information of China (English)

    BI Jing-tao; GUO Yan-tong; ZHAO Jing-ming; ZHANG Zhong-tao

    2012-01-01

    Stercoral perforation of the colon is an unusual pathological condition with fewer than 150 cases reported in the literature to date.We present a case of stercoral colonic perforation mimicking upper gastrointestinal perforation,which was diagnosed by computed tomography preoperatively.However,at laparotomy,stercoral colonic diverticulum perforation with jejunal diverticulitis became the most appropriate diagnosis.Colonic perforation is a severe complication in surgery.It is a rather uncommon event usually caused by malignancy,diverticular disease,trauma or ulcerative colitis.Stercoral perforation of the colon was reported by Berry1 in 1894.Fewer than 150 cases have been reported in the literature to date.2,3 We present a rare case of stercoral diverticulum colonic perforation with jejunal diverticulitis mimicking upper gastrointestinal (GI) perforation,which was correctly diagnosed at laparotomy.

  11. Primary Clear Cell Adenocarcinoma of a Urethral Diverticulum Treated with Multidisciplinary Robotic Anterior Pelvic Exenteration

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    Dane Scantling

    2013-01-01

    Full Text Available Primary urethral carcinoma is extremely rare and is marked by a variety of clinical symptoms. Primary carcinoma of a urethral diverticulum is still rarer and clear cell adenocarcinoma of the urethra is particularly uncommon (Swartz et al., 2006. Such infrequency has led to inadequate management guidance in the literature for a disease that is often late in presentation and carries substantial morbidity and mortality. This treatable but grave disease deserves definitive curative treatment. We present the first published instance in which it was treated with robotic anterior exenteration. In our case, a 47-year-old female was referred to the urology service for investigation of recurring urinary tract infections. During the workup, the patient was found to have an advanced clear cell urethral adenocarcinoma originating in a urethral diverticulum. We discuss the natural history of this condition, its consequences, and the first instance of its treatment using robotic anterior pelvic exenteration.

  12. Carcinoid of the Meckel′s diverticulum: Case report and review of literature

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    Guraya Salman

    2006-01-01

    Full Text Available We report a 19-year-old female admitted to the Emergency Room with excruciating right lower abdominal pain of 1-day duration. The abdominal examination revealed a soft, lax abdomen with rigidity and guarding in her right iliac fossa without abdominal defense. Apart from a leukocytosis of 18.3/mm3, the rest of her baseline investigations and imaging, including abdominal X-rays, abdominal and pelvic ultrasound and abdominal CT scan were unremarkable. Patient′s persistent pain prompted the treating surgeon to undertake exploratory laparotomy, which disclosed an inflamed Meckel′s diverticulum and a normal-looking appendix. Meckel′s diverticulectomy along with appendectomy was performed. The histopathological report demonstrated carcinoid tumor in the Meckel′s diverticulum with free resection margins, whereas appendix was reported to be normal. The patient had an uneventful recovery and was discharged home on the sixth postoperative day.

  13. Pharyngoesophageal Obstruction on the Killian-Laimer Triangle by Zenker's Diverticulum: Case Report and Clinical Significance.

    Science.gov (United States)

    Leite, Tulio F; Chagas, Carlos A A; Pires, Lucas A S; Cisne, Rafael; Babinski, Marcio A

    2015-12-01

    Zenker's diverticulum is a form of esophageal and pharyngeal obstruction located at the Killian-Laimer triangle. It is relatively common in elderly man (seventh or eighth decade of life), and its pathophysiology is not completely understood, albeit theories regarding dysfunction of the upper esophageal sphincter were reported. The main symptoms are dysphagia and odynophagia, but it can complicate to aspiration and perforation of the pharyngeal pouch; also, it can be asymptomatic. Diagnosis is provided through a barium esophagogram. Treatment can be performed through endoscopic surgery, diverticulopexy and myotomy of the cricopharyngeus muscle, although there is no consensus among surgeons regarding the treatment of choice. We report a case of pharyngeal obstruction due to Zenker's diverticulum which caused massive weight loss in a 76-year-old male.

  14. Strangulation of a Meckel's diverticulum in a femoral hernia (Littre's hernia).

    Science.gov (United States)

    Misiak, Piotr; Piskorz, Lukasz; Kutwin, Leszek; Jabłoński, Sławomir; Kordiak, Jacek; Brocki, Marian

    2014-01-01

    Femoral hernia is usually presented as a flexible, round, domed shape lying on the medial side of the thigh about 2-3 cm below the inguinal ligament. Among the external hernias, femoral hernia is the second most common inguinal hernia. Its prevalence reaches 20%. Among all inguinal hernias, femoral hernias are characterised by a high level of incarceration and strangulation. This can be as high as 60%. We would like to present a case of 71-year-old patient who was admitted to the Clinic urgently due to strangulation of Meckel's diverticulum in a right-sided femoral hernia. Strangulation of Meckel's diverticulum in femoral hernia is an extremely rare entity. It was described for the very first time in 1700 by Littre.

  15. Small bowel obstruction due to phytobezoar formation within meckel diverticulum: CT findings

    Energy Technology Data Exchange (ETDEWEB)

    Frazzini, V.I. Jr.; English, W.J.; Bashist, B.; Moore, E. [Columbia Univ. College of Physicians and Surgeons, New York, NY (United States)

    1996-05-01

    Intestinal obstruction due to a phytobezoar within a Meckel diverticulum is exceedingly rare, with only seven reported cases in the surgical literature. The most important precipitating factor is the ingestion of agents high in fiber and cellulose. Small bowel obstruction in all but one case was due to retrograde propagation of the bezoar into the small bowel lumen. We report the clinical and CT findings in such a patient following a vegetarian diet. 14 refs., 2 figs.

  16. Unusual association of Meckel's diverticulum with double appendix – A rare finding

    OpenAIRE

    Sangram Keshari Panda; C. Prasad; Roshni Tirkey; V. Rajesh; Jagadananda Mishra; Rajesh Kumar Dora

    2014-01-01

    INTRODUCTION: Appendix duplication is an extremely rare congenital anomaly that is seen in 0.004–0.009% of appendectomy specimens. Duplicated appendix may be associated with number of congenital anomalies. PRESENTATION OF CASE: In this case report, we are presenting a rare case of duplicated vermiform appendix with a co-existing Meckel's diverticulum. DISCUSSION: Anomalies of appendix are rare and duplication of vermiform appendix is extremely rare. In 1936, Cave classified appendiceal ...

  17. Right-Sided Aortic Arch with Aberrant Left Subclavian Artery from Kommerell's Diverticulum

    Directory of Open Access Journals (Sweden)

    M.Y. Mubarak

    2011-06-01

    Full Text Available A previously healthy 52-year-old man had a chest radiograph for medical check-up and found to have a right-sided aortic arch. Computed tomography of the thorax revealed a right-sided aorticarch with aberrant left subclavian artery originated from Kommerell's diverticulum. Barium swallow examination showed compression of the posterior wall of the esophagus. He was asymptomatic and no surgical intervention was performed.

  18. Sigmoid sinus diverticulum and pulsatile tinnitus - Analysis of CT scans from 15 cases

    Energy Technology Data Exchange (ETDEWEB)

    Liu, Zhaohui; Wang, Zhenchang; Xian, Junfang; Wang, Yongzhe; Liang, Xihong [Dept. of Radiology, Capital Medical Univ., Beijing Tongren Hospital, Beijing (China); Chen, Chengfang; Gong, Shusheng; Ma, Xiaobo; Li, Yi [Dept. of Otolaryngology Head and Neck Surgery, Capital Medical Univ., Beijing Tongren Hospital, Beijing (China)], e-mail: gongs@ccmu.edu.cn

    2013-09-15

    Background: Although the imaging features of sigmoid sinus diverticulum induced pulsatile tinnitus (PT) have been presented in some extent, detailed imaging findings still have not been systematically evaluated and precise diagnostic radiographic criteria has not been established. Purpose: To examine the computed tomography (CT) characteristics of sigmoid sinus diverticulum accompanied with PT. Material and Methods: Fifteen PT patients with sigmoid sinus diverticula proven by surgery were recruited after consenting. CT images of 15 patients were obtained and analyzed, including features of diverticula, brain venous systems, integrity of the sigmoid plate, and the degree of temporal bone pneumatization. Results: Sigmoid sinus diverticulum was located on the same side of PT in 15 patients. Diverticula originated at the superior curve of the sigmoid sinus in 11 patients and the descending segment of the sigmoid sinus in four patients. Sigmoid sinus diverticula focally eroded into the adjacent mastoid air cells in 12 patients and mastoid cortex in three patients. Among eight patients with unilateral dominant brain venous systems, the diverticula were seen on the dominant side in seven patients and non-dominant side in one patient. In contrast, the other seven patients showed co-dominant brain venous systems, with three presenting diverticula on the right side and four on the left. More notably, dehiscent sigmoid plate on the PT side was demonstrated in all patients. In addition, temporal bone hyper-pneumatization was found in nine patients, good and moderate pneumatization in three patients, respectively. Conclusion: Dehiscent sigmoid plate and extensive temporal bone pneumatization are two important imaging characteristics of the PT induced by sigmoid sinus diverticulum.

  19. Appendicitis and Meckel's diverticulum in a femoral hernia: simultaneous De Garengeot and Littre's hernia.

    Science.gov (United States)

    Phillips, A W; Aspinall, S R

    2012-12-01

    This report presents the case of a 73-year-old woman who was admitted with sepsis, cachexia and confusion secondary to a strangulated femoral hernia containing both the appendix (De Garengeot hernia) and a Meckel's diverticulum (Littre's hernia). She underwent successful operative management and was discharged from hospital on the 10th post-operative day. This is the first report in the literature of a combined De Garengeot and Littre's hernia within a femoral hernia sac.

  20. Congenital Anterior Urethral Diverticulum in a Male Teenager: A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Sadat Haider Quoraishi

    2011-01-01

    Full Text Available We present the case of a 13-year-old boy with a congenital anterior urethral diverticulum. This is a rare condition in males which can lead to obstructive lower urinary tract symptoms and urosepsis. Diagnosis is by urethroscopy and radiological imaging. Surgical treatment can be open or endoscopic. Long-term followup is required to check for reoccurrence of the obstruction.

  1. Primary osteosarcoma of bladder diverticulum mimicking intradiverticular calculus: a case report

    OpenAIRE

    2011-01-01

    Abstract There is a well-documented relationship between urinary bladder diverticula and intradiverticular neoplasms. The great majorities of these tumors are urothelial carcinomas, but may also be of glandular or squamous type. Sarcomas occurring within bladder diverticula are exceptionally rare and highly malignant lesions, with only 20 well documented cases published in the literature to date (including carcinosarcomas). We report a case of osteosarcoma of the bladder diverticulum in a 68-...

  2. Duodenal metastases of renal cell carcinoma: a case report

    Institute of Scientific and Technical Information of China (English)

    HE Xiang-hui; LU Ning; ZHANG Rui; ZHU Li-wei

    2010-01-01

    @@ Malignancy accounts for about 5% of upper gastrointestinal hemorrhage and needs to be treated by surgical intervention. Duodenal metastases are a rare and peculiar cause of upper gastrointestinal bleeding.

  3. Post-operative duodenal fistula: percutaneous treatment and review

    Directory of Open Access Journals (Sweden)

    D.Huerta

    2015-04-01

    Full Text Available Duodenal fistula is a complex condition, relatively frequent presentation, being in most cases of postoperative origin. Among the latter, 6% to 11% are secondary to surgical treatment of perforated duodenal ulcer, and more unusual, as a complication of cholecystectomy. Two cases treated percutaneous at the Polyclinic Bank city of Buenos Aires are presented. The first, a female patient with a duodenal fistula as a postoperative complication of a perforated duodenal ulcer and the second one patient male with the same pathology but as a complication of cholecystectomy. Percutaneous treatment of this disease has been reported sporadically without having proven its usefulness. Once diagnosed the same Fistulography and obliteration were performed percutaneously achieving complete remission of the disease.

  4. Duodenal gangliocytic paraganglioma: A case report and literature review

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    Tyler J. Loftus

    2015-01-01

    Conclusion: Localized duodenal gangliocytic paragangliomas are best managed by resection with negative margins. In cases in which the tumor is resected with negative margins, it appears to be safe to embark on a course of surveillance and forego adjuvant therapy.

  5. Intrathoracic intestinal diverticulum in a late presenting congenital bilateral diaphragmatic hernia: a case report

    Science.gov (United States)

    2013-01-01

    Introduction Hernias comprise 3% of all defects of the diaphragm. Bilateral hernias are extremely rare and usually occur in children. Here we present a case report of a bilateral Morgagni-Larrey diaphragmatic hernia with an intrathoracic intestinal diverticulum and late presentation. To the best of our knowledge this is the first report of this type. Case presentation A 37-year-old Hispanic man was admitted to our emergency department with a 4-day history of obstipation, abdominal pain, distension, nausea, and vomiting. During the initial evaluation, chest and abdominal X-rays were performed, which revealed intestinal displacement into his right and left hemithorax. During laparotomy, a Morgagni-Larrey hernia with a sac was found. His small bowel with a large diverticulum, transverse colon, descending colon, and epiploic fat were herniated into his thorax. Tissues were returned to his abdominal cavity and the hernia defects were corrected with running non-absorbable sutures. He had no postoperative complications. Conclusions Bilateral congenital diaphragmatic hernias remain extremely rare. However, they should be considered in adult patients with intestinal obstruction even when respiratory symptoms are absent. This is the first description of a patient with a prolapsed intestinal diverticulum and bilateral diaphragmatic hernias. PMID:24377864

  6. Extranodal Marginal Zone Lymphoma Presenting within the Meckel Diverticulum as Diverticulitis: A Case Report

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    A. Nael

    2014-01-01

    Full Text Available Meckel diverticulum is the most common congenital defect of the gastrointestinal tract. It can be asymptomatic or mimic appendicitis and may be complicated by bleeding, diverticulitis, obstruction, and, rarely, neoplasia. We report the first case of extranodal marginal zone lymphoma occupying a Meckel diverticulum. A 44-year-old man with history of colonic diverticulitis presented to the emergency department for evaluation of acute abdominal pain. Radiography showed enteric obstruction, prompting diagnostic laparoscopy. Above the level of mid-ileum an intact Meckel diverticulum was identified. Microscopy showed extensive infiltration of sheets of small lymphocytes with abundant cytoplasm (monocytoid B-cells prominently in submucosa and focally transmural involving serosal adipose tissue with multiple reactive germinal centers. The immunostains showed positivity for CD20, BCL-2, and CD43 (weak and negativity for CD3, CD5, BCL-1, CD10, and BCL-6 in monocytoid B-cells. Fluorescence in situ hybridization studies revealed API2-MALT1 fusion signals consistent with t(11;18(q21;q21, which confirmed the diagnosis of extranodal marginal zone lymphoma, also known as mucosa associated lymphoid tissue lymphoma.

  7. Inverted Meckel's diverticulum as a cause of occult lower gastrointestinal hemorrhage

    Institute of Scientific and Technical Information of China (English)

    Omar M Rashid; Joseph K Ku; Masayuki Nagahashi; Akimitsu Yamada; Kazuaki Takabe

    2012-01-01

    Meckel's diverticulum is a common asymptomatic congenital gastrointestinal anomaly,but rarely it can present with hemorrhage.Over the last few years inverted Meckel's diverticulum has been reported in the literature with increasing frequency as an occult source of lower gastrointestinal hemorrhage.Here,we report a case of a 54-year-old male,who was referred for surgical evaluation with persistent anemia and occult blood per rectum after a work up which failed to localize the source over 12 mo,including upper and capsule endoscopy,colonoscopy,enteroclysis,Meckel scan,and tagged nuclear red blood cell scan.An abdominal computed tomography scan showed a possible mid-ileal intussusception and intraluminal mass.During the abdominal exploration,inverted Meckel's diverticulum was diagnosed and resected.We review the literature,discuss the forms in which the disease presents,the diagnostic modalities utilized,pathological findings,and treatment.Although less than 40 cases have been reported in the English literature from 1978 to 2005,19 cases have been reported in the last 6 years alone (2006-2012) due to improved diagnostic modalities.Successful diagnosis and treatment of this disease requires a high index of clinical suspicion,which is becoming increasingly relevant to general gastroenterologists.

  8. [A case of carcinoma arising in a diverticulum of the transverse colon].

    Science.gov (United States)

    Nomi, Masako; Umemoto, Satoshi; Kikutake, Takashi; Hosaka, Seiji; Mase, Takahiro; Kawamoto, Shunji; Yoshida, Takahisa

    2014-11-01

    A 64 year-old woman presented with advanced, transverse colon cancer arising in the diverticulum. Tumor invasion extended beyond the serosa to the anal side of the colon. Anemia and fatigue progressed after 6 months of iron administration. The hemoglobin value was 5.3 g/dL and carcinoembryonic antigen (CEA) level was elevated to 44.2 ng/mL. A palpable and tender fist-sized mass was found in the right upper abdomen. Computed tomography (CT) revealed a low-density mass in the transverse colon invading beyond the serosa to the anal side of the colon. Right hemi-colectomy with lymph node dissection was performed. The resected specimen contained multiple diverticula including the one from which the tumor arose. Histological examination revealed a well-differentiated, tubular adenocarcinoma (UICC TNM T4bN0M0) arising in a transverse colon diverticulum. There has been no recurrence for 2 years. Colon cancer arising in a diverticulum may expand to the extra-serosa and easily invade to the adjacent organ. In such cases, malignancy should be considered.

  9. Long segmental hyperplasia of interstitial cells of Cajal with giant diverticulum formation.

    Science.gov (United States)

    Xue, Liyan; Qiu, Tian; Song, Ying; Shan, Ling; Liu, Xiuyun; Guo, Lei; Ying, Jianming; Zou, Shuangmei; Shi, Susheng; Polydorides, Alexandros D; Zhao, Xinming; Lu, Ning; Lin, Dongmei

    2013-01-01

    Sporadic gastrointestinal stromal tumors (GISTs) usually form a well-circumscribed mass. In contrast, diffuse interstitial cell of Cajal (ICC) hyperplasia along the Auerbach plexus without a discrete mass may occur in patients with germline mutations in the NF1, c-KIT or PDGFRA genes. However, sporadic, diffuse ICC hyperplasia without c-KIT or PDGFRA mutations has not been reported. We describe herein one such case, forming a giant diverticulum. A 63-year-old woman with no features of Neurofibromatosis 1 (NF1) presented with increasing abdominal pain for more than 30 years. A large, diverticulum-like mass in the ileum was resected. Microscopically, a diffuse proliferation of bland spindle cells was seen extending for 12 cm, replacing the muscularis propria and lined by intact mucosa. The spindle cells were CD117+/CD34+/DOG1+/SMA+/Desmin-/S100-. Mutation analyses did not reveal any mutations in c-KIT or PDGFRA. The lesion had two silent mutations in the NF1 gene. It is rare of the diffuse form of sporadic ICC hyperplasia showing diffuse longitudinal microscopic growth completely replacing the muscularis propria, mimicking diffuse ICC hyperplasia in hereditary GIST syndromes, but without solid components and no c-KIT or PDGFRA gene mutations. This peculiar form of sporadic ICC hyperplasia may be related to intestinal dysmotility in this ileal segment and giant diverticulum formation.

  10. Omeprazole promotes proximal duodenal mucosal bicarbonate secretion in humans.

    OpenAIRE

    Mertz-Nielsen, A; Hillingsø, J; Bukhave, K; Rask-Madsen, J

    1996-01-01

    The proton pump inhibitor, omeprazole, surprisingly resulted in higher rates of proximal duodenal mucosal bicarbonate secretion than previously reported using an H2 receptor antagonist for gastric acid inhibition. Gastroduodenal perfusions were performed in healthy volunteers to evaluate whether this incidental finding is explained by more potent gastric acid inhibition by omeprazole or might be caused by the different mode of drug action. Basal and stimulated gastric and duodenal bicarbonate...

  11. Isolated duodenal rupture due to blunt abdominal trauma

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    Celik Atilla

    2006-01-01

    Full Text Available Duodenal rupture following blunt abdominal trauma is rare and it usually seen with other abdominal organ injuries. It represents approximately 2% to 20% of patients with blunt abdominal injury and often occurs after blows to the upper abdomen, or abdominal compression from high-riding seat belts. Two cases of blunt duodenal rupture successfully treated surgically, are presented with their preoperative diagnosis and final out comes.

  12. Malignant transformation of ectopic pancreatic cells in the duodenal wall

    Institute of Scientific and Technical Information of China (English)

    Roberto; Bini; Paolo; Voghera; Alberto; Tapparo; Raffaele; Nunziata; Andrea; Demarchi; Matteo; Capocefalo; Renzo; Leli

    2010-01-01

    Ectopic pancreas (EP) is the relatively uncommon presence of pancreatic tissue outside the normal location of the pancreas. This condition is usually asymptomatic and rarely complicated by pancreatitis and malignant transformation. A few cases of neoplastic phenomena that developed from EP into the duodenal wall are described in the literature. Herein we report a case of gastric outlet obstruction due to adenocarcinoma arising from EP of the duodenal wall. The patient underwent a Whipple's procedure and had...

  13. Therapeutic angiography for giant bleeding gastro-duodenal artery pseudoaneurysm

    Institute of Scientific and Technical Information of China (English)

    Ram; Elazary; Mahmoud; Abu-Gazala; Avraham; Schlager; Noam; Shussman; Avraham; I; Rivkind; Allan; I; Bloom

    2010-01-01

    We present the case of an 18-year-old female transferred to our center from an outside hospital due to persistent gastrointestinal bleeding. Two weeks prior to her transfer she underwent duodenal omentopexy for a perforated duodenal peptic ulcer. The patient underwent a computed tomography angiogram which identified the source of bleeding as a giant gastroduodenal artery (GDA) pseudoaneurysm. The patient was taken to interventional radiology where successful microcoil embolization was performed. We present ...

  14. Helicobacter pylori in duodenal ulcer disease and its eradication

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    Sengupta S

    2002-01-01

    Full Text Available Antral biopsy specimens were processed for Helicobacter pylori by Gram staining, rapid urease test (RUT and culture from 25 patients with symptoms of duodenal ulcer, amongst whom the positivity rate was 84%. Follow up of 16 patients after appropriate therapy showed complete regression of the disease in 87.5% of cases whereas in 12.5% of cases a decrease in the extent of duodenal ulceration was noted.

  15. Duodenal White Spots Mimicking Intestinal Candidiasis: Report of Case

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    Ozgur Turk

    2015-12-01

    Full Text Available Duodenal white spots are mentioned in these nonspecific lesions until recently. Although there is not enough studies about duedonal white spots yet; these lesions described in a separate syndrome. Here now we reported a case that we diagnosed multiple Duodenal white spots mimicking intestinal candidiasis. Clinical manifestation and endoscopic appearance of lesions gave rise to thought intestinal candidiasis histopathological examination revealed us several duodenitis. There was no evidence of fungal infection in PAS staining. Early after endoscopy patient took treatment of Lansoprozole at the 30 mg dose and bismuth salicylate. Patients compliant declined and control endoscopy exposed white duodenal spots cleared away three months later. Duodenal white spots are becoming to be designated as a separate disease even a syndrome. Etiology of duodenal white spots must be determined carefully during endoscopy. Sometimes it is difficult to make the correct diagnosis by appearance of lesion; in such cases histopathological examination can be useful both differential diagnosis of disease and determination of etiological factor. [J Contemp Med 2015; 5(4.000: 249-252

  16. Helicobacter pylori and gastric or duodenal ulcer.

    Science.gov (United States)

    2016-01-01

    In patients with gastric or duodenal ulcer associated with Helicobacter pylori, treatment of the infection improves healing and prevents complications and recurrences. The drug regimen generally consists of a high-dose proton-pump inhibitor (PPI) such as omeprazole plus antibiotics. Using the standard Prescrire methodology, we conducted a review of the literature in order to determine the standard empirical antibiotic regimen for H. pylori infection in adults with gastric or duodenal ulcer in France. In 2015, due to an increase in H. pylori resistance to clarithromycin, a 7-day course of the PPI + clarithromycin + amoxicillin combination is effective in only about 70% of cases. A Cochrane systematic review and meta-analysis of trials involving thousands of patients suggests that prolonging treatment with a PPI + amoxicillin + clarithromycin or a PPI + amoxicillin + metronidazole to 10 or 14 days improves the rate of H. pylori eradication by 5% to 10%. A metanalysis of seven trials including a total of about 1000 patients showed that combination therapy with a PPI + amoxicillin + clarithromycin + metronidazole for 5 days eradicates H. pylori in about 90% of cases, compared to about 80% of cases with a PPI + amoxicillin + clarithromycin given for 7 days. Sequential treatment with amoxicillin for 5 days, followed by clarithromycin + metronidazole for 5 days, has also been tested in thousands of patients. Efficacy and adverse effects were similar to those observed when the same antibiotics were taken simultaneously for 5 days. In randomised trials, replacing clarithromycin or amoxicillin with a fluoroquinolone yielded conflicting results. In 2009, nearly 20% of H. pylori isolates were resistant to levofloxacin in France. Tetracycline has only been evaluated in combination with bismuth. The few available data on doxycycline suggest that its efficacy is similar to that of tetracycline. A fixed-dose combination of bismuth subcitrate potassium + metronidazole

  17. Vitamin D-enhanced duodenal calcium transport.

    Science.gov (United States)

    Wongdee, Kannikar; Charoenphandhu, Narattaphol

    2015-01-01

    For humans and rodents, duodenum is a very important site of calcium absorption since it is exposed to ionized calcium released from dietary complexes by gastric acid. Calcium traverses the duodenal epithelium via both transcellular and paracellular pathways in a vitamin D-dependent manner. After binding to the nuclear vitamin D receptor, 1,25-dihydroxyvitamin D3 [1,25(OH)2D3] upregulates the expression of several calcium transporter genes, e.g., TRPV5/6, calbindin-D9k, plasma membrane Ca(2+)-ATPase1b, and NCX1, thereby enhancing the transcellular calcium transport. This action has been reported to be under the regulation of parathyroid-kidney-intestinal and bone-kidney-intestinal axes, in which the plasma calcium and fibroblast growth factor-23 act as negative feedback regulators, respectively. 1,25(OH)2D3 also modulates the expression of tight junction-related genes and convective water flow, presumably to increase the paracellular calcium permeability and solvent drag-induced calcium transport. However, vitamin D-independent calcium absorption does exist and plays an important role in calcium homeostasis under certain conditions, particularly in neonatal period, pregnancy, and lactation as well as in naturally vitamin D-impoverished subterranean mammals.

  18. The terminal web of the duodenal enterocyte.

    Science.gov (United States)

    Leeson, T S

    1982-06-01

    The terminal web-brush border complex of rodent duodenal enterocytes has been studied by electron microscopy to investigate its structure in relation to currently accepted models of motility in this region. The main adherens zone is composed chiefly of a fine feltwork of 5 to 7 nm filaments, some of which originate in zonulae adherentes. In some cells, this is not a complete layer or sheet. Passing into it from its deep aspect are 10 nm tonofilaments, which also form the basal zone. The filament density in the basal zone is less than that of the adherens zone, and many of the tonofilaments are associated with spot desmosomes. The apical zone contains a loose meshwork of 5 to 7 nm filaments with more filaments lying adjacent to plasmalemmae of the zonula occludens. The core of each microvillus contains a bundle of 17 to 48 microfilaments, 5-7 nm in diameter, apparently attached to the apical plasmalemma and with some slender cross filaments between core filaments and the plasmalemma. In the main, these core bundles of microfilaments pass deeply into and often through the adherens zone of the terminal web where they terminate abruptly. Filaments of the terminal web appear to interconnect microfilaments of adjacent core bundles but without positive evidence of 'splaying' of microfilaments of a core bundle within the adherens zone. These findings are discussed in relation to movement of microvilli.

  19. Perforated duodenal ulcer in Asir central hospital

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    Jastaniah Suleiman

    1997-01-01

    Full Text Available In a study of 27 cases of perforated duodenal ulcer seen at Asir Central Hospital over a period of seven years, two patients were females and 25 males. The highest incidence was in the fourth decade and the average age was 36.3 years. The Saudi-foreigner ratio was 1:2.9 in an area where the Saudi-foreigner population ratio was 1:3. Nine patients (33.3% were previously diagnosed as having peptic ulcer and had received treatment at one time or the other before perforation. Eighteen patients (66.7% were first diagnosed to peptic ulcer after the perforation. All the identified perforations were located anteriorly and anterosuperiorly. Only one case occurred in the second part of duodenum. The rest occurred in the first part. Two patients were treated successfully conservatively. The month perforations occurred most was the month of Shaaban. The fasting period during the month of Ramadhan did not show any increase in the prevalence of perforation in this hospital.

  20. [Frequency, diagnosis and dependance of duodenitis upon the morphological status of the gastric mucosa (author's transl)].

    Science.gov (United States)

    Konstantinidis, T; Wagner, P K

    1978-08-01

    In a attempt to prove the dependence of duodenitis upon the morphological status of the gastric mucosa, a biopsy of the corpus, antrum, and duodenal canal had been made of 354 patients. In 56 cases, a superficial duodenitis was histologically verified; however, this infection had not contaminated the Brunner' glands. A duodenitis was found to be more often associated with surface gastritis of the corpus and antrum than it was with atropic gastritis. A duodenitis was discovered by a biopsy in 16 patients possessing a normal antrum mucosa and in 25 patients having a normal corpus mucosa, thus proving the possibility of isolated duodenitis.

  1. A case of clear cell adenocarcinoma arising from the urethral diverticulum: Utility of urinary cytology and immunohistochemistry

    Directory of Open Access Journals (Sweden)

    Shin-ichi Nakatsuka

    2012-01-01

    Full Text Available Carcinomas rarely arise from the urethral diverticulum. In this report, we present a case of clear cell adenocarcinoma arising from the urethral diverticulum. A 42-year-old woman complained of bloody discharge and lower back pain. Imaging studies showed a tumor involving the region surrounding the urethra and cystourethroscopy showed papillary and villous tumors in the urethral diverticula. Cytology of the urine sediment showed papillary or spherical clusters of atypical cells, some of which had clear abundant cytoplasm and formed mirror ball-like clusters, suggesting adenocarcinoma. Although histological diagnosis was indeterminate by biopsy and transurethral resection (TUR because of absence of stromal invasion, surgically resected specimen via cysturethrectomy revealed that the tumor was clear cell carcinoma. Urinary cytological findings and immunohistochemical analysis for CD15, Ki-67, and p53 might be useful for accurate diagnosis of clear cell adenocarcinoma that arises from the urethral diverticulum when sufficient materials are not available by biopsy and TUR.

  2. Cytokeratin 20 (CK20 and apomucin 1 (MUC1 expression in ampullary carcinoma: Correlation with tumor progression and prognosis

    Directory of Open Access Journals (Sweden)

    Nishi Takeshi

    2010-11-01

    Full Text Available Abstract Background We assessed the expression of cytokeratin (CK and apomucin (MUC in ampullary carcinoma (AC to develop a system for the classification of ACs on the basis of their clinical significance. Method We studied the expressions of CK7, CK20, MUC1, MUC2, MUC5AC, and MUC6 in 43 patients with ACs. Clinical data were obtained retrospectively by examining surgically resected ACs of the patients. Results We classified the cases into 3 groups: tumors expressing CK20 and lacking MUC1 (intestinal type [I-type], 26%, tumors expressing MUC1 and lacking CK20 (pancreatobiliary type [PB-type], 35%, and those expressing or lacking both CK20 and MUC1 (other type [O-type], 39%. Eight (73% of 11 I-type carcinomas, 3 (20% of 15 PB-type carcinomas, and 4 (24% of 17 O-type carcinomas were classified as pT1. The number of I-type carcinomas in the early tumor stages was significantly higher than the number of PB- and O-type carcinomas (p = 0.014 and p = 0.018, respectively. The 5-year survival rates for pT1, pT2, and pT3 tumors were 76%, 33%, and 22%, respectively (p Conclusions The immunohistochemical subtypes based on CK and MUC expression correlated with tumor progression. Gastric MUC5AC and MUC6 coexpression correlated with better prognosis for O-type ACs.

  3. Omeprazole promotes proximal duodenal mucosal bicarbonate secretion in humans.

    Science.gov (United States)

    Mertz-Nielsen, A; Hillingsø, J; Bukhave, K; Rask-Madsen, J

    1996-01-01

    The proton pump inhibitor, omeprazole, surprisingly resulted in higher rates of proximal duodenal mucosal bicarbonate secretion than previously reported using an H2 receptor antagonist for gastric acid inhibition. Gastroduodenal perfusions were performed in healthy volunteers to evaluate whether this incidental finding is explained by more potent gastric acid inhibition by omeprazole or might be caused by the different mode of drug action. Basal and stimulated gastric and duodenal bicarbonate secretion rates were measured in the same subjects in control experiments (n = 17) and after pretreatment with high dose omeprazole (n = 17) and ranitidine (n = 9), respectively, by use of a technique permitting simultaneous measurements. Concentrations of bicarbonate were measured in the respective effluents by the method of back titration. Both omeprazole and ranitidine completely inhibited gastric acid secretion (pH 6.9 v 6.8; p > 0.05). Omeprazole caused higher rates of basal (mean (SEM)) (597 (48) v 351 (39) mumol/h; p 0.05) duodenal bicarbonate secretion compared with control experiments. Also the combination of omeprazole and ranitidine increased (p = 0.05) duodenal bicarbonate secretion, while ranitidine alone caused no change in either basal or stimulated secretion. In the stomach basal as well as vagally stimulated bicarbonate secretion was independent of the means of acid inhibition. These results show that the proton pump inhibitor, omeprazole, promotes proximal duodenal mucosal bicarbonate secretion apparently independent of its gastric acid inhibitory effect. The mechanism of action remains speculative.

  4. An unusual case of duodenal perforation caused by a blister pack: A case report and literature review

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    Si-Yuan Yao

    2015-01-01

    Conclusion: Unnoticed ingestion of blister packs can cause duodenal perforation. Although prompt management is necessary, duodenal perforation, especially in the third portion, may be potentially fatal.

  5. Does Ramadan Fasting Increase duodenal ulcer perforation?

    Directory of Open Access Journals (Sweden)

    Abdoulhossein Davoodabadi

    2016-03-01

    Full Text Available Introduction: In Ramadan, healthy adult Muslims are obliged to fast. Prolonged fasting increase gastric acid and pepsin levels, which promote the risk of duodenal ulcer perforation (DUP. Effects of Ramadan fasting on DUP have not been thoroughly studied yet, and the limited number of studies investigating the impact of Ramadan fasting on DUP yielded discrepant results. This study aimed to evaluate DUP frequency during Ramadan 2011-2015 and compare it with other months. Methods: This cross-sectional study was performed in 82 patients undergoing surgery due to DUP during July 2011-September 2015. The demographics, history of addiction, use of nonsteroidal and antiinflammatory drugs, previous history of acid peptic disease, as well as complications and outcomes of treatment were recorded and analyzed, and the obtained results were compared between Ramadan and other lunar months. Results: The majority of patients were male (86.6%, 71 patients, with a mean age of 43.9±16.5 years (age range: 20-75 years. Male to female ratio was 6:1. Cases with less than 30 years of age were less frequent (22%, 18 patients. DUP was more frequent during Rajab with nine cases (11%, while during Ramadan, six cases were reported, the difference between Ramadan and other months regarding the incidence of DUP was not significant (P=0.7. Risk factors such as smoking (60% and addiction (44%; especially to crystal and crack were noted. Consumption of nonsteroidal antiinflammatory drugs in 20 (24% patients, and use of antacids in 17 (25% patients. Distribution of DUP in different blood types was as follows: O+=41%, A+=28%, B+=23%, AB=5%, and O-=3%; moreover, post-operative Helicobacter pylori antibody was present in 67% of the patients. Conclusion: Ramadan fasting did not escalate DUP incidence, and those with DUP risk factors can fast with the use of antacids.

  6. Perforated Meckel’s diverticulum in an adult due to faecolith: A case report and review of literature

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    Sunny Modi

    2015-01-01

    Full Text Available Meckel’s diverticulum (MD is a persistent remnant of the vitelointestinal duct and is present in 2% of population [1]. It is the most common congenital malformation of the gastrointestinal tract. It can present clinically as haemorrhage, diverticulitis, intussusception, chronic ulceration, intestinal obstruction and perforation. Complicated presentation, especially bleeding, tends to be more common in the paediatric group, whereas intestinal obstruction is more common in adults [2]. Patients with a perforation of Meckel’s diverticulum by an enterolith are rare and may present with right iliac fossa pain, which mimics acute appendicitis.

  7. Spontaneous rupture of bladder diverticulum after postoperative radiotherapy for carcinoma of the uterine cervix. A case report

    Energy Technology Data Exchange (ETDEWEB)

    Nishimura, Tetsuo; Suzuki, Kazunori; Iijima, Mitsuharu; Nozue, Masashi; Imai, Michiko; Suzuki, Sachiko; Sakahara, Harumi; Ohta, Nobutaka; Kasami, Masako [Hamamatsu Univ. School of Medicine, Shizuoka (Japan)

    2000-08-01

    We present a case of spontaneous rupture of bladder diverticulum three years after postoperative whole pelvic irradiation (50.4 Gy) for carcinoma of the uterine cervix. The patient had suffered from a neurogenic bladder after hysterectomy, but excretory urography revealed no abnormalities. Bladder diverticulum was found two years later. Spontaneous rupture of the urinary bladder is one of the late complications associated with radiotherapy, although it is very rare. Postoperative neurogenic bladder may also be associated with rupture. We should be aware of this rare complication in patients who receive pelvic irradiation. (author)

  8. Reconstruction of the left-sided brachiocephalic trunk after vascular ring operation in left-handed child with Kommerell's diverticulum.

    Science.gov (United States)

    Haponiuk, Ireneusz; Paczkowski, Konrad; Chojnicki, Maciej; Jaworski, Radosław; Steffens, Mariusz; Szofer-Sendrowska, Aneta; Kwaśniak, Ewelina; Zieliński, Jacek; Gierat-Haponiuk, Katarzyna

    2013-01-01

    We report a case of a 2-year-old girl with prenatal diagnosis of vascular ring composed of a right-sided aortic arch, a left ligamentum arteriosum, and a left subclavian artery (arteria lusoria sin) originating from a retroesophageal Kommerell's diverticulum, who was referred for surgery with symptoms related to local compression - severe dysphagia and respiratory disorders. Through the left posterolateral thoracotomy, a ligamentum arteriosum between the Kommerell's diverticulum and the left pulmonary artery was divided and because of left-handedness of the child a brachiocephalic trunk was reconstructed in the fashion of anastomosis of the left subclavian artery and the left common carotid artery, originating from the ascending aorta.

  9. Divertículo de Meckel: conduta no achado incidental Meckel's diverticulum: behavior on accidental found

    Directory of Open Access Journals (Sweden)

    Luiz Alberto Mendonça de Freitas

    1999-02-01

    Full Text Available O Divertículo de Meckel é uma malfonnação rara. Quando presente, na maioria das vezes não é motivo de sintomatologia. Nos casos complicados, os sintomas são inespecíficos, o que torna o diagnóstico pré-operatório muito difícil. A raridade desta condição, assim como as dificuldades diagnósticas e as controvérsias no tratamento, principalmente quando seu achado é incidental, motivaram a análise de uma série de 18 Divertículos de Meckel (DM operados na Unidade de Cirurgia Geral (UCG do Hospital Regional de Sobradinho (HRS, Brasília-DF, no período de 1985 a 1995. O estudo demonstrou que os portadores destas anomalias foram operados sem diagnóstico pré-operatório mesmo nos pacientes sintomáticos. Em nove oportunidades, os achados foram incidentais durante laparotomias por outros motivos. Diversas condutas operatórias foram verificadas nesta revisão, variando desde a simples diverticulectomia até a enterectomia segmentar com reconstrução por anastomose primária término-terminal. Estas controvérsias levaram o staff da UCG do HRS a eleger a última técnica citada como a mais adequada para a uniformização do tratamento não só dos casos sintomáticos como também para os achados incidentais.Meckel's diverticulum is rare malformation, and in most of the suspectis has no symptoms. In complicated cases, the symptoms are not specific, what makes difficult the preoperative diagnosis. The rarity of this condition as well difficulties in diagnosis and controversies in treatment let us review and analyse records of 18 patients with Meckel 's diverticulum operated at Hospital Regional of Sobradinho in a ten year period (1985-1995. The review showed that all 18 patients underwent surgical procedure without preoperative diagnosis of Meckel's diverticulum. In nine patients the MD were found in the course of operation for some other lesion and remaining had others preoperative diagnosis due of complications of a existing MD

  10. A Rare Cause of Acute Pancreatitis: Intramural Duodenal Hematoma

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    Hemant Goyal

    2012-01-01

    Full Text Available We describe an interesting case of intramural duodenal hematoma in an otherwise healthy male who presented to emergency room with gradually progressive abdominal pain, nausea, and vomiting. This condition was missed on initial evaluation and patient was discharged from emergency room with diagnosis of acute gastritis. After 3 days, patient came back to emergency room and abdominal imaging studies were conducted which showed that patient had intramural duodenal hematoma associated with gastric outlet obstruction and pancreatitis. Hematoma was the cause of acute pancreatitis as pancreatic enzymes levels were normal at the time of first presentation, but later as the hematoma grew in size, it caused compression of pancreas and subsequent elevation of pancreatic enzymes. We experienced a case of pancreatitis which was caused by intramural duodenal hematoma. This case was missed on initial evaluation. We suggest that physicians should be more vigilant about this condition.

  11. Upper gastrointestinal barium evaluation of duodenal pathology: A pictorial review

    Institute of Scientific and Technical Information of China (English)

    Pankaj; Gupta; Uma; Debi; Saroj; Kant; Sinha; Kaushal; Kishor

    2014-01-01

    Like other parts of the gastrointestinal tract(GIT), duodenum is subject to a variety of lesions both congenital and acquired. However, unlike other parts of the GIT viz. esophagus, rest of the small intestine and large intestine, barium evaluation of duodenal lesions is technically more challenging and hence not frequently reported. With significant advances in computed tomography technology, a thorough evaluation including intraluminal, mural and extramural is feasible in a single non-invasive examination. Notwithstanding, barium evaluation still remains the initial and sometimes the only imaging study in several parts of the world. Hence,a thorough acquaintance with the morphology of various duodenal lesions on upper gastrointestinal barium examination is essential in guiding further evaluation. We reviewed our experience with various common and uncommon barium findings in duodenal abnormalities.

  12. Acyclovir in the prevention of duodenal ulcer recurrence

    DEFF Research Database (Denmark)

    Rune, S J; Linde, J; Bonnevie, O;

    1990-01-01

    This study tests the hypothesis that reactivation of a latent herpes simplex virus infection may be a cause of recurrent duodenal ulceration. Patients with recently healed duodenal ulcer were entered into a double blind, randomised study of maintenance treatment with the antiviral drug acyclovir...... (400 mg bid) versus placebo, to determine if suppression of herpes virus infection would influence the natural history of the ulcer disease. One hundred and fifteen patients entered the trial and 76 patients completed it according to the protocol. Endoscopy was performed when ulcer symptoms recurred...... and at the end of the 25 week trial period. In the acyclovir group the cumulated relapse rate was 63% compared with 56% in the placebo group (NS). This result suggests that reactivation of herpes simplex virus is not a cause of recurrent duodenal ulcer....

  13. Laparoscopic gastric partitioning gastrojejunostomy for an unresectable duodenal malignant tumor

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    Matsumoto Toshifumi

    2005-01-01

    Full Text Available As a palliative bypass for unresectable gastric or periampullary cancer, gastrojejunostomy (GJ is sometimes associated with postoperative delayed gastric emptying. We report the successful laparoscopic application of this procedure in a 78-year-old man with duodenal obstruction. Computed tomography revealed a mass in the duodenum along with multiple masses in the liver. A radiological image showed an ulcerative tumour in the third portion of the duodenum occluding the lumen. He was diagnosed as having an unresectable duodenal cancer with multiple liver metastases. He needed palliative bypass surgery. Laparoscopically, the stomach was partially divided using an endoscopic autosuture device, and end-to-side GJ was performed successfully. He was given a normal diet on the fourth postoperative day, and there was no delayed gastric emptying. Laparoscopic gastric partitioning GJ is a feasible and safe procedure to prevent postoperative delayed gastric emptying in case of malignant duodenal obstruction.

  14. A newborn with duodenal atresia and a gastric perforation

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    Akcora Bulent

    2010-01-01

    Full Text Available Congenital duodenal atresia complicated by gastric perforation (GP is a very rare and a very mortal condition. Only three newborns could be cured in the reported 13 cases. We report a successfully treated newborn with this complicated disease. A 2-day-old male was hospitalized with prediagnosis of duodenal obstruction. Twelve hours later, significant abdominal distention occurred promptly. At laparotomy, GP and preampullary duodenal atresia were detected. Gastrorrhaphy and duodenoduodenostomy were performed in the same operation. The patient was discharged on the 15th postoperative day. This complicated disease can be treated by early diagnosis and surgical intervention. We choose one-stage operation because of the clean peritoneal cavity. However, generalized peritonitis may require two-stage operation in delayed cases.

  15. Duodenal adenocarcinoma: Advances in diagnosis and surgical management

    Institute of Scientific and Technical Information of China (English)

    Jordan M Cloyd; Elizabeth George; Brendan C Visser

    2016-01-01

    Duodenal adenocarcinoma is a rare but aggressive malignancy. Given its rarity, previous studies have traditionally combined duodenal adenocarcinoma(DA) with either other periampullary cancers or small bowel adenocarcinomas, limiting the available data to guide treatment decisions. Nevertheless, management primarily involves complete surgical resection when technically feasible. Surgery may require pancreaticoduodenectomy or segmental duodenal resection; either are acceptable options as long as negative margins are achievable and an adequate lymphadenectomy can be performed. Adjuvant chemotherapy and radiation are important components of multi-modality treatment for patients at high risk of recurrence. Further research would benefit from multiinstitutional trials that do not combine DA with other periampullary or small bowel malignancies. The purpose of this article is to perform a comprehensive review of DA with special focus on the surgical management and principles.

  16. Transoral treatment of Zenker diverticulum: flexible endoscopy versus endoscopic stapling. A retrospective comparison of outcomes.

    Science.gov (United States)

    Repici, A; Pagano, N; Fumagalli, U; Peracchia, A; Narne, S; Malesci, A; Rosati, R

    2011-05-01

    Transoral stapled diverticulo-esophagostomy (TSDE) has gained increased popularity in surgical treatment of Zenker diverticulum (ZD). One of the advantages of this approach is early rehabilitation with significant decrease in patient morbidity and time to resumption of oral intake as compared with open treatment. The section of the septum between the diverticulum and the esophagus with a flexible endoscopic (ES) approach has also been proposed since mid-90s as an alternative for treatment of ZD. Both these approaches are a minimally invasive approach to treat ZD. We compared the TSDE management of ZD versus the ES treatment in a retrospective consecutive series of patients who were referred to either the ES or surgical unit of our Institute. Fifty-eight consecutive patients underwent treatment for ZD either by TSDE or ES. The two techniques were evaluated for length of hospital stay, diverticulum size, resumption of oral intake, resolution of dysphagia, and complications. Clinical outcome was evaluated throughout a symptom score from 0 to 3, calculated before and after the procedure. The two groups were compared on the various parameters using a Mann--Whitney test. Twenty-eight patients underwent ES and 30 TSDE for ZD. In both groups, a significant decrease in postoperative versus preoperative dysphagia was reported. The average length of hospital stay wasn't significantly different in the two groups (3.38 days for TSDE vs. 2.42 days for ES). The overall complication rate was similar in the two groups. There were two cases in the ES group and three cases in the TDSE group that required an ES revision to take down a residual diverticular wall that produced a mild but persistent dysphagia. Minimally invasive treatment of ZD both with ES and with TSDE is a valuable option for this disease: both techniques are safe and effective, with similar outcome in terms of hospital stay, symptom reduction, and complication rate. Long-term results have to be evaluated.

  17. Large Epiphrenic Diverticulum with Perforation and Leakage below the Diaphragm: A Case Report

    DEFF Research Database (Denmark)

    Brønserud, Majken Munk; Brenøe, Anne-Sofie; Eckardt, Jens

    2015-01-01

    contrast revealed contrast leakage near the minor curvature of the stomach. The following esophagogastroduodenoscopy demonstrated a giant dilatation of the esophagus, as well as a second esophageal lumen originating 25 cm from the incisors. The “false” lumen of the esophagus was located parallel...... to esophagus, ending blindly in a perforation below the diaphragm. The clinical presentation and the patient’s age make it most likely, that it was a long epiphrenic diverticulum of pulsion type. The patient was treated conservatively, discharged after 10 days and has been followed in our outpatient clinic...... for 8 months, until he died of aggressive pulmonary cancer....

  18. Surgical management of bladder transitional cell carcinoma in a vesicular diverticulum: case report.

    LENUS (Irish Health Repository)

    Raheem, Omer A

    2012-02-01

    We report a case of primary transitional cell carcinoma (TCC) of a bladder diverticum along with a literature review. A 55-year-old male presented with painless gross hematuria. A histological diagnosis of TCC within a bladder diverticulum was made following cystoscopical examination. Initially transurethral resection of bladder tumour with subsequent intravesical chemotherapy followed. As a result of recurrence and in view of bladder-sparing therapy, a distal partial cystectomy was performed. This report demonstrates that conservative bladder-sparing treatment can be achieved and subsequently followed by vigilant cystoscopy.

  19. Surgical management of bladder transitional cell carcinoma in a vesicular diverticulum: case report.

    LENUS (Irish Health Repository)

    Raheem, Omer A

    2011-08-01

    We report a case of primary transitional cell carcinoma (TCC) of a bladder diverticum along with a literature review. A 55-year-old male presented with painless gross hematuria. A histological diagnosis of TCC within a bladder diverticulum was made following cystoscopical examination. Initially transurethral resection of bladder tumour with subsequent intravesical chemotherapy followed. As a result of recurrence and in view of bladder-sparing therapy, a distal partial cystectomy was performed. This report demonstrates that conservative bladder-sparing treatment can be achieved and subsequently followed by vigilant cystoscopy.

  20. Ruptured Jejunal Diverticulum Due to a Single-Band Small Bowel Obstruction

    Directory of Open Access Journals (Sweden)

    Rajaraman Durai

    2008-01-01

    Full Text Available Jejunal diverticulosis is rare and often goes unnoticed until complications occur. The diverticula are true, acquired diverticula and often asymptomatic. Jejunal diverticulosis can be associated with diverticulosis of the duodenum, ileum, and colon. Here we describe a patient with known severe diverticular disease of the large bowel, who presented acutely with abdominal pain and signs of generalised peritonitis. Laparotomy showed ruptured jejunal diverticulosis with a single band over the terminal ileum, causing small bowel obstruction. Spontaneous perforation of a jejunal diverticulum is rare and is usually an intraoperative finding. One should exclude a precipitating cause, such as coexisting distal obstruction, stricture, or a foreign body.

  1. Duodenal intussusception secondary to web presenting as recurrent pancreatitis in a 7-year-old girl

    Energy Technology Data Exchange (ETDEWEB)

    Tu, Long H. [University of Connecticut School of Medicine, Farmington, CT (United States); Kaweah Delta Healthcare District, Graduate Medical Education, Visalia, CA (United States); Villalona, Gustavo A. [Yale School of Medicine, Department of Surgery, Section of Pediatric Surgery, New Haven, CT (United States); SSM Health Cardinal Glennon Children' s Hospital, Department of Pediatric Surgery, St. Louis, MO (United States); Cowles, Robert A. [Yale School of Medicine, Department of Surgery, Section of Pediatric Surgery, New Haven, CT (United States); Silva, Cicero T. [Yale School of Medicine, Department of Diagnostic Imaging, Section of Pediatric Radiology, 333 Cedar St., P.O. Box 208042, New Haven, CT (United States)

    2016-03-15

    Duodenal intussusception is a rare entity in children, with 32 cases reported in the English literature to our knowledge. Most reported cases are associated with endoluminal tubes or polyps, and the presenting symptoms are chronic and nonspecific. We report a case of duodenal intussusception in a 7-year-old girl secondary to a duodenal web and review the imaging findings. (orig.)

  2. Gastric outlet obstruction from duodenal lipoma in an adult

    Directory of Open Access Journals (Sweden)

    Promise N Wichendu

    2013-01-01

    Full Text Available The duodenum is a rare site for gastrointestinal lipoma with less than 230 cases reported in the literature. Although, peptic ulcer disease remains the most common benign cause of gastric outlet obstruction (GOO, duodenal lipomas remain a rare, but possible cause of GOO and could pose a diagnostic challenge, especially in countries where access to endoscopy and modern imaging techniques poses a challenge. The authors present a case of GOO in a 40-year-old male, secondary to a duodenal lipoma. It was successfully treated by a transduodenal resection through a midline laparotomy. The histology report confirmed it was a submucosal lipoma.

  3. Delayed duodenal hematoma and pancreatitis from a seatbelt injury.

    Science.gov (United States)

    Deambrosis, Katherine; Subramanya, Manjunath S; Memon, Breda; Memon, Muhammed A

    2011-02-01

    Traumatic duodenal hematoma is a rare condition that is encountered in the paediatric age group following blunt abdominal trauma. It poses both a diagnostic and therapeutic challenge. The main concern is increased morbidity secondary to delayed diagnosis and associated occult injuries to the adjacent structures. Most of these hematomas resolve spontaneously with conservative management, and the prognosis is good. We present a case of a 15-year-old boy who had a delayed presentation of duodenal hematoma and acute pancreatitis, which was treated conservatively with complete resolution.

  4. Delayed Duodenal Hematoma and Pancreatitis from a Seatbelt Injury

    Directory of Open Access Journals (Sweden)

    DeAmbrosis, Katherine

    2011-02-01

    Full Text Available Traumatic duodenal hematoma is a rare condition that is encountered in the paediatric age group following blunt abdominal trauma. It poses both a diagnostic and therapeutic challenge. The main concern is increased morbidity secondary to delayed diagnosis and associated occult injuries to the adjacent structures. Most of these hematomas resolve spontaneously with conservative management, and the prognosis is good. We present a case of a 15-year-old boy who had a delayed presentation of duodenal hematoma and acute pancreatitis, which was treated conservatively with complete resolution. [West J Emerg Med. 2011;12(1:128-130.

  5. A Lethal Complication of Endoscopic Therapy: Duodenal Intramural Hematoma

    Directory of Open Access Journals (Sweden)

    Turan Calhan

    2015-01-01

    Full Text Available Duodenal intramural hematoma (DIH usually occurs in childhood and young adults following blunt abdominal trauma. It may also develop in the presence of coagulation disorders and may rarely be an iatrogenic outcome of endoscopic procedures. Management of DIH is usually a conservative approach. A case of intramural duodenal hematoma that developed following endoscopic epinephrine sclerotherapy and/or argon plasma coagulation and that was nonresponsive to conservative therapy in a patient with chronic renal failure who died from sepsis is being discussed in this report. Clinicians should be aware of such possible complications after endoscopic hemostasis in patients with coagulation disorders.

  6. The incidence and prognosis of true duodenal carcinomas

    DEFF Research Database (Denmark)

    Buchbjerg, Thomas; Fristrup, C.; Mortensen, M. B.

    2015-01-01

    Introduction Primary duodenal carcinoma (PDC) is a rare gastrointestinal tumor. The difficult distinction between PDC and other types of carcinoma (e.g. within the periampullary region) is reflected in the scarce literature on true duodenal carcinomas. However, this distinction may be important...... the criteria for true PDC. The incidence was 5.4 per 1,000,000, and the pathological classification was: Adenocarcinoma 87%, mucinous adenocarcinoma 7%, carcinoma 4% and signet ring cell carcinoma 1%. Intended curative resection was performed in 28 patients (39%) (22 Whipple procedures and 6 local resections...

  7. Sigmoid colon cancer arising in a diverticulum of the colon with involvement of the urinary bladder: a case report and review of the literature

    Science.gov (United States)

    2014-01-01

    Background Colon cancer can arise from the mucosa in a colonic diverticulum. Although colon diverticulum is a common disease, few cases have been previously reported on colon cancer associated with a diverticulum. We report a rare case of sigmoid colon cancer arising in a diverticulum with involvement of the urinary bladder, which presented characteristic radiographic images. Case presentation A 73-year-old man was admitted to our hospital for macroscopic hematuria. Computed tomography and magnetic resonance imaging revealed a sigmoid colon tumor that protruded into the urinary bladder lumen. The radiographs showed a tumor with a characteristic dumbbell-shaped appearance. Colonoscopy showed a type 1 cancer and multiple diverticula in the sigmoid colon. A diagnosis of sigmoid colon cancer with involvement of the urinary bladder was made based on the pathological findings of the biopsied specimens. We performed sigmoidectomy and total resection of the urinary bladder with colostomy and urinary tract diversion. Histopathological findings showed the presence of a colovesical fistula due to extramurally growing colon cancer. Around the colon cancer, the normal colon mucosa was depressed sharply with lack of the muscular layer, suggesting that the colon cancer was arising from a colon diverticulum. Conclusion The present case is the first report of sigmoid colon cancer arising in a diverticulum with involvement of the urinary bladder. Due to an accurate preoperative radiological diagnosis, we were able to successfully perform a curative resection for sigmoid colon cancer arising in a diverticulum with involvement of the urinary bladder. PMID:24884743

  8. Novel deployment of a covered duodenal stent in open surgery to facilitate closure of a malignant duodenal perforation

    Directory of Open Access Journals (Sweden)

    Psaila Josephine

    2009-10-01

    Full Text Available Abstract Background Its a dilemma to attempt a palliative procedure to debulk the tumour and/or prevent future obstructive complications in a locally advanced intra abdominal malignancy. Case presentation A 38 year old Vietnamese man presented with a carcinoma of the colon which had invaded the gallbladder and duodenum with a sealed perforation of the second part of the duodenum. Following surgical exploration, it was evident that primary closure of the perforated duodenum was not possible due to the presence of unresectable residual tumour. Conclusion We describe a novel technique using a covered duodenal stent deployed at open surgery to aid closure of a malignant duodenal perforation.

  9. Giant sacral meningeal diverticulum containing a thickened filum with lipoma in an adult with spinal cord tethering. Case report and review of the literature.

    Science.gov (United States)

    Feigenbaum, Frank

    2008-09-01

    An unusual case of a patient with a giant intrasacral meningeal diverticulum and spinal cord tethering with a thickened filum is presented. Instead of being empty as is typical, the meningeal diverticulum in this case contained a segment of the thickened tethering filum, which entered from the thecal sac through an ostium. A search of the literature revealed no prior description of a meningeal diverticulum containing a portion of tethered filum or any other structure. Only 2 previous cases of intrasacral meningeal cyst and spinal cord tethering with a thickened filum were found, both in the non-English literature.

  10. Effect of oral epidermal growth factor on mucosal healing in rats with duodenal ulcer

    Institute of Scientific and Technical Information of China (English)

    Jane CJ Chao; Kuo-Yu Liu; Sheng-Hsuan Chen; Chia-Lang Fang; Chih-Wei Tsao

    2003-01-01

    AIM: To investigate the effect of epidermal growth factor (EGF) on mucosal healing in rats with duodenal ulcer.METHODS: Male Sprague-Dawley rats were randomly divided into sham operation without EGF, sham operation with EGF, duodenal ulcer without EGF, or duodenal ulcer with EGF groups. Additionally, normal rats without operation served as the control group. Duodenal ulcer was induced in rats by 300 mL/L acetic acid. Rats with EGF were orally administered at a dose of 60 μg/kg/day in drinking water on the next day of operation (day 1). Healing of duodenal ulcer was detected by haematoxylin and eosin staining. Cell growth of damaged mucosa was determined by the contents of nucleic acids and proteins. The level of EGF in duodenal mucosa was measured by ELISA.RESULTS: The pathological results showed that duodenal ulcer rats with EGF improved mucosal healing compared with those without EGF after day 5. Duodenal ulcer rats with EGF significantly increased duodenal DNA content compared with those without EGF on day 15 (6.44±0.54mg/g VS 1.45±0.52 mg/g mucosa, P<0.05). Duodenal RNA and protein contents did not differ between duodenal ulcer rats with and without EGF during the experimental period.Sham operation and duodenal ulcer rats with EGF significantly increased duodenal mucosal EGF content compared with those without EGF on day 5 (76.0±13.7 ng/g VS 35.7±12.9ng/g mucosa in sham operation rats, and 68.3±10.9 ng/gVS 28.3±9.2 ng/g mucosa in duodenal ulcer rats, P<0.05).CONCLUSION: Oral EGF can promote mucosal healing of the rats with duodenal ulcer by stimulating mucosal proliferation accompanied by an increase in mucosal EGF content.

  11. Phytobezoar impaction in a Meckel’s diverticulum; a rare cause of bowel obstruction: Case report and review of literature

    Directory of Open Access Journals (Sweden)

    Bassem Abou Hussein

    2017-01-01

    Conclusion: Complicated Meckel’s diverticulum can have different clinical presentations and can cause bowel obstruction. An association with bezoars impaction is possible and it should be suspected in adult patients presenting with bowel obstruction of unknown causes especially those with high vegetarian diet.

  12. Endoscopic ultrasound with double-balloon endoscopy for the diagnosis of inverted Meckel’s diverticulum: a case report

    Directory of Open Access Journals (Sweden)

    Araki Akihiro

    2012-09-01

    Full Text Available Abstract Introduction Inverted Meckel’s diverticulum has usually been misdiagnosed in the cases based on computed tomography images presented in the literature. The final diagnosis was made intra-operatively or by pathology reports after surgery. Despite this, preoperative diagnosis could be made successfully by using endoscopic ultrasound with double-balloon endoscopy prior to surgery. Case presentation A 60-year-old Japanese woman with severe anemia complained of several episodes of black stool over the preceding 2 years. Abdominal computed tomography showed a 3.0-cm low-density tumor in the ileum, suggesting a diagnosis of intestinal lipoma. Examination of the tumor by endoscopic ultrasound with double-balloon endoscopy revealed a hypo-echoic layer corresponding to the muscularis propria, and a hyper-echoic layer corresponding to the fat tissue. These findings, which suggested that the tumor included areas outside the intestinal serosa, are not typical for a lipoma, despite the existence of a hyper-echoic layer corresponding to fatty tissue. We then considered a diagnosis of inverted Meckel’s diverticulum. Conclusion Lipoma and inverted Meckel’s diverticulum are difficult to differentially diagnose by computed tomography. Polypectomy is the preferred therapeutic approach when a lipoma is present; however, polypectomy in a patient with Meckel’s diverticulum requires full-thickness resection. Situations where polypectomy is performed without preparing for full-thickness resection can be avoided by first making a precise diagnosis using double-balloon endoscopy and endoscopic ultrasound.

  13. Efficacy of Combined Laparoscopic and Hysteroscopic Repair of Post-Cesarean Section Uterine Diverticulum: A Retrospective Analysis

    Directory of Open Access Journals (Sweden)

    Cuilan Li

    2016-01-01

    Full Text Available Background. Diverticulum, one of the long-term sequelae of cesarean section, can cause abnormal uterine bleeding and increase the risk of uterine scar rupture. In this study, we aimed to evaluate the efficacy of combined laparoscopic and hysteroscopic repair, a newly occurring method, treating post-cesarean section uterine scar diverticulum. Methods. Data relating to 40 patients with post-cesarean section uterine diverticulum who underwent combined laparoscopic and hysteroscopic repair were retrospectively analyzed. Preoperative clinical manifestations, size of uterine defects, thickness of the lower uterine segment (LUS, and duration of menstruation were compared with follow-up findings at 1, 3, and 6 months after surgery. Results. The average preoperative length and width of uterine diverticula and thickness of the lower uterine segment were recorded and analyzed. The average durations of menstruations at 1, 3, and 6 months after surgery were significantly shorter than the preoperative one (p<0.05, respectively. At 6 months after surgery, the overall success improvement rate of surgery was 90% (36/40. Three patients (3/40 = 7.5% developed partial improvement, and 1/40 (2.5% was lost to follow-up. Conclusions. Our findings showed that combined treatment with laparoscopy and hysteroscopy was an effective method for the repair of post-cesarean section uterine diverticulum.

  14. Long-term results of endosurgical and open surgical approach for Zenker diverticulum

    Institute of Scientific and Technical Information of China (English)

    Luigi Bonavina; Davide Bona; Medhanie Abraham; Greta Saino; Emmanuele Abate

    2007-01-01

    AIM: To assess the effectiveness of minimally invasive versus traditional open surgical approach in the treatment of Zenker diverticulum.METHODS: Between 1976 and 2006, 297 patients underwent transoral stapling (n = 181) or stapled diverticulectomy and cricopharyngeal myotomy (n = 116). Subjective and objective evaluations of the outcome of the two procedures were made at 1 and 6 mo after operation, and then every year. Long-term follow-up data were available for a subgroup of patients at a minimum of 5 and 10 years.RESULTS: The operative time and hospital stay were markedly reduced in patients undergoing the endosurgical approach. Overall, 92% of patients undergoing the endosurgical approach and 94% of those undergoing the open approach were symptom-free or were significantly improved after a median follow-up of 27 and 48 mo, respectively. At a minimum follow-up of 5 and 10 years, most patients were asymptomatic after both procedures, except for those individuals undergoing an endosurgical procedure for a small diverticulum (< 3cm).CONCLUSION: Both operations relieve the outflow obstruction at the pharyngoesophageal junction,indicating that cricopharyngeal myotomy has an important therapeutic role in this disease independent of the resection of the pouch and of the surgical approach.Diverticula smaller than 3 cm represent a formal contraindication to the endosurgical approach because the common wall is too short to accommodate one cartridge of staples and to allow complete division of the sphincter.

  15. Cardiac anomalies in Cantrell's pentalogy: From ventricular diverticulum to complete thoracic ectopia cordis.

    Science.gov (United States)

    Kaouthar, Hakim; Jihen, Ayari; Faten, Jebri; Hela, Msaad; Fatma, Ouarda; Lilia, Chaker; Rafik, Boussaada

    2013-01-01

    Cantrell's pentalogy is a very rare syndrome associating varying degrees of midline wall defects and congenital cardiac anomalies. It is characterized by a combination of five anomalies that are: a midline supra umbilical abdominal wall defect, a sternal defect, an anterior diaphragmatic defect, a diaphragmatic pericardial defect and a congenital intra cardiac defect. Ectopia cordis, defined as a developmental defect in which the heart is abnormally located partially or totally outside the thorax, is in some cases a part of this syndrome. We report two cases of Cantrell's pentalogy in which cardiac ectopia was complete in one case and limited to left ventricular diverticulum in the other case. Both cases had a common intracardiac defect which is a double outlet right ventricle. The first case underwent surgical repair of the intracardiac lesions with resection of the diverticulum associated to repair of the midline defects with good outcome. The second case that presented with complete extra thoracic ectopia cordis died because of sepsis. We review through this article the main characteristics of Cantrell's pentalogy, we highlight the diversity of anatomic lesions and study the prognosis of this syndrome.

  16. Cardiac anomalies in Cantrell’s pentalogy: From ventricular diverticulum to complete thoracic ectopia cordis

    Science.gov (United States)

    Kaouthar, Hakim; Jihen, Ayari; Faten, Jebri; Hela, Msaad; Fatma, Ouarda; Lilia, Chaker; Rafik, Boussaada

    2014-01-01

    Summary Cantrell’s pentalogy is a very rare syndrome associating varying degrees of midline wall defects and congenital cardiac anomalies. It is characterized by a combination of five anomalies that are: a midline supra umbilical abdominal wall defect, a sternal defect, an anterior diaphragmatic defect, a diaphragmatic pericardial defect and a congenital intra cardiac defect. Ectopia cordis, defined as a developmental defect in which the heart is abnormally located partially or totally outside the thorax, is in some cases a part of this syndrome. We report two cases of Cantrell’s pentalogy in which cardiac ectopia was complete in one case and limited to left ventricular diverticulum in the other case. Both cases had a common intracardiac defect which is a double outlet right ventricle. The first case underwent surgical repair of the intracardiac lesions with resection of the diverticulum associated to repair of the midline defects with good outcome. The second case that presented with complete extra thoracic ectopia cordis died because of sepsis. We review through this article the main characteristics of Cantrell’s pentalogy, we highlight the diversity of anatomic lesions and study the prognosis of this syndrome. PMID:25541632

  17. Karyotype analysis of a male exhibiting Meckel's diverticulum and aural atresia

    Energy Technology Data Exchange (ETDEWEB)

    Frizzell, B.; Hicks, M.F. (David Lipscomb Univ., Nashville, TN (United States))

    Patau's Syndrome is caused by inheritance of an extra chromosome 13. It is characterized primarily by severe mental retardation, cleft palate, and retarded growth. Most fetuses expressing Patau's Syndrome spontaneously abort, and those that are born usually die before one year. Both Meckel's diverticulum and aural atresia are defects found in patients with Patau's at levels higher than those in the general population. An otherwise asymptomatic male expressing only Meckel's diverticulum and aural atresia has a female sibling whose son expressed Patau's syndrome. Twenty percent of patients with Patau's show a translocation of part of chromosome 13 to another D chromosome. If a translocation were the cause of the expression of Patau's in this family, it is possible that the normal male inherited a balanced translocation and the Patau's male received an unbalanced translocation. A karyotype analysis of the non-Patau's male was done to determine if such a translocation were present.

  18. Gastric pneumatosis associated with duodenal stenosis and malrotation

    Energy Technology Data Exchange (ETDEWEB)

    Kawano, Shoji [Dept. of Paediatrics, Kawasaki Medical School, Okayama (Japan); Dept. of Paediatrics, Shimonoseki Municipal Hospital, Yamaguchi (Japan); Tanaka, Hiroyuki; Daimon, Yusuke; Niizuma, Takahiro; Terada, Kihei; Kataoka, Naoki [Dept. of Paediatrics, Kawasaki Medical School, Okayama (Japan); Iwamura, Yoshinobu; Aoyama, Kohji [Department of Paediatric Surgery, Kawasaki Medical School, Okayama (Japan)

    2001-09-01

    Pneumatosis intestinalis, which is linear or cystic gas within the bowel wall, is usually found in premature babies in association with necrotizing enterocolitis. Gastric pneumatosis defined as intramural gas of the stomach is a rare sign during infancy. We report an infant with Down's syndrome and a duodenal web with obvious gastric pneumatosis. (orig.)

  19. Duodenal atresia in association with situs inversus abdominus

    Directory of Open Access Journals (Sweden)

    Raghu Shankar

    2012-01-01

    Full Text Available We report a rare association of duodenal atresia with situs inversus abdominus in a newborn. The infantogram revealed "reverse double-bubble sign" without dextrocardia. The sonography and echocardiography confirmed the diagnosis of situs inversus abdominus with multiple cardiac anomalies. Laparotomy and a duodenoduodenostomy were carried out.

  20. Spontaneous oesophageal rupture with duodenal atresia in a newborn infant.

    OpenAIRE

    1981-01-01

    A newborn infant with spontaneous oesophageal rupture associated with duodenal atresia is described. The diagnosis was established by the pattern of hydropneumothorax on the chest x-ray film and by the aspiration of gastric juice by thoracocentesis. Necropsy showed a tear, which extended from the oesophagogastric junction to the upper portion of the stomach.

  1. Duodenal Toxicity After Fractionated Chemoradiation for Unresectable Pancreatic Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Kelly, Patrick; Das, Prajnan; Pinnix, Chelsea C.; Beddar, Sam; Briere, Tina; Pham, Mary; Krishnan, Sunil; Delclos, Marc E. [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Crane, Christopher H., E-mail: ccrane@mdanderson.org [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States)

    2013-03-01

    Purpose: Improving local control is critical to improving survival and quality of life for patients with locally advanced unresectable pancreatic cancer (LAPC). However, previous attempts at radiation dose escalation have been limited by duodenal toxicity. In order to guide future studies, we analyzed the clinical and dosimetric factors associated with duodenal toxicity in patients undergoing fractionated chemoradiation for LAPC. Methods and Materials: Medical records and treatment plans of 106 patients with LAPC who were treated with chemoradiation between July 2005 and June 2010 at our institution were reviewed. All patients received neoadjuvant and concurrent chemotherapy. Seventy-eight patients were treated with conventional radiation to 50.4 Gy in 28 fractions; 28 patients received dose-escalated radiation therapy (range, 57.5-75.4 Gy in 28-39 fractions). Treatment-related toxicity was graded according to Common Terminology Criteria for Adverse Events, version 4.0. Univariate and multivariate analyses were performed to assess prognostic influence of clinical, pathologic, and treatment-related factors by using Kaplan-Meier and Cox regression methods. Results: Twenty patients had treatment-related duodenal toxicity events, such as duodenal inflammation, ulceration, and bleeding. Four patients had grade 1 events, 8 had grade 2, 6 had grade 3, 1 had grade 4, and 1 had grade 5. On univariate analysis, a toxicity grade ≥2 was associated with tumor location, low platelet count, an absolute volume (cm{sup 3}) receiving a dose of at least 55 Gy (V{sub 55} {sub Gy} > 1 cm{sup 3}), and a maximum point dose >60 Gy. Of these factors, only V{sub 55} {sub Gy} ≥1 cm{sup 3} was associated with duodenal toxicity on multivariate analysis (hazard ratio, 6.7; range, 2.0-18.8; P=.002). Conclusions: This study demonstrates that a duodenal V{sub 55} {sub Gy} >1 cm{sup 3} is an important dosimetric predictor of grade 2 or greater duodenal toxicity and establishes it as a

  2. Acute small bowel obstruction as a result of a Meckel's diverticulum encircling the terminal ileum: A case report

    Directory of Open Access Journals (Sweden)

    Thakor Avnesh S

    2007-03-01

    Full Text Available Abstract Background In the developed world, small bowel obstruction accounts for 20% of all acute surgical admissions. The aetiology for majority of these cases includes postoperative adhesions and herniae. However, a relatively uncommon cause is a Meckel's diverticulum. Although this diagnosis is primarily reported in the adolescent population, it should also be considered in adults. Case Presentation In the present report, we present a rare case where a fit and healthy 74-year-old gentleman, with no previous history of abdominal surgery, presented with the cardinal symptoms and signs of small bowel obstruction as the result of a Meckel's diverticulum encircling his terminal ileum. Initial investigations included a supine abdominal x-ray showing dilated loops of small bowel and computerised tomographic imaging of the abdomen, which revealed a stricture in the terminal ileum of unknown aetiology. At laparotomy, multiple loops of distended small bowel were seen from the duodeno-jeujenal junction to the terminal ileum, which was encircled by a Meckel's diverticulum. The Meckel's diverticulum was then divided to release the obstruction, mobilised and subsequently removed. Finally, the small bowel contents were decompressed into the stomach and the nasogastric tube aspirated, before returning the loops of bowel into the abdomen in sequence. The patient made a good postoperative recovery and was discharged home 5 days later. Conclusion This report highlights the importance of considering a Meckel's diverticulum as a cause of small bowel obstruction in individuals from all age groups and especially in a person with no previous abdominal pathology or surgery.

  3. High degree of duodenal inflammation in Nigerians with functional dyspepsia

    Directory of Open Access Journals (Sweden)

    Nwokediuko SC

    2013-12-01

    Full Text Available Sylvester Chuks Nwokediuko,1 Uchenna N Ijoma,1 Olive Obienu,1 Gideon E Anigbo,1 Okechukwu Okafor21Department of Medicine, 2Department of Morbid Anatomy, University of Nigeria Teaching Hospital, Ituku/Ozalla Enugu, NigeriaBackground: Functional dyspepsia (FD is a heterogeneous disorder associated with diverse pathophysiological mechanisms, including immune activation and low-grade mucosal inflammation. Genetic factors, physiological functions, and environmental factors may determine the relative importance of various pathophysiological mechanisms. This study was designed to determine the histological alterations in the duodenal mucosa of Nigerian patients with FD.Methods: Consecutive patients with dyspepsia seen over a 27-month period in two gastrointestinal endoscopy facilities in Enugu, South-East Nigeria were further evaluated with upper gastrointestinal endoscopy and duodenal mucosal biopsies if no lesion was found in the upper gastrointestinal tract. Patients with heartburn and/or regurgitation who did not have any dyspeptic symptoms and did not have any lesion in the upper gastrointestinal tract on endoscopy were presumed to have non-erosive reflux disease (NERD and they served as controls. The control subjects also had duodenal biopsies. The histopathological findings in the cases and controls were compared.Results: There were 68 patients with FD and 52 patients with NERD. The total inflammatory score was 242 in FD and 66 in NERD (Mann-Whitney U =1168, P=0.0011. Similarly, the scores for chronic inflammation, gastric metaplasia, neutrophilic activity, eosinophilic infiltration, and Helicobacter pylori were significantly higher in FD than NERD.Conclusion: Functional dyspepsia is associated with a high degree of inflammation in the duodenal mucosa. This may reflect the high prevalence of gastrointestinal infections in a tropical environment such as Nigeria. These findings may have therapeutic potential that further studies might elucidate

  4. Loss of intestinal O-glycans promotes spontaneous duodenal tumors.

    Science.gov (United States)

    Gao, Nan; Bergstrom, Kirk; Fu, Jianxin; Xie, Biao; Chen, Weichang; Xia, Lijun

    2016-07-01

    Mucin-type O-glycans, primarily core 1- and core 3-derived O-glycans, are the major mucus barrier components throughout the gastrointestinal tract. Previous reports identified the biological role of O-glycans in the stomach and colon. However, the biological function of O-glycans in the small intestine remains unknown. Using mice lacking intestinal core 1- and core 3-derived O-glycans [intestinal epithelial cell C1galt1(-/-);C3GnT(-/-) or double knockout (DKO)], we found that loss of O-glycans predisposes DKO mice to spontaneous duodenal tumorigenesis by ∼1 yr of age. Tumor incidence did not increase with age; however, tumors advanced in aggressiveness by 20 mo. O-glycan deficiency was associated with reduced luminal mucus in DKO mice before tumor development. Altered intestinal epithelial homeostasis with enhanced baseline crypt proliferation characterizes these phenotypes as assayed by Ki67 staining. In addition, fluorescence in situ hybridization analysis reveals a significantly lower bacterial burden in the duodenum compared with the large intestine. This phenotype is not reduced with antibiotic treatment, implying O-glycosylation defects, rather than bacterial-induced inflammation, which causes spontaneous duodenal tumorigenesis. Moreover, inflammatory responses in DKO duodenal mucosa are mild as assayed with histology, quantitative PCR for inflammation-associated cytokines, and immunostaining for immune cells. Importantly, inducible deletion of intestinal O-glycans in adult mice leads to analogous spontaneous duodenal tumors, although with higher incidence and heightened severity compared with mice with O-glycans constitutive deletion. In conclusion, these studies reveal O-glycans within the small intestine are critical determinants of duodenal cancer risk. Future studies will provide insights into the pathogenesis in the general population and those at risk for this rare but deadly cancer.

  5. Severe acute abdomen caused by symptomatic Meckel's diverticulum in three children with trisomy 18.

    Science.gov (United States)

    Hayashi, Anri; Kumada, Tomohiro; Furukawa, Oki; Nozaki, Fumihito; Hiejima, Ikuko; Shibata, Minoru; Kusunoki, Takashi; Fujii, Tatsuya

    2015-10-01

    Meckel's diverticulum (MD) is the most prevalent congenital anomaly of the gastrointestinal tract and often presents a diagnostic challenge. Patients with trisomy 18 frequently have MD, but the poor prognosis and lack of consensus regarding management for neonates has meant that precise information on the clinical manifestations in infants and children with MD is lacking. We describe the cases of three children with trisomy 18 who developed symptomatic MD. Intussusception was diagnosed in Patient 1, intestinal volvulus in Patient 2, and gastrointestinal bleeding in Patient 3. All three patients underwent surgical treatment and only the Patient 1 died due to pulmonary hypertensive crisis. The other two patients experienced no further episodes of abdominal symptoms. In patients with trisomy 18, although consideration of postoperative complications and prognosis after surgical treatment is necessary, symptomatic MD should carry a high index of suspicion in patients presenting with acute abdomen.

  6. Laparoscopic surgery for small-bowel obstruction caused by Meckel’s diverticulum

    Institute of Scientific and Technical Information of China (English)

    Takatsugu Matsumoto; Motoki Nagai; Daisuke Koike; Yukihiro Nomura; Nobutaka Tanaka

    2016-01-01

    A 26-year-old woman was referred to our hospital because of abdominal distention and vomiting. Contrastenhanced computed tomography showed a blind loop of the bowel extending to near the uterus and a fibrotic band connecting the mesentery to the top of the bowel,suggestive of Meckel’s diverticulum(MD) and a mesodiverticular band(MDB). After intestinal decompression,elective laparoscopic surgery was carried out. Using three 5-mm ports,MD was dissected from the surrounding adhesion and MDB was divided intracorporeally. And subsequent Meckel’s diverticulectomy was performed. The presence of heterotopic gastric mucosa was confirmed histologically. The patient had an uneventful postoperative course and was discharged 5 d after the operation. She has remained healthy and symptom-free during 4 years of follow-up. This was considered to be an unusual case of preoperatively diagnosed and laparoscopically treated small-bowel obstruction due to MD in a young adult woman.

  7. Intussusception of the small bowel secondary to an enterolith from a jejunal diverticulum.

    Science.gov (United States)

    di Marco, Aimee N; Purkayastha, Sanjay; Zacharakis, Emmanouil

    2012-09-01

    We report a case of acute, small bowel obstruction secondary to intussusception caused by an enterolith from a jejunal diverticulum, in an elderly female with a history of chronic, intermittent abdominal pain. Diagnostic work-up of the patient included a computed tomographic (CT) scan which demonstrated the intussusception, but not the enterolith, which was characteristically radiolucent. A laparotomy was performed and the enterolith was found and delivered. A fistula between the gallbladder and small bowel was sought, but not found. Multiple diverticulae were found throughout the small bowel. Although small bowel diverticulosis is rare, it should be considered in the differential diagnosis of the acute abdomen and chronic abdominal pain, especially in those with known colonic diverticulosis, in whom this condition is more common.

  8. Sepsis-Associated Encephalopathy in a Child with the Torsion of Meckel s Diverticulum

    Directory of Open Access Journals (Sweden)

    Esra Gurkas

    2016-05-01

    Full Text Available Sepsis-associated encephalopathy (SEA is a diffuse brain dysfunction secondary to the systemic response to infection and is associated with high mortality rate. We report a 4-year-old boy with SEA. He presented with abdominal pain and vomiting. On the second day of admission, he developed consciousness disturbance with impaired attention, confusion and delirium. Routine laboratory tests, brain magnetic resonance imaging and cerebrospinal fluid examination were normal. Electroencephalography (EEG showed high-voltage slow wave activity on the right hemisphere with epileptiform discharge. He immediately underwent surgery and a torsed, gangrenous Meckel%u2019s diverticulum with extension of ischemia to adjacent small bowel was seen and resected. His consciousness had become normal by the third day and he was discharged without any sequela. To overcome a poor prognosis in patients with SEA, the early recognition of the symptoms of SEA and also appropriate treatment of the underlying cause are essential.

  9. Acquired urethral diverticulum in a man with paraplegia presenting with a scrotal mass: a case report

    Directory of Open Access Journals (Sweden)

    El Ammari Jalal Eddine

    2012-11-01

    Full Text Available Abstract Introduction Male urethral diverticula are rare. Patients with paraplegia may present with acquired diverticula as a result of prolonged catheterization. Diverticula may be asymptomatic or lead to lower urinary tract symptoms. Rarely, the diverticulum may initially present as a scrotal mass. Case presentation We report the case of a male 45-year-old Arab with paraplegia who presented with a mass in the peno-scrotal junction. He had in his medical history iterative prolonged urethral catheterizations associated with urine leakage through the urethral meatus upon applying compression. Diagnosis confirmation of urethral diverticula is obtained by retrograde urethrography. The patient underwent a diverticulectomy with urethroplasty. Conclusion Male acquired urethral diverticula can be found in patients who have a spinal cord injury because of prolonged urethral catheterization. Clinical presentations are different and sometimes can be misleading. Retrograde urethrography is the key to diagnosis and open surgery is the treatment of reference.

  10. Penile Urethral Hypospadias with Two Fistulae and Diverticulum in a Saanen Kid

    Directory of Open Access Journals (Sweden)

    Areeg Mohamed Almubarak

    2016-01-01

    Full Text Available Hypospadias is a rare congenital defect reported in most animal species and humans. This case study reports a hypospadiac case in a goat kid with urethral diverticulum diagnosed in Sudan for the first time. A 45-day-old male kid was presented to the Veterinary Teaching Hospital, College of Veterinary Medicine, Sudan University of Science and Technology (SUST, with a history of an increasing prescrotal swelling. At presentation in the clinic the kid was bright and alert and the vital parameters were within the normal physiological range. Ultrasonography was performed to assess the integrity of the urinary system using (3.5–5 MHz curvilinear probe and it revealed normal kidneys and a distended urinary bladder. The kid was referred to surgery and two hypospadiac urinary fistulae were found. One fistula was sutured and the other was not corrected due to catheterization failure.

  11. Peritonitis Aguda por Diverticulo Apendicular Perforado / Acute perforated diverticulum appendiceal peritonitis

    Directory of Open Access Journals (Sweden)

    Martinez Villalba N

    2015-11-01

    Full Text Available Appendix diverticular disease is a casual finding after appendectomies or pathological studies of surgical samples. Most patients are male adults between the fourth and fifth decade of life. 16 years old male consults for a 48 hours stitch pain in right iliac fossa of moderate intensity radiating to lower abdomen with nausea and fever, without vomiting or diarrhea. Presents lower abdominal pain with muscle guarding and pain on physical examination. Bowel sounds negative. Laboratory routine study shows leukocytosis with neutrophilia. A perforated diverticulum of about 15cm diameter is found during surgery in the middle third of the cecum appendix with 200cc purulent fluid in and multiple adhesions to transverse colon, omentum and small intestine. A conventional appendectomy is performed. Acute appendix diverticulitis is a rare entity and its finding is by casualty. It is important to consider it a differential diagnosis especially in the intraoperative treatment which in most cases does not differ from conventional appendectomy.

  12. Early Rupture of an Ultralow Duodenal Stump after Extended Surgery for Gastric Cancer with Duodenal Invasion Managed by Tube Duodenostomy and Cholangiostomy

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    Konstantinos Blouhos

    2013-01-01

    Full Text Available When dealing with gastric cancer with duodenal invasion, gastrectomy with distal resection of the duodenum is necessary to achieve negative distal margin. However, rupture of an ultralow duodenal stump necessitates advanced surgical skills and close postoperative observation. The present study reports a case of an early duodenal stump rupture after subtotal gastrectomy with resection of the whole first part of the duodenum, complete omentectomy, bursectomy, and D2+ lymphadenectomy performed for a pT3pN2pM1 (+ number 13 lymph nodes adenocarcinoma of the antrum. Duodenal stump rupture was managed successfully by end tube duodenostomy, without omental patching, and tube cholangiostomy. Close assessment of clinical, physical, and radiological signs, output volume, and enzyme concentration of the tube duodenostomy, T-tube, and closed suction drain, which was placed near the tube duodenostomy site to drain the leak around the catheter, dictated postoperative management of the external duodenal fistula.

  13. An Unusual Cause of Duodenal Obstruction: Persimmon Phytobezoar.

    Science.gov (United States)

    Fan, Shengxian; Wang, Jing; Li, Yousheng

    2016-12-01

    Duodenal phytobezoar, an unusual cause of acute duodenal obstruction, is rarely seen. The most common cause of this type of bezoar is persimmon. It frequently arises from underlying gastrointestinal tract pathologies (gastric surgery, etc.). Here, we report the case of a 66-year-old man who had undergone distal gastrectomy with Billroth I reconstruction for gastric cancer and experienced severe epigastric discomfort, abdominal pain, and vomiting for a few days. The abdominal computed tomography scan showed a large-sized mass in the horizontal portion of the duodenum. On following endoscopic examination, a large phytobezoar was revealed in the duodenum. He was treated with endoscopic fragmentation combined with nasogastric Coca-Cola. The patient tolerated the procedure well and resumed a normal oral diet 3 days later.

  14. Total Robotic Biliopancreatic Diversion with Duodenal Switch Technique.

    Science.gov (United States)

    Antanavicius, Gintaras; Mohammed, Ricardo; Van Houtte, Olivier

    2016-12-31

    The use of robotic bariatric surgery has increased significantly since its advent in 1999. Its utility and safety has been demonstrated in the literature for all bariatric procedures, including most recently the biliopancreatic diversion with duodenal switch (BPDDS). The robotic-assisted biliopancreatic diversion with duodenal switch (RBPDDS) was first described by Sudan et al. in 2007 with the use of the robot primarily for the duodeno-ileal anastomosis, then in 2015, the same authors described 59 cases of totally RBPDDS using the robot for the most of the operation, but still utilizing laparoscopic staplers. Robotic staplers were introduced recently and it became possible to utilize robot throughout the entire procedure without relying on stapling performed by an assistant. Described here is the technique of a total RBPDDS utilizing robotic staplers.

  15. Omeprazole promotes proximal duodenal mucosal bicarbonate secretion in humans

    DEFF Research Database (Denmark)

    Mertz-Nielsen, Anette; Hillingsø, J; Bukhave, Klaus

    1996-01-01

    The proton pump inhibitor, omeprazole, surprisingly resulted in higher rates of proximal duodenal mucosal bicarbonate secretion than previously reported using an H-2 receptor antagonist for gastric acid inhibition. Gastroduodenal perfusions were performed in healthy volunteers to evaluate whether...... this incidental finding is explained by more potent gastric acid inhibition by omeprazole or might be caused by the different mode of drug action. Basal and stimulated gastric and duodenal bicarbonate secretion rates were measured in the same subjects in control experiments (n=17) and after pretreatment with high...... dose omeprazole (n=17) and ranitidine (n=9), respectively, by use of a technique permitting simultaneous measurements. Concentrations of bicarbonate were measured in the respective effluents by the method of back titration. Both omeprazole and ranitidine completely inhibited gastric acid secretion (p...

  16. Omeprazole promotes proximal duodenal mucosal bicarbonate secretion in humans

    DEFF Research Database (Denmark)

    Mertz-Nielsen, A; Hillingsø, Jens; Bukhave, K

    1996-01-01

    The proton pump inhibitor, omeprazole, surprisingly resulted in higher rates of proximal duodenal mucosal bicarbonate secretion than previously reported using an H2 receptor antagonist for gastric acid inhibition. Gastroduodenal perfusions were performed in healthy volunteers to evaluate whether...... this incidental finding is explained by more potent gastric acid inhibition by omeprazole or might be caused by the different mode of drug action. Basal and stimulated gastric and duodenal bicarbonate secretion rates were measured in the same subjects in control experiments (n = 17) and after pretreatment...... with high dose omeprazole (n = 17) and ranitidine (n = 9), respectively, by use of a technique permitting simultaneous measurements. Concentrations of bicarbonate were measured in the respective effluents by the method of back titration. Both omeprazole and ranitidine completely inhibited gastric acid...

  17. Epidermal growth factor inhibits cysteamine-induced duodenal ulcers

    DEFF Research Database (Denmark)

    Poulsen, Steen Seier

    1983-01-01

    The effect of the duodenal ulcerogen cysteamine on secretion of epidermal growth factor from Brunner's gland pouches was studied in the rat. Total output of immunoreactive epidermal growth factor was reduced to approximately 55%, compared with controls, 5 h after administration of cysteamine (300...... mg/kg, s.c.). Furthermore, measurements on tissue extracts of the pouches revealed that 5 h after cysteamine treatment, Brunner's glands were depleted of epidermal growth factor. The effect on ulcer development of intraduodenally applied exogenous epidermal growth factor (1 micrograms/kg . h) also...... factor used, when tested on chronic fistula rats, had no effect on acid secretion and did not influence bicarbonate secretion from Brunner's gland pouches. These results demonstrate that epidermal growth factor has a cytoprotective effect on the duodenal mucosa, and it is suggested that inhibition...

  18. Lipase assay in duodenal juice using a conductimetric method.

    Science.gov (United States)

    Ballot, C; Favre-Bonvin, G; Wallach, J M

    1984-11-15

    Lipase activity in duodenal juice is known to undergo important variations in pathologic states, especially in cases of chronic pancreatitis. Almost all of the current assay methods are based on the measurement of hydrolysis of olive oil or triolein, mainly by potentiometry. As we have developed a conductimetric method for enzyme activity measurements, we have applied it to lipase assay. A higher experimental conductimetric sensitivity is obtained when liberated acids have a short chain (higher limiting equivalent conductivity). We have therefore used triacetin as a substrate and compared out method with potentiometry (pH-stat) and spectrophotometry. The correlation coefficients of both methods with conductimetry were 0.94 and 0.97, respectively, indicating that the conductimetric method may be used for lipase assay in duodenal juice, using triacetin as a substrate.

  19. An uncommon cause of gastro-duodenal ulceration

    Institute of Scientific and Technical Information of China (English)

    Sebastian Mallach; Uwe Ramp; Andreas Erhardt; Marcus Schmitt; Dieter H(a)ussinger

    2008-01-01

    Gastrointestinal ulcers occur frequently and are mainly caused by H pylori infection.In this report, we present a rare case of gastro-duodenal ulcer following selective internal radiation therapy (SIRT).SIRT is a palliative treatment for unresectable liver tumours.During SIRT,90Y-microspheres are infused into the hepatic artery.Pretreatment evaluation for the presence of arterial shunts to neighbouring organs should be determined in order to avoid complications of SIRT.

  20. Gallstone ileus of duodenum with huge duodenal stone

    OpenAIRE

    Mohammad Ehsan; Mohammad Reza Ahangaran

    2006-01-01

    Gastrointestinal obstruction by a gallstone is an uncommon but important complication of biliary stone disease which mostly affects the elderly. The classic triad of radiological features includes pneumobilia, ectopic gallstone and evidence of intestinal obstruction. Terminal ileum is the most common site of obstruction, followed by jejunum and gastric outlet. We present a case of duodenal gallstone ileus of a large, fluid-density mixed biliary stone with a peripheral rim of hyperdensity (ver...

  1. [Perforated duodenal diverticula. Case report and treatment options].

    Science.gov (United States)

    Guardado-Bermúdez, Fernando; Ardisson-Zamora, Fernando Josafat; Rojas-González, Juan Daniel; Medina-Benítez, Alberto; Corona-Suárez, Fernando

    2013-01-01

    Antecedentes: los divertículos duodenales los describió por primera vez Chromel en 1710. El divertículo duodenal es el segundo sitio más frecuente de divertículos en el tubo digestivo, el diagnóstico se limita a los casos con complicaciones y síntomas. Los divertículos duodenales se localizan en 10- 67% en la segunda porción del duodeno. Su hallazgo en la mayoría de los casos es incidental. Cerca de 90% de los pacientes cursan asintomáticos y sólo se manifiestan cuando sobrevienen las complicaciones, como la hemorragia digestiva y la perforación. Caso clínico: paciente femenina de 78 años de edad, que acudió al hospital debido a disnea de medianos esfuerzos y epigastralgia moderada, distensión abdominal, constipación y dificultad para canalizar gases. La laparotomía identificó un divertículo duodenal con perforación en su cúpula de 5 mm que dio pie a la realización de la diverticulectomía. Conclusiones: el diagnóstico de divertículo duodenal, como etiología de abdomen agudo, debe contemplarse en cualquier diagnóstico diferencial con cuadro de abdomen agudo, apoyados siempre en la imagenología y endoscopia. El tratamiento quirúrgico del divertículo duodenal, en especial su resección, sigue siendo la recomendación dirigida a la menor morbilidad y mejor recuperación.

  2. Duodenal gossypiboma: a case report and literature review.

    Science.gov (United States)

    Velasco-Mata, Stephany; Díaz-Gómez, Marialy; Cova-Bianco, Tamarys; Hopp-Mora, Evelyn; Rodriguez-Rojas, Roselin; Chirinos-Malave, Yeirama; Carreiro-Rodriguez, Manuel

    2015-09-01

    Gossypiboma is a retained surgical cotton matrix material in the body after a surgical procedure. Cases are rarely reported due to medico-legal concerns. Although infrequent, it causes serious morbidity and even mortality if left undiagnosed. We present the case of a trans-mural migration of gossypiboma and a review of the literature. Gossypiboma's trans-duodenal migration is a rare complication of retained gauzes. Cases reported in the literature were easy to diagnose based on clinical grounds and endoscopic studies.

  3. An Unusual Cause of Gastrointestinal Bleeding: Duodenal Lipoma

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    R. Kadaba

    2011-04-01

    Full Text Available Common causes of chronic upper gastrointestinal bleeding include oesophageal varices, gastroduodenal ulcers and malignancy, and patients mostly present with iron deficiency type anaemia. We present the case of a 60-year-old lady who presented with iron deficiency anaemia and on investigation was found to have a large duodenal polyp requiring surgical excision. On histological examination, the polyp was revealed to be a lipoma. We review the recent literature and formulate a management plan for this rare entity.

  4. Peptic Ulcer Disease Different Pathogenesis of Duodenal and Gastric Ulcer

    OpenAIRE

    Hendra Koncoro; I Dewa Nyoman Wibawa

    2015-01-01

    Despite decrease frequency of Helicobacter pylori (H. pylori) due to eradication therapy, peptic ulcer disease as a manifestation of this infection is still remain a health burden. Understanding the physiology of gastric acid secretion and its alteration by H. pylori induced inflammation will aid physician in differentiating peptic ulcer disease based on its location. Duodenal ulcer and gastric ulcer disease are two common condition that usually found in peptic ulcer. Recognition of symptoms ...

  5. Perforated duodenal ulcer: An unusual manifestation of allergic eosinophilic gastroenteritis.

    Science.gov (United States)

    Riggle, Kevin M; Wahbeh, Ghassan; Williams, Elizabeth M; Riehle, Kimberly J

    2015-11-28

    Spontaneous perforation of a duodenal ulcer secondary to allergic eosinophilic gastroenteritis (EGE) has not been previously reported. We present such a case in a teenager who presented with peritonitis. After exploration and operative repair of his ulcer, he continued to experience intermittent abdominal pain, and further evaluation revealed eosinophilic gastroenteritis in the setting of multiple food allergies. His EGE resolved after adhering to a restrictive diet. Both duodenal ulcers and EGE are very rarely seen in pediatric patients. EGE has a variable presentation depending on the layer(s) of bowel wall affected and the segment of the gastrointestinal tract that is involved. Once diagnosed, it may respond to dietary changes in patients with recognized food allergies, or to steroids in patients in whom an underlying cause is not identified. Our case highlights the need to keep EGE in the differential diagnosis when treating pediatric patients with duodenal ulcers. The epidemiology, pathophysiology, and treatment of EGE are also discussed, along with a review of the current literature.

  6. Perforated duodenal ulcer: A rare complication of deferasirox in children

    Science.gov (United States)

    Yadav, Sunil Kumar; Gupta, Vipul; El Kohly, Ashraf; Al Fadhli, Wasmi

    2013-01-01

    Duodenal ulcer perforation in pediatric age group is an uncommon entity; hence, it is not usually considered in the differential diagnosis of acute abdomen in these patients. It is important for the emergency physician to consider perforated peptic ulcer in the differential diagnosis of children presenting with acute abdominal pain, gastrointestinal bleeding, or shock. We report a 6½-year-old male child with thalassemia major who presented to emergency room with an acute abdomen and shock, who was subsequently found to have a perforated duodenal ulcer, probably related to use of oral chelating agent, deferasirox. Although, gastrointestinal symptoms like nausea, vomiting, and abdominal pain has been mentioned as infrequent adverse event in the scientific product information of deferasirox, in our current knowledge this is the first case report of perforated duodenal ulcer after oral deferasirox. The severity of this event justifies the reporting of this case. This patient had an atypical presentation in that there were no signs or symptoms of peptic ulcer disease before perforation and shock he was successfully managed with open surgery after initial resuscitation and stabilization of his general condition. PMID:23833377

  7. War, traffic and iatrogenic injuries of D3 duodenal segment

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    Ignjatović Dragan

    2005-01-01

    Full Text Available Background. Injuries of the duodenum at the level of aortomesenteric clamp (segment D3 are with a high incidence of death due to the development of fistula and peritonitis. In three successfully managed cases, we applied the biliary surgery method. Case reports. All three cases were with the injuries of D3 duodenal segment. The first patient suffered from the blast perforation of duodenum at the level of the aortomesenteric clamp which occurred at the 7th day after the injury. The second patient suffered from the duodenal injury caused in a traffic accident. The third patient suffered from an iatrogenic injury at the beginning of D3 duodenal segment inflicted during ureterolithotomy. The described surgical procedure included basically the suture to narrow the site of the injury, then lateroterminal anastomosis with the Roux-en-Y jejunal flexure and, finally, the placement of a silicone prosthesis starting from the duodenum through the site of injury and the Roux-en-Y out. Octreotide and the total parenteral nutrition were administered to the patients postoperatively. Conclusion. The use of the releasing silicone prosthesis in all three patients provided the repair of the site of the injury with anastomosed Reux-en-Y jejunum.

  8. Superoxide dismutase phenotypes in duodenal ulcers: A genetic marker?

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    Sulekha S

    2006-01-01

    Full Text Available Background:Cu-Zn superoxide dismutases are antioxidative defensive enzymes that catalyze the reduction of superoxide anions to hydrogen peroxide. Aim:The study focuses on the association of electromorph of superoxide dismutase with duodenal ulcers, which result due to an imbalance between aggressive and defensive factors. Materials and Methods:Endoscopically confirmed 210 duodenal ulcer patients and 185 healthy individuals for comparative analysis were considered for the present study. Phenotyping of superoxide dismutase was carried out by subjecting the RBC membranes to polyacrylamide gel electrophoresis, using appropriate staining protocols. Results:Statistical analysis of SOD phenotypes revealed a significant increase of SOD AFNx012 allele and Superoxide dismutases (SOD 2-2 phenotype in duodenal ulcer group. Among these individuals, a predominance of Helicobacter pylori infection was observed. The increased preponderance of homozygotes can be explained on the basis of reduced and altered enzyme activity, which may lead to disturbance in homeostasis of antioxidant/oxidant culminating in high lipid peroxidative gastric mucosal tissue damage and ulceration. No variation in the distribution of SOD phenotypes with respect to Helicobacter pylori indicates the role of Mn-SOD rather than Cu-Zn SOD in the Helicobacter pylori infected cases as reported earlier. Conclusions:Superoxide dismutase as a genetic marker / gene modifier, encoding for an antioxidant enzyme in maintaining tissue homeostasis of the gastric mucosa is discussed.

  9. Situs inversus totalis with perforated duodenal ulcer: a case report

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    Khan Faiz

    2011-07-01

    Full Text Available Abstract Introduction Situs inversus is an uncommon anomaly. Situs inversus viscerum can be either total or partial. Total situs inversus, also termed as mirror image dextrocardia, is characterized by a heart on the right side of the midline while the liver and the gall bladder are on the left side. Patients are usually asymptomatic and have a normal lifespan. The exact etiology is unknown but an autosomal recessive mode of inheritance has been speculated. The first case of perforated duodenal ulcer with situs inversus was reported in 1986; here, we report the second case of this nature in the medical literature. Case presentation A 22-year-old Pakistani man presented with severe epigastric and left hypochondrial pain. Examination and investigations (chest X-ray and ultrasonography confirm peritonitis in a case of situs inversus totalis. On exploratory laparotomy, a diagnosis of situs inversus totalis with perforated duodenal ulcer was confirmed. Graham's patch closure of the duodenal ulcer was performed with absorbable sutures, and a thorough peritoneal lavage was also performed; an incidental appendectomy was also performed to avoid further diagnostic problems. Our patient had an uneventful recovery. Conclusions A diagnostic dilemma arises whenever abdominal pathology occurs in patients with situs inversus. Although an uncommon anomaly, to choose a proper surgical incision site for abdominal exploration pre-operative recognition of the condition is important.

  10. Perforated duodenal ulcer: a rare complication of deferasirox in children.

    Science.gov (United States)

    Yadav, Sunil Kumar; Gupta, Vipul; El Kohly, Ashraf; Al Fadhli, Wasmi

    2013-01-01

    Duodenal ulcer perforation in pediatric age group is an uncommon entity; hence, it is not usually considered in the differential diagnosis of acute abdomen in these patients. It is important for the emergency physician to consider perforated peptic ulcer in the differential diagnosis of children presenting with acute abdominal pain, gastrointestinal bleeding, or shock. We report a 6½-year-old male child with thalassemia major who presented to emergency room with an acute abdomen and shock, who was subsequently found to have a perforated duodenal ulcer, probably related to use of oral chelating agent, deferasirox. Although, gastrointestinal symptoms like nausea, vomiting, and abdominal pain has been mentioned as infrequent adverse event in the scientific product information of deferasirox, in our current knowledge this is the first case report of perforated duodenal ulcer after oral deferasirox. The severity of this event justifies the reporting of this case. This patient had an atypical presentation in that there were no signs or symptoms of peptic ulcer disease before perforation and shock he was successfully managed with open surgery after initial resuscitation and stabilization of his general condition.

  11. Perforated duodenal ulcer: A rare complication of deferasirox in children

    Directory of Open Access Journals (Sweden)

    Sunil Kumar Yadav

    2013-01-01

    Full Text Available Duodenal ulcer perforation in pediatric age group is an uncommon entity; hence, it is not usually considered in the differential diagnosis of acute abdomen in these patients. It is important for the emergency physician to consider perforated peptic ulcer in the differential diagnosis of children presenting with acute abdominal pain, gastrointestinal bleeding, or shock. We report a 6½-year-old male child with thalassemia major who presented to emergency room with an acute abdomen and shock, who was subsequently found to have a perforated duodenal ulcer, probably related to use of oral chelating agent, deferasirox. Although, gastrointestinal symptoms like nausea, vomiting, and abdominal pain has been mentioned as infrequent adverse event in the scientific product information of deferasirox, in our current knowledge this is the first case report of perforated duodenal ulcer after oral deferasirox. The severity of this event justifies the reporting of this case. This patient had an atypical presentation in that there were no signs or symptoms of peptic ulcer disease before perforation and shock he was successfully managed with open surgery after initial resuscitation and stabilization of his general condition.

  12. Childhood chronic gastritis and duodenitis: Role of altered sensory neuromediators

    Science.gov (United States)

    Islek, Ali; Yilmaz, Aygen; Elpek, Gulsum Ozlem; Erin, Nuray

    2016-01-01

    AIM To investigate the roles of the neuropeptides vasoactive intestinal peptide (VIP), substance P (SP), and calcitonin gene-related peptide (CGRP) in chronic gastritis and duodenitis in children. METHODS Biopsy samples from the gastric and duodenal mucosa of 52 patients and 30 control subjects were obtained. Samples were taken for pathological examination, immunohistochemical staining, enzyme activity measurements and quantitative measurements of tissue peptide levels. RESULTS We observed differential effects of the disease on peptide levels, which were somewhat different from previously reported changes in chronic gastritis in adults. Specifically, SP was increased and CGRP and VIP were decreased in patients with gastritis. The changes were more prominent at sites where gastritis was severe, but significant changes were also observed in neighboring areas where gastritis was less severe. Furthermore, the degree of changes was correlated with the pathological grade of the disease. The expression of CD10, the enzyme primarily involved in SP hydrolysis, was also decreased in patients with duodenitis. CONCLUSION Based on these findings, we propose that decreased levels of VIP and CGRP and increased levels of SP contribute to pathological changes in gastric mucosa. Hence, new treatments targeting these molecules may have therapeutic and preventive effects. PMID:27729741

  13. Ectopic Opening of the Common Bile Duct into the Duodenal Bulb: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Hwang, Seong Su; Park, Soo Youn [Catholic University St. Vincent' s Hospital, Suwon (Korea, Republic of)

    2009-08-15

    An ectopic opening of the common bile duct into the duodenal bulb is a very rare congenital malformation of the bile duct, which may cause a recurrent duodenal ulcer or biliary diseases including choledocholithiasis or cholangitis. ERCP plays major role in the diagnosis of this biliary malformation. We report a case of an ectopic opening of the common bile duct into the duodenal bulb, which was detected on the upper gastrointestinal series.

  14. Association of Duodenal Atresia, Malrotation, and Atrial Septal Defect in a Down-Syndrome Patient

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    R Angotti

    2016-04-01

    Full Text Available Duodenal atresia is the frequent cause of neonatal intestinal obstruction. The association between duodenal atresia, intestinal malrotation, cardiac anomalies and Down syndrome is infrequently reported. We present a prenatally suspected case of duodenal atresia which was associated with malrotation and atrial septal defect in a patient of Down syndrome. Duodenotomy and resection of web was performed in addition to Ladd’s procedure. Postoperative course remained uneventful.

  15. Axial torsion of meckel's diverticulum causing small bowel obstruction in adult: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Youn, In Kyung; Lee, Su Lim; Ku, Young Mi [Dept. of Radiology, Uijeongbu St. Mary' s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu (Korea, Republic of)

    2016-02-15

    Meckel's diverticulum (MD) is the most common congenital abnormality of the gastrointestinal tract that is prevalent in 2–3% of the population. The lifetime risk of complications is estimated at 4%. Small bowel obstruction is the second most common complication of MD. Among the causes of bowel obstruction, axial torsion of MD is the rarest complication. Urgent surgical treatment is needed in cases of small bowel obstruction associated with torsion of MD. Pre-operative diagnosis of MD as a cause of small bowel obstruction is difficult, because the diagnosis can be made only if the diverticulum is delineated at the site of obstruction. We reported a case of axial torsion of MD with necrosis that caused proximal small bowel perforation in a 21 year old male.

  16. Pharyngoesophageal Obstruction on the Killian-Laimer Triangle by Zenker’s Diverticulum: Case Report and Clinical Significance

    Science.gov (United States)

    Leite, Tulio F.; Chagas, Carlos A. A.; Pires, Lucas A. S.; Cisne, Rafael; Babinski, Marcio A.

    2015-01-01

    Zenker’s diverticulum is a form of esophageal and pharyngeal obstruction located at the Killian-Laimer triangle. It is relatively common in elderly man (seventh or eighth decade of life), and its pathophysiology is not completely understood, albeit theories regarding dysfunction of the upper esophageal sphincter were reported. The main symptoms are dysphagia and odynophagia, but it can complicate to aspiration and perforation of the pharyngeal pouch; also, it can be asymptomatic. Diagnosis is provided through a barium esophagogram. Treatment can be performed through endoscopic surgery, diverticulopexy and myotomy of the cricopharyngeus muscle, although there is no consensus among surgeons regarding the treatment of choice. We report a case of pharyngeal obstruction due to Zenker’s diverticulum which caused massive weight loss in a 76-year-old male. PMID:27785316

  17. Adult intussusception caused by Meckel's diverticulum complicated by anisakiasis of the small intestine: report of a case.

    Science.gov (United States)

    Furukawa, Kenei; Yoshida, Kazuhiko; Nojiri, Takuya; Ogawa, Masaichi; Kohno, Shuzou; Yanaga, Katsuhiko

    2014-08-01

    We report an extremely rare case of adult intussusception caused by Meckel's diverticulum complicated by anisakiasis of the small intestine. A 48-year-old female was admitted to our hospital with vomiting and abdominal pain 3 days after eating raw fish. The abdomen was distended with tenderness. Computed tomography demonstrated a target-shaped mass in the ileum and wall thickness of the distal ileum. We diagnosed intussusception and performed emergency surgery. At laparotomy, intussusception was already released. Since Meckel's diverticulum was observed at 40 cm and wall thickness was observed at 20 cm from the terminal ileum, we performed partial ileal resection including these lesions. On pathology, the anisakis body was found in the resected specimen of the ileum with wall thickness. The patient was discharged 8 days after surgery.

  18. A CLINICAL STUDY ON PATIENTS WITH DUODENAL ULCER PERFORATION

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    Kishore Babu

    2016-03-01

    Full Text Available INTRODUCTION Perforated duodenal ulcer, the most catastrophic complication was Associated with high mortality in the past due to late presentation of the patients, delay in surgery and lack of antibiotics. Various authors state that the incidence of peptic ulcer disease and perforation has been declining for the past 3 decades. Because of advances in the medical therapy of peptic ulcer with a wide range of drugs the management of peptic ulcer disease has been changing and the role of surgery has been declining. Perforation is usually seen in 3rd and 4th decades with a male preponderance and the epidemiological trend is not the same worldwide. Incidence is slightly declining in western countries. The present study has been done during the period between 2013 and 2014 in S. V. R. R. Government general hospital Tirupati. AIMS AND OBJECTIVES The aim of the present study is to analyze the probable factors for increase in incidence of duodenal ulcer perforation, with particular emphasis on assessment of impact of H2 receptor antagonists and Proton Pump inhibitors on the incidence of perforation. STUDY SETTING S. V. Medical College, Department of General Surgery, Tirupati. STUDY PERIOD Patients attending S. V. Medical College, Department of General Surgery with perforation during the period from November 2013 to October 2014. INCLUSION CRITERIA Patients between age group of more than 14 years presenting with pain abdomen and who are diagnosed to have peritonitis due to duodenal ulcer perforation. EXCLUSION CRITERIA Patients with peritonitis due causes other than duodenal ulcer. STUDY METHOD Prospective Observational study among the selected patients. Total numbers of peptic ulcer cases that were admitted in this hospital and treated either medically or surgically were noted. The details of their clinical history and findings, investigation reports, operative findings, post-operative complications were recorded. Simple closure was performed for all the

  19. Clinical diagnosis and surgical treatment of pancreatic and/or duodenal injuries

    Institute of Scientific and Technical Information of China (English)

    Zekuan Xu; Leyao Lian; Yi Miao; Xunliang Liu

    2005-01-01

    Objective: To investigate the points of the clinical diagnosis and surgical treatment for pancreatic and/or duodenal injuries. Methods: Clinical data of 30 patients who suffered from pancreatic and/or duodenal injuries were reviewed. Results: There were 29 cases who received surgical management. Of the 30 cases, 22 cases were cured, seven cases died, and postoperative complications occurred in 16 cases. The cure rate was 73.3%. Conclusion: Pancreatic and/or duodenal injuries are severe abdominal injuries and difficult to treat. The mortality and complication rate are high. The keys to successful treatments for pancreatic and/or duodenal injuries are early diagnosis, careful exploration and proper operational management.

  20. Meckel's diverticulum

    Science.gov (United States)

    ... series References Kahn E, Daum F. Anatomy, histology, embryology, and developmental anomalies of the small and large ... M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health ...

  1. Duodenal intraepithelial T lymphocytes in patients with functional dyspepsia

    Institute of Scientific and Technical Information of China (English)

    Gilles Gargala; Stéphana Lecleire; Arnaud Frangois; Serge Jacquot; Pierre Déchelotte; Jean Jacques Ballet; Loic Favennec; Philippe Ducrotté

    2007-01-01

    AIM:To quantify the intraepithelial lymphocytes (IELs) and to document the membrane expression of CD4,CD8,TCRγδ and adhesion and/or activation-associated molecules (CD103,CD28,CD44,CD69,HLA-DR,CD95/Fas) in the duodenal mucosa of patients with functional dyspepsia (FD) in order to provide arguments for an immunological process in FD.METHODS:Twenty-six FD patients according to Rome Ⅱ criteria (20 were H pylori negative) were studied and compared to 12 healthy adults.IELs were isolated from five duodenal biopsy samples,then quantified by microscopy and flow cytometry while the membrane phenotypes were determined by cytofluorometry.RESULTS:Duodenal histological examination was normal.In H pylori negative patients,the number of IELs was not different from that in healthy controls.Median percentage expression of CD4,CD8,or TCRγδ and CD103,CD44,CD28,CD69 on CD3+ IELs,among the adhesion/activation associated molecules tested,was not different from that in healthy controls.In contrast,the median percentage expression of CD95/Fas [22(9-65) vs 45(19-88),P=0.03] and HLADR expressing CD3+ IELs [4(0-30) vs 13(4-42),P=0.041 was signifcantly lower in the H pylori negative FD group than in healthy controls,respectively.The number of IELs was significantly greater in H pylori positive FD patients than in healthy controls [median ratio for 100 enterocytes 27.5 (6.7-62.5) vs 10.8 (3-33.3), P = 0.02] due to a higher number of CD8+ CD3+ IELs.CONCLUSION: In H pylori negative FD patients, the phenotypic characterization of IELs suggests that we cannot exclude a role of IELs in FD.

  2. Intraoperative methods to stage and localize pancreatic and duodenal tumors.

    Science.gov (United States)

    Norton, J A

    1999-01-01

    Intraoperative methods to stage and localize tumors have dramatically improved. Advances include less invasive methods to obtain comparable results and precise localization of previously occult tumors. The use of new technology including laparoscopy and ultrasound has provided some of these advances, while improved operative techniques have provided others. Laparoscopy with ultrasound has allowed for improved staging of patients with pancreatic cancer and exclusion of patients who are not resectable for cure. We performed laparoscopy with ultrasound on 50 consecutive patients with adenocarcinoma of the pancreas or liver who appeared to have resectable tumors based on preoperative computed tomography. 22 patients (44%) were found to be unresectable because of tumor nodules on the liver and/or peritoneal surfaces or unsuspected distant nodal or liver metastases. The site of disease making the patient unresectable was confirmed by biopsy in each case. Of the 28 remaining patients in whom laparoscopic ultrasound predicted to be resectable for cure, 26 (93%) had all tumor removed. Thus laparoscopy with ultrasound was the best method to select patients for curative surgery. Intraoperative ultrasound (IOUS) has been a critical method to identify insulinomas that are not palpable. Nonpalpable tumors are most commonly in the pancreatic head. Because the pancreatic head is thick and insulinomas are small, of 9 pancreatic head insulinomas only 3 (33%) were palpable. However, IOUS precisely identified each (100%). Others have recommended blind distal pancreatectomy for individuals with insulinoma in whom no tumor can be identified. However, our data suggest that this procedure is contraindicated as these occult tumors are usually within the pancreatic head. Recent series suggest that previously missed gastrinomas are commonly in the duodenum. IOUS is not able to identify these tumors, but other methods can. Of 27 patients with 31 duodenal gastrinomas, palpation identified 19

  3. Gallstone ileus of duodenum with huge duodenal stone

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    Mohammad Ehsan

    2006-12-01

    Full Text Available Gastrointestinal obstruction by a gallstone is an uncommon but important complication of biliary stone disease which mostly affects the elderly. The classic triad of radiological features includes pneumobilia, ectopic gallstone and evidence of intestinal obstruction. Terminal ileum is the most common site of obstruction, followed by jejunum and gastric outlet. We present a case of duodenal gallstone ileus of a large, fluid-density mixed biliary stone with a peripheral rim of hyperdensity (very fine calcification in CT scan. KEY WORDS: Gallstone ileus, duodenum, intestinal obstruction.

  4. Microcirculatory remodeling in marginal zone of duodenal ulcer after bleeding

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    Sulayeva О.N.

    2009-01-01

    Full Text Available To estimate objectively vessels network remodeling in duodenal mucosa after ulcer bleeding the morphometric analysis of marginal ulcer zone biopsies was performed in 32 patients. It was shown that reparation is accompanied with chronic inflammation and acute alteration of microcirculation. Injection hemostasis led to enhancement of microcirculation, development of edema and ischemic alteration of mucosal tissues. Acute neutrophilic infiltration during 1 day was changed on 3 day with granular tissue development and angiogenesis stimulation. Intensification and prolongation of angiogenesis paral-leled with lymphocytes infiltration after 7 days resulted to villi dysmorphogenesis and changes in cellular content of intestinal epithelium.

  5. Study of the duodenal contractile activity during antral contractions

    Institute of Scientific and Technical Information of China (English)

    Ahmed Shafik; Olfat El Sibai; Ali A Shafik

    2007-01-01

    AIM: To investigate the hypothesis that duodenal bulb (DB)inhibition on pyloric antrum (PA) contraction is reflex.METHODS: Balloon (condom)-tipped tube was introduced into 1st duodenum (DD) and a manometric tube into each of PA and DD. Duodenal and antral pressure response to duodenal and then PA balloon distension with saline was recorded. These tests were repeated after separate anesthetization of DD and PA.RESULTS: Two and 4 mL of 1st DD balloon distension produced no pressure changes in DD or PA (10.7 ± 1.2 vs 9.8 ± 1.2, 11.2 ± 1.2 vs 11.3±1.2 on H2O respectively,P > 0.05). Six mL distension effected 1st DD pressure rise (30.6 ± 3.4 cm H2O, P < 0.01) and PA pressure decrease (6.2±1.4 cm H2O, P < 0.05); no response in 2nd, 3rd and 4th DD. There was no difference between 6, 8, and 10 mL distensions. Ten mL PA distension produced no PA or 1st DD pressure changes (P > 0.05).Twenty mL distension increased PA pressure (92.4 ±10.7 cm H2O, P < 0.01) and decreased 1st DD pressure (1.6±0.3 cm H2O, P < 0.01); 30, 40, and 50 mL distension produced the same effect as the 20 mL distension (P > 0.05). PA or DD distension after separate anesthetization produced no significant pressure changes in PA or DD.CONCLUSION: Large volume DD distension produced DD pressure rise denoting DD contraction and PA pressure decline denoting PA relaxation. PA relaxation upon DD contraction is postulated to be mediated through a reflex which we call duodeno-antral reflex. Meanwhile, PA distension effected DD relaxation which we suggest to be reflex and termed antro-duodenal reflex. It is suggested that these 2 reflexes, could act as investigative tools in diagnosis of gastroduodenal motility disorders.

  6. Peptic Ulcer Disease Different Pathogenesis of Duodenal and Gastric Ulcer

    Directory of Open Access Journals (Sweden)

    Hendra Koncoro

    2015-12-01

    Full Text Available Despite decrease frequency of Helicobacter pylori (H. pylori due to eradication therapy, peptic ulcer disease as a manifestation of this infection is still remain a health burden. Understanding the physiology of gastric acid secretion and its alteration by H. pylori induced inflammation will aid physician in differentiating peptic ulcer disease based on its location. Duodenal ulcer and gastric ulcer disease are two common condition that usually found in peptic ulcer. Recognition of symptoms and its pathogenesis may lead physician to understand the fate of each condition in the future. This article reviews concept of peptic ulcer pathogenesis according to ulcer etiology.

  7. Upper gastrointestinal bleeding from duodenal vascular ectasia in a patient with cirrhosis

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    We report a cirrhotic patient with duodenal vascular ectasia and spontaneous bleeding. The bleeding was successfully controlled with argon plasma coagulation.Duodenal vascular ectasia may be a cause of upper gastrointestinal bleeding in patients with cirrhosis, and argon plasma coagulation may be effective and safe to achieve hemostasis of this lesion.

  8. MULTIPLE ASSOCIATED ANOMALIES IN PATIENTS OF DUODENAL ATRESIA: A CASE SERIES

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    Bilal Mirza

    2012-04-01

    Full Text Available Duodenal atresia has been reported in association with various malformations and syndromes common being Down syndrome, malrotation, and annular pancreas. Its association with multiple anomalies is rare and scarcely reported in literature. Herein 3 cases of duodenal atresia associated with multiple congenital anomalies are being reported.

  9. Chromosomal and methylation alterations in sporadic and familial adenomatous polyposis-related duodenal carcinomas.

    NARCIS (Netherlands)

    Berkhout, M.; Nagtegaal, I.D.; Cornelissen, S.J.B.; Dekkers, M.M.G.; Molengraft, F.J. van de; Peters, W.H.M.; Nagengast, F.M.; Krieken, J.H.J.M. van; Jeuken, J.W.M.

    2007-01-01

    Primary carcinomas of the small intestine are rare and the mechanism of their pathogenesis is poorly understood. Patients with familial adenomatous polyposis (FAP) have a high risk of developing duodenal carcinomas. The aim of this study is to gain more insight into the development of duodenal carci

  10. [The prognostic value of gastric metaplasia in the duodenal mucosa in patients with Helicobacter pylori positive duodenal bulb ulcer].

    Science.gov (United States)

    Marshalko, O V; Konorev, M R

    2008-01-01

    The predictive value of gastric metaplasia in the duodenal mucosa in patients Helicobacter pylori-positive patients with duodenal bulb ulcer (DBU) was investigated. One hundred and twenty four randomly selected patients with DBU were included in this prospective study. The detection of Helicobacter pylori (HP) in the stomach and duodenum was carried out with Giemsa (using standard visual analogue scale), rapid urease test (standard Jatrox-HP test, Rohm Pharma, Germany), and polymerase chain reaction (PCR) to detect the specific fragment of ureC HP gene (Helicopol II, Lytech, Russia). Regions of gastric metaplasia of the duodenum were confirmed by periodic acid-Schiff and alcian blue (Serva) staining (pH 1.0; 2.5) Duodenal ulcer (DU) complications were registered within 8 to 10 years. Estimation of the predictive factor (gastric metaplasia in the duodenum) was carried out in patients with non-complicated DU (Group 1; n = 73), and with such complications as bleeding, perforation, penetration, pyloroduodenal stenosis (Group 2; n = 51) which were revealed within the 8 to 10 years of observation. Gastric metaplasia in the duodenum was found in 64 or 87.7% of the 73 patients with non-complicated DU and in 5 or 9.8% of the 51 patients with complicated DU within 8 to 10 years of observation. The following facts about the predictive factor for the prognosis of DU complication were found: the sensitivity of 83.6%, the specificity of 92.8%, the predictive accuracy of 88.7%, the relative risk of the predicted outcome of 7.5, the relative risk of a different outcome of 0.11, the odds ration of 65.4. The study revealed a high and significant (p gastric metaplasia in the duodenum as a marker of non-complicated clinical course of DU in HP-positive patients within an 8 to 10-year period.

  11. Balloon-assisted enteroscopy for suspected Meckel’s diverticulum and indefinite diagnostic imaging workup

    Science.gov (United States)

    Gomes, Guilherme Francisco; Bonin, Eduardo Aimore; Noda, Rafael William; Cavazzola, Leandro Totti; Bartholomei, Thiago Ferreira

    2016-01-01

    Meckel’s diverticulum (MD) is estimated to affect 1%-2% of the general population, and it represents a clinically silent finding of a congenital anomaly in up to 85% of the cases. In adults, MD may cause symptoms, such as overt occult lower gastrointestinal bleeding. The diagnostic imaging workup includes computed tomography scan, magnetic resonance imaging enterography, technetium 99m scintigraphy (99mTc) using either labeled red blood cells or pertechnetate (known as the Meckel’s scan) and angiography. The preoperative detection rate of MD in adults is low, and many patients ultimately undergo exploratory laparoscopy. More recently, however, endoscopic identification of MD has been possible with the use of balloon-assisted enteroscopy via direct luminal access, which also provides visualization of the diverticular ostium. The aim of this study was to review the diagnosis by double-balloon enteroscopy of 4 adults with symptomatic MD but who had negative diagnostic imaging workups. These cases indicate that balloon-assisted enteroscopy is a valuable diagnostic method and should be considered in adult patients who have suspected MD and indefinite findings on diagnostic imaging workup, including negative Meckel’s scan. PMID:27803776

  12. Unusual presentation of obscure Meckel diverticulum treated with robot-assisted diverticulectomy

    Science.gov (United States)

    Pandey, Sagar; Fan, Miao; Xu, Zhe; Yan, Chaogui; Zhu, Junfeng; Li, Xiuhong

    2016-01-01

    Abstract Introduction: Meckel diverticulum (MD) is the most common congenital abnormality of gastrointestinal tract. Tough believed to occur in 2% of population, most of them remain veiled because majority are clinically asymptomatic and remain obscure in radiological examination. Clinical Findings and Diagnosis: A 26-year-old male with episodic black colored stool since last 10 years. Tough symptomatic, diagnosis of pathological lesion, and the bleeding site could not be established with any of the sophisticated diagnostic technique. After 10 years, it was finally diagnosed as MD with careful observation of bowel loops on computed tomography enterography (CTE) where remnant of vitelline vessel and hyper-enhancing nodule are seen along the wall of diverticular loop. Interventions and outcomes: The patient underwent robot assisted laparoscopic surgery with excision of diverticular loop. To the best of our knowledge, this robot-assistant Meckel diverculectomy is probably the first reported surgical procedure in PubMed. Follow-up for 3 month showed no complication or recurrence. Conclusion: Every case is unique and we must be aware and remain alert in tracing the possible morphological variation of the case. Here, we present one unique but rare feature of MD, which helped us in making diagnosis. PMID:27741148

  13. Axial torsion and gangrene of Meckel’s diverticulum: Case report

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    Radović Saša V.

    2015-01-01

    Full Text Available Introduction. Meckel’s diverticulum (MD is the most prevalent congenital anomaly of small intestine. It develops due to the incomplete obliteration of omphalomesenterict duct which normally undergoes obliteration during the seventh week of gestation. In the majority of cases MD is asymptomatic but it may cause various complications, such as bleeding, intestinal obstruction and inflammation. Cases of umbilical sinuses, fistulas and neoplasms related with MD have been reported, but extremely rare gangrene due to its axial torsion, especially in children, as is the case of our patients. Case Outline. An 11-year-old boy admitted to hospital due to 24 hours epigastric pain, vomiting and malaise. After a complete physical examination, and appropriate pre-surgical laboratory and radiographic tests, surgical exploration was performed with a midline abdominal incision. On 60th cm proximal to the ileocecal valve we found a long and in a narrow based ganrenous MD with axial torsion and fibrotic cord extending from the tip of MD to the ileal mesentery. Surrounding ileum had normal appearance. A demarcation and subsequent resection of MD and the surrounding ileum was performed with endto- end ileal anastomosis. Postoperative recovery was successful and the patient was discharged after six days. Conclusion. Axial torsion of MD is presented with non-specific abdominal symptoms and difficult preoperative diagnosis. The choice of diagnosis and therapy is surgical exploration and resection of MD.

  14. Wireless Capsule Endoscopy Detects Meckel’s Diverticulum in a Child with Unexplained Intestinal Blood Loss

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    I. Xinias

    2012-10-01

    Full Text Available Meckel’s diverticulum (MD is the most common congenital anomaly of the gastrointestinal (GI tract, affecting about 2% of the population. Most cases of Meckel’s diverticula are asymptomatic. The diagnosis of symptomatic MD is often difficult to make. We report the case of an 8-year-old boy who presented with GI bleeding due to MD. The diagnostic difficulties after an initial negative endoscopic evaluation and the diagnostic value of the various endoscopic procedures are discussed. The patient had suffered from bright red stools for 20 h before hospital admission. GI scintigraphy with 99mTc-Na-pertechnetate was negative for heterotopic gastric tissue in the small bowel area. Colonoscopy performed in order to exclude Crohn’s disease was also negative. He was placed on ranitidine at a dose of 6 mg/kg body weight twice daily. The patient remained asymptomatic over a period of 6 months before he was readmitted due to macroscopic rectal bleeding. Upper endoscopy and colonoscopy used to investigate the source of bleeding showed normal macroscopic findings. Radiolabeling of blood constituents with 99mTc on delayed imaging showed radionucleotide concentration in the ascending and transverse colon suggestive of a lesion in the ileocecal area. Further investigation with the use of wireless capsule endoscopy revealed a MD. Wireless capsule endoscopy may thus be indicated for patients with GI blood loss when other diagnostic methods, such as upper and lower endoscopy and colonoscopy, have failed to identify the source of bleeding.

  15. Temporal Bone Pneumatization and Pulsatile Tinnitus Caused by Sigmoid Sinus Diverticulum and/or Dehiscence

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    Liu Wenjuan

    2015-01-01

    Full Text Available Background. Although air cells within temporal bone may play an important role in the transmission of pulsatile tinnitus (PT noise, it has not been studied systematically. Purpose. To evaluate the difference in temporal bone pneumatization between PT patients with sigmoid sinus diverticulum and/or dehiscence (SSDD and healthy people. Material and Methods. A total of 199 unilateral persistent PT patients with SSDD and 302 control subjects underwent dual-phase contrast-enhanced CT (DP-CECT, to assess the grade of temporal bone pneumatization in each ear. Results. In the bilateral temporal bone of 302 controls, 16 ears were grade I, 53 were grade II, 141 were grade III, and 394 were grade IV. Among the affected ears of 199 PT cases, 1 ear was grade I, 18 were grade II, 53 were grade III, and 127 were grade IV. There was no significant difference in the pneumatization grade between the affected PT ear and either ear in the healthy subjects (p>0.05.  Conclusion. Although air cells within the temporal bone are an important factor in the occurrence of PT, its severity does not differ significantly from the pneumatization of healthy people.

  16. Endoscopic Management of a Primary Duodenal Carcinoid Tumor

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    Albin Abraham

    2012-03-01

    Full Text Available Carcinoids are rare, slow-growing tumors originating from a variety of different neuroendocrine cell types. They are identified histologically by their affinity for silver salts and by positive reactions to neuroendocrine markers such as neuron-specific enolase, synaptophysin and chromogranin. They can present with various clinical symptoms and are difficult to diagnose. We present the case of a 43-year-old woman who was referred for evaluation of anemia. Upper endoscopy showed a duodenal bulb mass around 1 cm in size. Histopathological and immunohistochemistry staining were consistent with the diagnosis of a carcinoid tumor. Further imaging and endoscopic studies showed no other synchronous carcinoid lesions. Endoscopic ultrasound (EUS revealed a 1 cm lesion confined to the mucosa and no local lymphadenopathy. Successful endoscopic mucosal resection of the mass was performed. Follow-up surveillance 6 months later with EUS and Octreoscan revealed no new lesions suggestive of recurrence. No consensus guidelines exist for the endoscopic management of duodenal carcinoid tumors. However, endoscopic resection is safe and preferred for tumors measuring 1 cm or less with no evidence of invasion of the muscularis layer.

  17. Duodenal pseudomelanosis (pseudomelanosis duodeni: a rare endoscopic finding

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    Aloísio Felipe-Silva

    2011-12-01

    Full Text Available Duodenal pseudomelanosis (or pseudomelanosis duodeni is a rare benigncondition characterized by black-brown speckled pigmentation of the duodenalmucosa. Collections of pigment−laden macrophages are found in the tips ofduodenal villi. The pigment is thought to be mostly composed of ferrous sulfide.Histochemichal stains for iron (Perl’s prussian blue or melanin (Masson-Fontana may be positive, but are usually negative or unpredictable. Duodenalpseudomelanosis occurs predominantly in middle-aged to old adults andmore commonly in females. It is associated with chronic renal failure, arterialhypertension, diabetes mellitus and gastrointestinal bleeding. Medications suchas ferrous sulfate, hydralazine, propranolol, hydrochlorothiazide and furosemideare thought to play a role as well. We report a case of a 86-year-old femalewho presented with a history of watery diarrhea and melena. The patient had ahistory of high blood pressure and ischemic stroke episodes. She was on multiplemedication including hidralazine, captopril, hydrochlorthiazide and aspirin. She wasdehydrated, her blood pressure was 96 × 60 mmHg and neurologic examinationshowed complete left hemiplegia with central VII nerve palsy. Laboratory testsshowed normal serum electrolytes and renal function. Hemoglobin level was10.7 g%. An upper endoscopy showed multiple diminutive black spots throughoutthe distal duodenal bulb and second portion. Histology showed multiple foci ofa brown-black granular pigment inside macrophages within the tips of the villi(pseudomelanosis. Stains for iron and melanin were negative. She was treatedwith omeprazol, parenteral fluid replacement with saline and partial fasting. Aftercomplete recovery she was discharged for ambulatory follow up.

  18. Roxatidine acetate in the long term maintenance of duodenal ulcers.

    Science.gov (United States)

    Brunner, G

    1988-01-01

    A non-comparative multicentre study of 105 patients with healed duodenal ulcers was conducted to determine the effect on ulcer recurrence of 6 months' maintenance treatment with roxatidine acetate 75 mg daily. All patients had previously received roxatidine acetate treatment. 31 patients out of 89 had 32 relapsed ulcers after 6 months of treatment, which represents an overall relapse rate of around 30%; the relapse rate in smokers was double that of non-smokers. The overall incidence of epigastric pain did not increase significantly over the period of the trial, although some patients complained of mild pain when they entered the study despite having endoscopically confirmed healed ulcers. At the end of the study continuous poor appetite and pyrosis were reported by 17% and 6% of patients, respectively. Side effects, which included constipation and diarrhoea, were reported by 4 patients, 1 of whom withdrew from therapy. There were no clinically significant changes in laboratory values. Thus, maintenance treatment with roxatidine acetate 75 mg daily proved a safe and effective method of preventing symptomatic duodenal ulcer relapse.

  19. The value of repeat scintigraphy in patients with a high clinical suspicion for Meckel diverticulum after a negative or equivocal first Meckel scan

    Energy Technology Data Exchange (ETDEWEB)

    Vali, Reza; Daneman, Alan; McQuattie, Susan; Shammas, Amer [Hospital for Sick Children, Diagnostic Imaging, Toronto (Canada)

    2015-09-15

    Technetium {sup 99m}Tc-pertechnetate is the most common and accurate noninvasive method of preoperative investigation for Meckel diverticulum. Despite introducing various methods to increase the sensitivity of the study, there are many case reports of false-negative Meckel scans. A repeat scan is sometimes requested in patients with a high suspicion for Meckel diverticulum and negative or equivocal first Meckel scan. The purpose of this retrospective study is to evaluate the value of repeat scintigraphy for these patients. Seven hundred fifty-three Meckel scans were recorded retrospectively. In 33 cases (22 male and 11 female; mean age: 6.8 years), the Meckel scintigraphy was repeated either due to a high clinical suspicion of Meckel diverticulum and a negative study (n = 21) or due to equivocal findings in the first scan (n = 12). The study was interpreted as positive if an abnormal focal activity was identified in the abdomen and pelvis during the procedure. The results were correlated with pathology and clinical symptoms. Seven out of 12 (58%) equivocal studies were positive on the second study. Six of them were proven to be positive at operation (confirmed by pathology) while one of them was negative on laparoscopy. From 21 negative first scans with a high suspicion for Meckel diverticulum, three (14%) were positive on the second study. All three were proven to be Meckel diverticulum on pathology. Repeat Meckel scans in patients with equivocal findings on the first study or a negative result with a high clinical suspicion for a Meckel diverticulum are useful especially in cases in which the first study had been done without appropriate preparation. (orig.)

  20. A rare complication of colonic diverticulosis: giant diverticulum. Case report and overview of pathophysiology, diagnosis and therapeutic options.

    Science.gov (United States)

    Vanderstappen, J H H; Hoofwijk, A G M; Sikkink, C J J M

    2014-01-01

    A rare complication of diverticulosis of the colon is giant colonic diverticulum, an entity first described by Bonvin in 1946. The experience of any surgeon with this problem is at the most still small and reported management in the literature has been varied. We present the case of a 84-year-old woman presenting with a painless abdominal mass and constipation. A 30 x 10 cm gas-filled cyst was discovered on abdominal X-ray and CT examination. Furthermore, we provide an overview of pathophysiology, diagnosis and therapeutic options.

  1. Regulation of duodenal bicarbonate secretion during stress by corticotropin-releasing factor and beta-endorphin.

    Science.gov (United States)

    Lenz, H J

    1989-02-01

    Proximal duodenal mucosal bicarbonate secretion is an important factor in the pathogenesis of duodenal ulcer disease. To examine the central nervous system regulation of duodenal bicarbonate secretion, an animal model was developed that allowed cerebroventricular and intravenous injections as well as collection of duodenal perfusates in awake, freely moving rats. The hypothalamic peptide corticotropin-releasing factor (CRF) and stress (physical restraint) significantly stimulated duodenal bicarbonate secretion. These responses were abolished by pretreatment of the animals with the CRF receptor antagonist alpha-helical CRF-(9-41), hypophysectomy, and naloxone. In contrast, blockade of autonomic efferents by surgical and pharmacological means did not prevent the stimulatory effects of stress and CRF. Intravenous, but not cerebroventricular, administration of beta-endorphin that produced plasma concentrations of beta-endorphin that were similar to those produced by exogenous CRF and stress significantly stimulated duodenal bicarbonate secretion. These results indicate that endogenous CRF released during stress and exogenously administered CRF stimulate duodenal bicarbonate secretion by release of beta-endorphin from the pituitary, thus, demonstrating a functional hypothalamus-pituitary-gut axis.

  2. Patients with Helicobacter pylori positive and negative duodenal ulcers have distinct clinical characteristics

    Institute of Scientific and Technical Information of China (English)

    Kent-Man Chu; Ka-Fai Kwok; Simon Law; Kam-Ho Wong

    2005-01-01

    AIM: To assess the clinical characteristics of Helicobacterpylori(H pylori) negative duodenal ulcer.METHODS: Patients with an endoscopic diagnosis of duodenal ulcer between 1996 and 2002 were included in the present study. Patients were considered to be negative for Hpylori, if both histological examination and rapid urease test of biopsy specimens were negative. A comparison was made between patients with H pyloripositive and negative duodenal ulcers.RESULTS: A total of 1 343 patients were studied. Their mean age was 54.7±0.5 years. There was a male preponderance (M:F = 2.5:1). Three hundred and ninetyeight patients (29.6%) did not have H pylori infection. The annual proportion of patients with H pylori negative duodenal ulcers increased progressively from 1996 to2002. On multivariate analysis, patients with H pylorinegative duodenal ulcer were more likely to be older, have concomitant medical problem, pre-existing malignancy, recent surgery, underlying sepsis, or taken non-steroidal anti-inflammatory drugs. In terms of clinical presentations, patients with H pylori negative duodenal ulcer were more likely to present with bleeding, multiple ulcers and larger ulcers.CONCLUSION: The proportion of patients with H pylori negative duodenal ulcers is on the rise because of a continued drop in incidence of H pylori positive duodenalulcers in recent years. Such patients have distinct clinical characteristics and it is important to ascertain the H pylori status before starting eradication therapy.

  3. Prevalence of non- Helicobacter pylori duodenal ulcer in Karachi,Pakistan

    Institute of Scientific and Technical Information of China (English)

    Javed Yakoob; Wasim Jafri; Nadim Jafri; Muhammad Islam; Shahab Abid; Saeed Hamid; Hasnain AliShah; Hizbullah Shaikh

    2005-01-01

    AIM: To determine the prevalence of non-Helicobacter pylori (H pylori)-related duodenal ulcer in patients with acid-peptic diseases.METHODS: Medical records of patients who attended the Gastroenterology Department at Aga Khan University Hospital from 1999 to 2001 and had endoscopic diagnosis of duodenal ulcers were reviewed. Duodenal ulcer associated with H pylori was diagnosed on the basis of endoscopy,rapid urease test and histopathology whereas histories of aspirin or other non-steroidal anti-inflammatory drugs (NSAIDs) related duodenal ulcers. Non-H pylori, non-NSAID duodenal ulcers were those without H pylori infection and history of NSAID intake. Co-morbid conditions associated were noted.RESULTS: Of 2 260 patients, 10% (217/2 260) had duodenal ulcer. Duodenal ulcer related to H pylori infectionaccounted for 53% (116/217), NSAID-related 10% (22/217),non-H pylori non-NSAID 29% (62/217), and 8% (17/217) had both Hpyloriinfection and histories of NSAID intake. Fifteen percent (18/116)_patients had past histories of peptic ulcer disease in Hpyloriinfection, while 8% (5/62) in non-Hpylorinon-NSAID ulcer. Co-morbid conditions in H pylori infection were seen in 23% (27/116) and 34%(21/62) in non-H pylori non-NSAID ulcer.CONCLUSION: Incidence of H pylori infection related with duodenal ulcer is common. In the presence of co-morbids, non-Hpyloriand non-NSAID duodenal ulcer is likely to be present.

  4. Congenital duodenal obstruction with situs inversus totalis: Report of a rare association and discussion

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    Sharma Satendra

    2008-01-01

    Full Text Available This report is to present and discuss an extremely rare association of situs inversus with duodenal atresia in an 11-day-old male neonate born full term and weighing 1.9 kg. The baby presented with recurrent bilious vomiting. Babygram revealed situs inversus and duodenal obstruction. Echocardiography showed dextrocardia with a small ASD. Exploration confirmed a duodenal diaphragm with a central perforation between the third and fourth part of the duodenum and situs inversus. The literature search revealed 20 cases reported so far.

  5. First case reported of Bouveret's syndrome associated to duodenal and biliary perforation to retroperitoneum

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    María Victoria Vieiro-Medina

    Full Text Available We present the case of a 69 year old woman with a history of cholecystitis, who consulted for severe abdominal pain, nausea and vomiting. Abdominal CT showed duodenal obstruction caused by a gallstone, cholecystoduodenal fistula and pneumobilia, what is known as Bouveret's syndrome, a rare form of gallstone ileus. Additionally, she presented free duodenal and vesicular perforation to retroperitoneum at the same level of the cholecystoduodenal transit point. The patient underwent a difficult cholecystectomy, enterolithotomy, repair of the duodenal defect, extensive washing and drainage of the retroperitoneum. The postoperative course was uneventful except for a laparotomy infection.

  6. Upper gastrointestinal hemorrhage due to duodenal stromal tumor

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    Parreira José Gustavo

    2003-01-01

    Full Text Available BACKGROUND: Gastrointestinal stromal tumor represents a rare neoplasm that originates in the muscular wall of the hollow viscera. AIM: To report gastrointestinal stromal tumor as a source of upper gastrointestinal bleeding, which required urgent surgical control. PATIENT/METHOD: A man with 61 years old was admitted to the emergency service sustaining hematemesis and melena. Endoscopy showed active bleeding from a tumor in the second portion of the duodenum, which was controlled by heater probe cauterization. Surgery was performed through a median laparotomy. A local resection of a 4 cm tumor in the second portion of the duodenum was carried out, together with a primary end-to-end anastomosis and a duodenal diverticulization. No complications happened during the post-operative period. Morphologic examination showed gastrointestinal stromal tumor with no atypical mitosis and a preserved capsule. CONCLUSION: Albeit not being common, gastrointestinal stromal tumors can represent a source of substantial gastrointestinal hemorrhage.

  7. Duodenal perforation as result of blunt abdominal trauma in childhood.

    Science.gov (United States)

    Hartholt, Klaas Albert; Dekker, Jan Willem T

    2015-12-23

    Blunt abdominal trauma may cause severe intra-abdominal injuries, while clinical findings could be mild or absent directly after the trauma. The absence of clinical findings could mislead physicians into underestimating the severity of the injury at the primary survey, and inevitably leads to a delay in the diagnosis. The Blunt Abdominal Trauma in Children (BATiC) score may help to identify children who are at a high risk for intra-abdominal injuries in an early stage and requires additional tests directly. A case of a 10-year-old girl with a duodenal perforation after a blunt abdominal trauma is presented. A delay in diagnosis may lead to an increased morbidity and mortality rate. A low admission threshold for children with abdominal pain after a blunt trauma is recommended.

  8. Functional characterization of serotonin receptor subtypes in human duodenal secretion

    DEFF Research Database (Denmark)

    Engelmann, Bodil Elisabeth; Bindslev, Niels; Poulsen, Steen Seier;

    2006-01-01

    of dyspeptic patients with or without Helicobacter pylori infection, and to determine the 5-HT receptor subtypes functionally involved. Biopsies from the second part of duodenum were obtained from 43 dyspeptic patients during routine endoscopy. Biopsies were mounted in modified Ussing chambers with air suction......: ketanserin, ondansetron, or SB-204070 (1-butyl-4 piperidinmethyl-8-amino-7-chloro-2,3-dihydro-1,4-benzodioxin-5-carboxylate HCl). Histological examination was performed on duodenal biopsies. Helicobacter urease testing and histological examination determined Helicobacter pylori infection. 5-HT induced a dose......-dependent and bumetanide-sensitive short-circuit current, which was independent of the presence of Helicobacter pylori infection. All the three 5-HT receptor antagonists failed to significantly effect basal and 5-HT-induced short-circuit current. Our results indicate that in human duodenum 1) 5-HT is a potent stimulator...

  9. Laparoscopic diverticulectomy with the aid of intraoperative gastrointestinal endoscopy to treat epiphrenic diverticulum

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    Lei Yu

    2016-01-01

    Full Text Available Objective: Most researchers believe that the presence of large epiphrenic diverticulum (ED with severe symptoms should lead to the consideration of surgical options. The choice of minimally invasive techniques and whether Heller myotomy with antireflux fundoplication should be employed after diverticulectomy became points of debate. The aim of this study was to describe how to perform laparoscopic transhiatal diverticulectomy (LTD and oesophagomyotomy with the aid of intraoperative gastrointestinal (GI endoscopy and how to investigate whether the oesophagomyotomy should be performed routinely after LTD. Patients and Methods: From 2008 to 2013, 11 patients with ED underwent LTD with the aid of intraoperative GI endoscopy at our department. Before surgery, 4 patients successfully underwent oesophageal manometry: Oesophageal dysfunction and an increase of the lower oesophageal sphincter pressure (LESP were found in 2 patients. Results: There were 2 cases of conversion to an open transthoracic procedure. Six patients underwent LTD, Heller myotomy and Dor fundoplication; and 3 patients underwent only LTD. The dysphagia and regurgitation 11 patients experienced before surgery improved significantly. Motor function studies showed that there was no oesophageal peristalsis in 5 patients during follow-up, while 6 patients showed seemingly normal oesophageal motility. The LESP of 6 patients undergoing LTD, myotomy and Dor fundoplication was 16.7 ± 10.2 mmHg, while the LESPs of 3 patients undergoing only LTD were 26 mmHg, 18 mmHg and 21 mmHg, respectively. In 4 cases experiencing LTD, myotomy and Dor fundoplication, the gastro-oesophageal reflux occurred during the sleep stage. Conclusions: LTD constitutes a safe and valid approach for ED patients with severe symptoms. As not all patients with large ED have oesophageal disorders, according to manometric and endoscopic results, surgeons can categorise and decide whether or not myotomy and antireflux surgery

  10. Meckel′s diverticulum in paediatric practice on Crete (Greece: A 10-year review

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    Evangelos Blevrakis

    2011-01-01

    Full Text Available Background: Although Meckel′s diverticulum (MD is the most prevalent congenital abnormality of the gastrointestinal tract, it has varied presentations and often becomes a diagnostic challenge. The purpose of this study was to review the diverse presentations of MD, record the epidemiologic features for Crete and review the detection techniques and the treatment options. Patients and Methods: This was a review of the records of all children who underwent surgery for MD in the department of Paediatric Surgery of the University Hospital of Crete (Greece between January 1999 and January 2009. Result: A total of 45 patients (32 male and 13 female aged 1 to 13 years (median 10 years with a diagnosis of MD were retrospectively reviewed. The collected data were analysed, looking at age, gender, clinical features, investigations, histopathological findings and surgical interventions. In 25 patients, MD was an incidental finding at laparotomy because of appendicitis. The remaining 20 patients were symptomatic and presented with various clinical features. Nine patients (19.9% had clinical features of peritonitis; of these, three had perforated MD and six had Meckel′s diverticulitis at laparotomy. Four patients were diagnosed with intestinal obstruction. Seven patients (15.5% presented with lower gastrointestinal bleeding. Ultrasound scans revealed intussusception in three patients, requiring open reduction. The remaining four patients with bleeding per rectum underwent a Meckel′s Tc99 scan that showed a positive tracer. Conclusion: All patients with MD underwent Meckel′s diverticulectomy with appendicectomy. MD has an incidence of approximately 1 to 2% in our population. It is necessary to maintain a high index of suspicion in the in the diagnosis of MD paediatric age group because it can be easily misdiagnosed.

  11. Female Urethral Diverticulum: Presentation, Diagnosis, and Predictors of Outcomes After Surgery

    Science.gov (United States)

    El-Nashar, Sherif A.; Singh, Ruchira; Bacon, Melissa M.; Kim-Fine, Shunaha; Occhino, John A.; Gebhart, John B.; Klingele, Christopher J.

    2017-01-01

    Introduction and Hypothesis To report on clinical presentation, diagnosis, and outcomes after treatment of female urethral diverticulum (UD). Methods Using a record linkage system, women with a new diagnosis of UD at Mayo Clinic from January 1, 1980, through December 31, 2011, were identified. The presenting symptoms, clinical characteristics, diagnosis, and management of women presenting with UD were recorded. Outcomes after surgery were assessed using survival analysis. All statistical analyses were 2-sided and P values less than 0.05 were considered significant. Statistical analysis was done using SAS version 9.2 and JMP version 9.0 (SAS Institute Inc.). Results A total of 164 cases were identified. Median age at diagnosis was 46 years (range, 21–83). The most common presenting symptom was recurrent urinary tract infection (98, 59.8%), followed by urinary incontinence (81, 49.4%), dysuria (62, 37.8%), dyspareunia (37, 22.6%), and hematuria (15, 9.1%). Examination revealed vaginal mass in 55 (33.5%) of the women. A significant trend was noted toward an increase in use of both magnetic resonance imaging and computed tomography (P < 0.001) along with a progressive decrease in use of urethrogram (P < 0.001) for diagnosis of UD over the years. Among 114 women who underwent surgical treatment for UD, 14(12.3%) women presented with recurrent UD and the 5-year recurrence rate after surgery for UD was 23.4% (95% confidence interval, 13.9–37.0) and a reoperation rate of 17.0% (95% confidence interval, 8.8–30.2) at 5 years. Conclusions Female UD is a rare and unique condition. Clinical presentation is usually nonspecific, and magnetic resonance imaging is commonly used for confirming the diagnosis. Recurrence is not uncommon, and repeat surgical intervention might be needed. PMID:27636213

  12. Effects of calcium and nifedipine on noradrenaline- and PGF-2 alpha-induced activity of the ampullary-isthmic junction of the human oviduct in vitro.

    Science.gov (United States)

    Forman, A; Andersson, K E; Ulmsten, U

    1983-03-01

    From 22 women undergoing hysterectomy at various stages of the menstrual cycle, strip preparations were dissected from the outer, longitudinal and the inner, circular smooth muscle layers of the ampullary-isthmic junction (AIJ). The strips were mounted in organ baths, and isometric tension was recorded. Spontaneous contractions were recorded mainly in circular muscle strips. Contractions were elicited by 127 mM-K+, 10(-6) M-noradrenaline and 10(-6) M-PGF-2 alpha. Potassium induced biphasic responses that were slightly different in the two tissues. In circular muscle strips, noradrenaline and PGF-2 alpha induced phasic contractions superimposed on a rise in tone. In longitudinal muscle specimens, the two compounds produced tonic responses. All types of mechanical activity were inhibited by removal of extracellular calcium. K+-induced responses and phasic contractions produced by noradrenaline and PGF-2 alpha could be abolished by 10(-6) M-nifedipine whereas the tonic contractions in the circular and longitudinal muscle were more resistant to the calcium antagonist. The results suggest that K+-induced responses in circular and longitudinal muscle of the human AIJ, and the phasic contractions in circular muscle, depend on calcium influx via potential-sensitive membrane channels. Receptor-operated calcium channels seem to be involved in the tonic contractions observed mainly in the longitudinal smooth muscle.

  13. Diagnosis of 65 cases of ampullary renal pelvis after postnatal follow-up of 1,167 newborn infants with prenatally suspected hydronephrosis.

    Science.gov (United States)

    Zhang, Lei; Liu, Chao; Li, Fujiang; Li, Xiang; Sun, Chao; Sun, Hao

    2015-01-01

    The aim of the present study was to assess the morbidity of ampullary renal pelvis (ARP) and document its natural history in post-natal life. A total of 1,167 newborn infants with prenatally suspected hydronephrosis were retrospectively analyzed. Of these, 65 patients were diagnosed with ARP by computed tomography urography (CTU) and/or magnetic resonance urography (MRU). All cases were followed up with ultrasonogrophy at 1, 3, 6 and 12 months after birth, and one case was followed up for 5 years. Changes in the separation of the renal pelvis collection system were recorded. Children with ARP accounted for 5.57% of the total cases (65/1,167) followed-up. No lack of connection between the renal calyces and the renal pelvis was detected. The long-term follow-up revealed that the separation of the renal pelvis collection system did not tend to increase over time. In addition to imaging examinations, long-term follow-up observation is recommended for the accurate diagnosis of pediatric ARP, particularly for differentiation from hydronephrosis.

  14. Perforation of Meckel's diverticulum associated with enterolith: diagnosis by ultrasound and computed tomography; Diverticulitis de Meckel perforada con enterolito: diagnostico mediante ecografia y TC

    Energy Technology Data Exchange (ETDEWEB)

    Saez de Ormijana, J.; Aisa, P.; Anorbe, E.; Olabarria, I. [Hospital Santiago Apostol. Vitoria (Spain)

    2001-07-01

    We present a case of acute abdomen that was diagnosed preoperatively as Meckel's diverticulum complicated by perforation and the presence of enterolith. the diagnosis was confirmed intraoperatively and a marked radiologic-pathologic correlation was observed. We have encountered only one other similar case in the literature, in which the diagnosis was based on computed tomography alone. (Author) 17 refs.

  15. Ultrastructure and electrolyte transport of the epithelium of coprodeum, colon and the proctodeal diverticulum of Rhea americana

    DEFF Research Database (Denmark)

    Elbrønd, Vibeke Sødring; Laverty, Gary; Dantzer, Vibeke;

    2009-01-01

    in the proctodeal diverticulum, indicating retrograde peristalsis of the urine. Thus, unlike the ostrich, there is no sphincter separating colon and coprodeum. On the other hand, a thick mucus layer was seen overlying the mucosa in both colon and coprodeum, as in the ostrich. This may help to prevent osmotic water...

  16. Effect of cysteamine on cytosolic somatostatin binding sites in rabbit duodenal mucosa.

    Science.gov (United States)

    Gonzalez-Guijarro, L; Lopez-Ruiz, M P; Bodegas, G; Prieto, J C; Arilla, E

    1987-04-01

    Administration of cysteamine in rabbits elicited a rapid depletion of both duodenal mucosa and plasma somatostatin. A significant reduction was observed within 5 min, returning toward control values by 150 min. The depletion of somatostatin was associated with an increase in the binding capacity and a decrease in the affinity of both high- and low-affinity binding sites present in cytosol of duodenal mucosa. Incubation of cytosolic fraction from control rabbits with 1 mM cysteamine did not modify somatostatin binding. Furthermore, addition of cysteamine at the time of binding assay did not affect the integrity of 125I-Tyr11-somatostatin. It is concluded that in vivo administration of cysteamine to rabbits depletes both duodenal mucosa and plasma somatostatin and leads to up-regulation of duodenal somatostatin binding sites.

  17. Inflammatory Duodenal Polyposis Associated with Primary Immunodeficiency Disease: A Novel Case Report

    Science.gov (United States)

    Shera, Irfan Ali; Khurshid, Sheikh Mudassir

    2017-01-01

    Agammaglobulinemia is a rare form of B-cell primary immunodeficiency disease characterized by reduced levels of IgG, IgA, or IgM and recurrent bacterial infections. Agammaglobulinemia is most commonly associated with diffuse nodular lymphoid hyperplasia. Duodenal polyps are a rare entity; however, due to wide use of esophagogastroduodenoscopy, incidental diagnosis of duodenal polyps appears to be increasing. Although inflammatory duodenal polyposis has been reported in the literature, its association with common variable immunodeficiency has not been reported till date to the best of our knowledge. We report a case of a 59-year-old male with chronic symptoms of agammaglobulinemia associated with inflammatory duodenal polyposis. PMID:28163721

  18. Inflammatory Duodenal Polyposis Associated with Primary Immunodeficiency Disease: A Novel Case Report

    Directory of Open Access Journals (Sweden)

    Irfan Ali Shera

    2017-01-01

    Full Text Available Agammaglobulinemia is a rare form of B-cell primary immunodeficiency disease characterized by reduced levels of IgG, IgA, or IgM and recurrent bacterial infections. Agammaglobulinemia is most commonly associated with diffuse nodular lymphoid hyperplasia. Duodenal polyps are a rare entity; however, due to wide use of esophagogastroduodenoscopy, incidental diagnosis of duodenal polyps appears to be increasing. Although inflammatory duodenal polyposis has been reported in the literature, its association with common variable immunodeficiency has not been reported till date to the best of our knowledge. We report a case of a 59-year-old male with chronic symptoms of agammaglobulinemia associated with inflammatory duodenal polyposis.

  19. Effects of Ginkgo biloba extract on cytoprotective factors in rats with duodenal ulcer

    Institute of Scientific and Technical Information of China (English)

    Jane C.-J. Chao; Huei-Chen Hung; Sheng-Hsuan Chen; Chia-Lang Fang

    2004-01-01

    AIM: To investigate the effects of Ginkgo biloba extract on cytoprotective factors in rats with duodenal ulcer.METHODS: Sprague-Dawley rats were randomly divided into four groups: sham operation without ginkgo, sham operation with ginkgo, duodenal ulcer without ginkgo, and duodenal ulcer with ginkgo. Rats with duodenal ulcer were induced by 500 mL/L acetic acid. Rats with ginkgo were intravenously injected with Ginkgo biloba extract from the tail at a dose of 0.5 mg/(kg.d) for 7 and 14 days.RESULTS: Pathological result showed that duodenal ulcer rats with ginkgo improved mucosal healing and inflammation compared with those without ginkgo after 7 d treatment. After 14 d treatment, duodenal ulcer rats with ginkgo significantly increased weight gain (34.0±4.5 g versus 24.5±9.5 g,P<0.05) compared with those without ginkgo. Duodenal ulcer rats significantly increased cell proliferation (27.4l±4.0and 27.8±2.3 BrdU-labeled cells in duodenal ulcer rats with and without ginkgo versus 22.4±3.5 and 20.8±0.5 BrdUlabeled cells in sham operation rats with and without ginkgo,P<0.05) compared with sham operation rats. Mucosal prostaglandin E2 concentration significantly increased by 129% (P<0.05) in duodenal ulcer rats with ginkgo compared with that in those without ginkgo. Duodenal ulcer rats without ginkgo significantly decreased superoxide dismutase activity in the duodenal mucosa and erythrocytes (19.4±6.7 U/mg protein versus 38.1±18.9 U/mg protein in the duodenal mucosa,and 4.87±1.49 U/mg protein versus 7.78±2.16 U/mg protein in erythrocytes, P<0.05) compared with sham operation rats without ginkgo. However, duodenal ulcer rats with ginkgo significantly increased erythrocyte superoxide dismutase activity (8.22±1.92 U/mg protein versus 4.87±1.49 U/mg protein,P<0.05) compared with those without ginkgo. Duodenal ulcer rats without ginkgo significantly increased plasma lipid peroxides (4.18±1. 12 μmol/mL versus 1.60±1.10 μmol/mL and 1.80±0.73

  20. [A case of pancreatic and duodenal fistula after total gastrectomy successfully treated with coagulation factor XIII].

    Science.gov (United States)

    Nishino, Hitoe; Kojima, Kazuhiro; Oshima, Hirokazu; Nakagawa, Koji; Fumura, Masao; Kikuchi, Norio

    2013-11-01

    Pancreatic fistula( PF) is a challenging postoperative complication. We report a case of PF following gastrectomy successfully treated using intravenous coagulation factor XIII( FXIII).A 78-year-old man with early gastric cancer underwent total gastrectomy with Roux-en-Y reconstruction. PF developed postoperatively, following which, leakage from the duodenal stump was observed. Percutaneous drainage and re-operative surgery were performed. A somatostatin analogue, antibiotic drugs, and gabexate mesilate were administrated along with nutritional support. The pancreatic and duodenal fistula had been producing duodenal juice for over 30 days since the re-operative surgery. As suspected, reduced FXIII activity was confirmed in the patient. After administering FXIII for 5 days, the amount of duodenal juice from the fistula markedly reduced, and the fistula closed immediately afterwards. The results of our study suggest that administration of FXIII could be a reasonable and effective treatment for patients with pancreatic or/and enterocutaneous fistula who are resistant to standard treatments.

  1. Computer simulation of flow and mixing at the duodenal stump after gastric resection

    Institute of Scientific and Technical Information of China (English)

    Nenad Filipovic; Aleksandar Cvetkovic; Velibor Isailovic; Zoran Matovic; Mirko Rosic; Milos Kojic

    2009-01-01

    AIM: To investigate the flow and mixing at the duodenal stump after gastric resection, a computersimulation was implemented.METHODS: Using the finite element method, two different Billroth ? procedure cases (A and B) were modeled. Case A was defined with a shorter and almost straight duodenal section, while case B has a much longer and curved duodenal section. Velocity,pressure and food concentration distribution were determined and the numerical results were compared with experimental observations.RESULTS: The pressure distribution obtained by numerical simulation was in the range of the recorded experimental results. Case A had a more favorable pressure distribution in comparison with case B.However, case B had better performance in terms of food transport because of more continual fooddistribution,as well as better emptying of the duodenal section.

  2. [Functional state of the gastro-duodenal area in gastro-esophageal reflux disease].

    Science.gov (United States)

    Vakhrushev, Ia M; Potapova, L O

    2007-01-01

    The complex study of stomach and duodenal function was performed in 150 patients with GERD. It was revealed that 84,3% of patients had increased stomach acid-production. In GERD exacerbation we found the disturbance of gastric mucosa decreasing protective properties of esophageal, stomach and duodenal mucosa. The patients had increased intragastral and intraduodenal pressure leading to decreasing of closing function of pylorus. Due to dynamic gastroscintigraphy the slowing of stomach evacuation was revealed in 69,2% patients, the acceleration - in 7,7% patients. The prevalence of bradyperistalsis was found in elecrogastromyography. The role of hormones (gastrin, insulin, cortisol, thyrotrophin, thyroxin) in disorders of gastro-duodenal complex function was shown. The complex investigation of gastro-duodenal complex function opens the pathophysiologic base of GERD and these data may be used in the choice of adequate therapy.

  3. Massive duodenal variceal bleed; complication of extra hepatic portal hypertension: Endoscopic management and literature review

    Institute of Scientific and Technical Information of China (English)

    Christopher; Steevens; Maisa; Abdalla; Truptesh; H; Kothari; Vivek; Kaul; Shivangi; Kothari

    2015-01-01

    Bleeding from duodenal varices is reported to be a catastrophic and often fatal event. Most of the cases in the literature involve patients with underlying cirrhosis. However, approximately one quarter of duodenal variceal bleeds is caused by extrahepatic portal hypertension and they represent a unique population given their lack of liver dysfunction. The authors present a case where a 61-year-old male with history of remote crush injury presented with bright red blood per rectum and was found to have bleeding from massive duodenal varices. Injection sclerotherapy with ethanolamine was performed and the patient experienced a favorable outcome with near resolution of his varices on endoscopic follow-up. The authors conclude that sclerotherapy is a reasonable first line therapy and review the literature surrounding the treatment of duodenal varices secondary to extrahepatic portal hypertension.

  4. Chronic diarrhea due to duodenal candidiasis in a patient with a history of kidney transplantation.

    Science.gov (United States)

    Nouri-Majalan, Nader; Moghaddasi, Sarasadat; Qane, Mohammad Davud; Shefaie, Farzane; Masoumi Dehshiri, Roghayyeh; Amirbaigy, Mohammad Kassem; Baghbanian, Mahmoud

    2014-11-01

    Candida infection in the small intestine is uncommon. We report an unusual case of duodenal candidiasis that presented as chronic diarrhea in a patient who had previously undergone kidney transplantation. A 60-year-old man presented with profuse watery diarrhea that had lasted 6 months 13 years after kidney transplantation. Upper gastrointestinal endoscopy results indicated candidiasis within the esophagus and duodenum. Biopsy results revealed active duodenitis with hyphal and yeast forms of Candida overlying the duodenal epithelium in periodic acid Schiff staining. The patient was successfully treated with fluconazole. After 6 months of follow-up, the patient had no complaint of diarrhea. Duodenal candidiasis may be the result of chronic diarrhea in patients with a history of kidney transplantation.

  5. Endoscopic Injection of a Ruptured Duodenal Varix with N-butyl-2-cyanoacrylate

    Directory of Open Access Journals (Sweden)

    Paulo Salgueiro

    2014-04-01

    Conclusions: The presented case supports endoscopic injection sclerotherapy with N-butyl-2-cyanoacrylate as a treatment option for ruptured duodenal varices that, despite being a rare event, when it occurs, is often fatal.

  6. The MSCT diagnosis of colon multiple diverticulum%结肠多发憩室的 MSCT 诊断

    Institute of Scientific and Technical Information of China (English)

    赵凡玉; 陆建常; 李高忠

    2015-01-01

    Objective To discuss MSCT signs of colon multiple diverticulum in order to improve the accuracy of diagnosis.Meth-ods MSCT signs and clinical data of 30 cases with colon multiple diverticulum of were analyzed retrospectively.Imaging character-istics of colon multiple diverticulum were summarized and comparated with the results of colonoscopic appearance.Results There were 30 cases of colon multiple diverticulum confirmed by colonoscopy,including 1 6 cases in the ascending colon,6 cases the de-scending colon,5 cases the sigmoid colon,1 case transverse colon,2 cases the whole colon,5 cases with diverticulitis.Multiple pro-jecting processes were showed in 1 9 cases(63.3%,1 9/30),lesion diameter were 3.0-10.0 mm,gas or liquid filled in the lesion in 1 1 cases,small bezoar filled in 8 cases and the surrounding fat gaps were fuzzy in 5 cases.There was no any MSCT abnormal sign in 1 1 cases.Conclusion The typical MSCT signs of colon multiple diverticulum are multiple projecting processes,which size is smaller than 1 cm and filled with gas,liquid or small bezoar.The sign of surrounding fat gap fuzzy often means diverticulitis.%目的:总结结肠多发憩室的多层螺旋 CT(MSCT)表现,提高 MSCT 对结肠多发憩室的诊断水平。方法回顾性分析30例经结肠镜证实的结肠多发憩室临床及 CT 资料,总结其 CT 特征并与结肠镜表现相对照。结果30例经内镜证实结肠多发憩室患者中,发生于升结肠16例,降结肠6例,乙状结肠5例,横结肠1例,全结肠2例;5例提示憩室黏膜炎。19例患者 MSCT 表现为多发突出于肠壁小囊袋状突起(阳性率63.3%,19/30),直径约3.0~10.0 mm,多发小囊状突起内单纯含有气体或液体11例,小粪石充填8例;5例病变肠管周围脂肪间隙模糊;11例病变肠管无明显影像学异常。结论结肠多发憩室较为可靠的 MSCT 表现为多发突出于结肠壁外的小囊状突起,内容物可以是气体、液体及小粪石,直径多<1 cm;当

  7. Helicobacter pylori: the primary cause of duodenal ulceration or a secondary infection?

    Institute of Scientific and Technical Information of China (English)

    M Hobsley; Fl Tovey

    2001-01-01

    @@INTRODUCTION It is generally accepted that Helicobacter pylori ( H.pylori) infection has a role in duodenal ulceration .Eradicaton of H .pylori accelerates healing compared with placebo in the absence of control of gastric secretion and reduces ulcer recurrence .There is increasing evidence ,however ,that is may not be the primary cause of duodenal ulceration ,but that is may be a secondary factor in a nnmber of cases .This possibility is supported by four sets of observations : 1 Geographical distribution:

  8. Helicobacter pylori virulence factors in duodenal ulceration: A primary cause or a secondary infection causing chronicity

    Institute of Scientific and Technical Information of China (English)

    Frank I Tovey; Michael Hobsley; John Holton

    2006-01-01

    Reports from countries with a high prevalence of Helicobacter pylori (H pylori) infection do not show a proportionately high prevalence of duodenal ulceration,suggesting the possibility that H pylori cannot be a primary cause of duodenal ulceration. It has been mooted that this discrepancy might be explained by variations in the prevalence of virulence factors in different populations. The aim of this paper is to determine whether the published literature gives support to this possibility. The relevant literature was reviewed and analyzed separately for countries with a high and low prevalence of H pylori infection and virulence factors. Although virulent strains of H pylori were significantly more often present in patients with duodenal ulcer than without the disease in countries with a low prevalence of H pyloriinfection in the population, there was no difference in the prevalence of virulence factors between duodenal ulcer, non- ulcer dyspepsia or normal subjects in many countries, where the prevalence of both H pylori infection and of virulence factors was high.In these countries, the presence of virulence factors was not predictive the clinical outcome. To explain the association between virulence factors and duodenal ulcer in countries where H pylori prevalence is low,only two papers were found that give little support to the usual model proposed, namely that organisms with the virulence factors are more likely than those without them to initiate a duodenal ulcer. We offer an alternative hypothesis that suggests virulence factors are more likely to interfere with the healing of a previously produced ulcer. The presence of virulence factors only correlates with the prevalence of duodenal ulcer in countries where the prevalence of H pylori is low. There is very little evidence that virulence factors initiate duodenal ulceration, but they may be related to failure of the ulcer to heal.

  9. Gastric Duplication Cyst in Association with Duodenal Atresia in a Neonate

    Science.gov (United States)

    Mirshemirani, Alireza; Roshanzamir, Fatollah; Razavi, Sajad; Sarafi, Mehdi

    2016-01-01

    Concurrence of duodenal atresia and gastric duplication cyst is extremely rare entity. We report a 6-day-old female neonate who presented with neonatal intestinal obstruction. X-ray abdomen showed double bubble sign. At laparotomy, a huge cystic structure attached to greater curvature of the stomach along with duodenal atresia of second part of duodenum was found. The cystic structure was excised and duodeno-duodenostomy performed. Histopathology report confirmed it gastric duplication cyst. PMID:26816679

  10. Perforated duodenal ulcer a rare cause of acute abdomen in infancy: A report of two cases

    Directory of Open Access Journals (Sweden)

    Kadian Yogender

    2008-01-01

    Full Text Available Duodenal ulcer perforation is very uncommon in infants and children, that is why it is not usually considered in the differential diagnosis of acute abdomen in this age group. Moreover, the diagnosis of this condition is usually overlooked because of vague and variable symptoms and low index of suspicion on the part of the treating physicians. In this brief report, we are reporting two cases of successfully managed perforated duodenal ulcer in infancy.

  11. Duodenal ileus caused by a calf feeding nipple in a cow

    OpenAIRE

    2011-01-01

    Abstract Background The aim of this report was to describe duodenal obstruction caused by a rubber foreign body in a cow. Case Presentation The clinical, biochemical and ultrasonographic findings in a five-year-old Swiss Braunvieh cow with duodenal ileus caused by a calf feeding nipple are described. The main clinical signs were anorexia, ruminal tympany, decreased faecal output and abomasal reflux syndrome. Ultrasonographic examination revealed reticular hyperactivity and a dilated duodenum....

  12. Duodenal Wedge Resection for Large Gastrointestinal Stromal Tumour Presenting with Life-Threatening Haemorrhage

    Directory of Open Access Journals (Sweden)

    Alexander Shaw

    2013-01-01

    Full Text Available Background. Duodenal gastrointestinal stromal tumours (GISTs are an uncommon malignancy of the gastrointestinal (GI tract. We present a case of life-threatening haemorrhage caused by a large ulcerating duodenal GIST arising from the third part of the duodenum managed by a limited duodenal wedge resection. Case Presentation. A 61-year-old patient presented with acute life-threatening gastrointestinal bleeding. After oesophagogastroduodenoscopy failed to demonstrate the source of bleeding, a 5 cm ulcerating exophytic mass originating from the third part of the duodenum was identified at laparotomy. A successful limited wedge resection of the tumour mass was performed. Histopathology subsequently confirmed a duodenal GIST. The patient remained well at 12-month followup with no evidence of local recurrence or metastatic spread. Conclusion. Duodenal GISTs can present with life-threatening upper GI haemorrhage. In the context of acute haemorrhage, even relatively large duodenal GISTs can be treated by limited wedge resection. This is a preferable alternative to duodenopancreatectomy with lower morbidity and mortality but comparable oncological outcome.

  13. A brief analysis of patients suffering from stomach or duodenal ulcers in Almaty hospital №1

    Directory of Open Access Journals (Sweden)

    Aryzbekova Aliya

    2015-12-01

    Full Text Available Peptic ulcers are a serious problem worldwide, and affect about 4 million people each year. Their etiology is connected with the presence of Helicobacter pylori, the act of smoking, drinking alcohol, being stress, and taking excessively nonsteroidal anti-inflammatory drugs, as well as steroids. The most common symptoms are abdominal pain, nausea, chest pain and fatigue, while less frequent symptoms include vomiting and weight loss. Helicobacter pylori is responsible for about 80% of gastric and 90% of duodenal ulcer cases. In this work, an analysis is made of a correlation between stomach or duodenal ulcer and gender, residence and number of patients hospitalized in the Almaty hospital №1, from 2009-2012, in order to learn about trends in the incidence of these diseases in Kazakhstan. A total number of 950 patients with stomach and duodenal ulcers, in 2009-2012, were questioned. The patient’s residence, gender and stomach or duodenal ulcer problem were taken into account in the study. The result of this work reveals that the largest amount of hospitalized patients suffering from stomach or duodenal ulcers came from urban areas. Moreover, more women than men suffered from peptic ulcers. Furthermore, the number of patients admitted to the hospital due to duodenal ulcers did not show any variation throughout the study. However, the least number of patients suffering from gastric ulcers was noticed in December 2009, and the greatest was in October and November 2011. The obtained data show that ulcers are a serious problem in Kazakhstan.

  14. Successful mucosal incision-assisted biopsy for the histological diagnosis of duodenal lymphoma: A case report

    Science.gov (United States)

    MORISHITA, ASAHIRO; MORI, HIROHITO; KOBARA, HIDEKI; NISHIYAMA, NORIKO; FUJIHARA, SHINTARO; YACHIDA, TATSUO; AYAKI, MAKI; MATSUNAGA, TAE; SAKAMOTO, TEPPEI; MAEDA, EMIKO; NOMURA, TAKAKO; TANI, JOJI; MIYOSHI, HISAAKI; YONEYAMA, HIROHITO; HIMOTO, TAKASHI; KAGAWA, SEIKO; HABA, REIJI; MASAKI, TSUTOMU

    2016-01-01

    Tissue sampling of primary duodenal lymphoma is essential for its histological diagnosis. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA), which is frequently used for submucosal tumor (SMT)-like duodenal tumors, is adequate for cytological diagnosis, but not for histological diagnosis. Therefore, in the present study, a mucosal incision-assisted biopsy (MIAB) was performed in an 81-year-old woman for the diagnosis of an SMT-like duodenal mass, as tissue sampling for histological analysis using a regular endoscopic biopsy had failed to establish a definite diagnosis of malignant lymphoma. EUS-FNA had also led to poor tissue sampling due to the difficult location of the duodenal tumor. The pathological examination of biopsy samples using MIAB revealed the presence of a diffuse proliferation of atypical lymphocytes, and the expression of cluster of differentiation (CD)20 and CD79a, but no expression of CD3 in the tumor specimens. The patient was diagnosed with diffuse large B-cell lymphoma. To the best of knowledge, this is first report of a case using MIAB as a sampling method for the histological diagnosis of SMT-like primary duodenal lymphoma. This case suggests that MIAB may be an essential method for obtaining tissue samples from SMT-like duodenal tumors. PMID:26870243

  15. Duodenal stenting for malignant gastric outlet obstruction:Prospective study

    Institute of Scientific and Technical Information of China (English)

    Eduardo Guimar(a)es Hourneaux Moura; Flávio Coelho Ferreira; Spencer Cheng; Diogo Turiani Hourneaux Moura; Paulo Sakai; Bruno Zilberstain

    2012-01-01

    AIM:To evaluate the results of duodenal stenting for palliation of gastroduodenal malignant obstruction by using a gastric outlet obstruction score (GOOS).METHODS:A prospective,non-randomized study was performed at a tertiary center between August 2005 and April 2010.Patients were eligible if they had malignant gastric outlet obstruction (GOO) and were not candidates for surgical treatment.Medical history and patient demographics were collected at baseline.Scheduled interviews were made on the day of the procedure and 15,30,90 and 180 d later or unscheduled as necessary.RESULTS:Fifteen patients (6 male,9 female; median age 61 years) with GOO who had undergone duodenal stenting were evaluated.Ten patients had metastasis at baseline (66.6%) and 14 were unable to accept oral intake (93.33%),including 7 patients who were using a feeding tube.Laboratory data showed biliary obstruction in eight cases (53.33%); all were submitted to biliary drainage.Two patients developed obstructive symptoms due to tumor ingrowth after 30 d and another due to tumor overgrowth after 180 d.Two cases of stent migration occurred.A good response to treatment was observed,with a mean time of approximately 1 d (19 h) until toleration of a liquid diet and slightly more than 2 d for both soft solids (51 h) and a solid food/normal diet (55 h).The mean time to first failure to maintain liquid intake (GOOS ≥ 1) was 93 d.During follow-up,the mean time to first failure to maintain the previously achieved GOOS of 2-3 (solid/semi-solid food),considered technical failure,was 71 d.On the basis of oral intake a GOOS is defined:0 for no oral intake; 1 for liquids only; 2 for soft solids only; 3 for lowresidue or full diet.CONCLUSION:Enteral stenting to alleviate gastroduodenal malignant obstruction improves quality of life in patients with limited life expectancy,which can be evaluated by using a GOO scoring system.

  16. Transitional cell carcinoma arising from a bladder diverticulum: computed tomography findings - case report; Carcinoma de celulas transicionais em um diverticulo de bexiga: achados na tomografia computadorizada - relato de caso

    Energy Technology Data Exchange (ETDEWEB)

    Almeida Junior, Jose Guiomar de; Santos, Maria Lucia de Oliveira; Vabo, Telmo Pimentel do; Marchiori, Edson [Universidade Federal Fluminense, Niteroi, RJ (Brazil). Dept. de Radiologia]. E-mail: edmarchiori@zipmail.com.br; Torres Neto, Gilberto [Hospital Universitario Pedro Ernesto, Rio de Janeiro, RJ (Brazil). Dept. de Radiologia; Silva, Klezer Gaspar Carvalho da [Hospital de Clinicas de Niteroi, RJ (Brazil)

    2003-03-01

    We report the case of a patient with a transitional cell carcinoma arising from a bladder diverticulum that was diagnosed by computed tomography. Although there is a greater incidence of neoplasms in bladder diverticula, its occurrence is uncommon and the diagnosis is at times difficult. The role, the importance and limitations of computed tomography in the diagnosis of transitional cell carcinoma arising from a bladder diverticulum are discussed. (author)

  17. A STUDY OF DUODENAL ULCER PERFORATION: RISK FACTORS AND PROGNOSTIC DETERMINANTS IN BTGH, GULBARGA

    Directory of Open Access Journals (Sweden)

    Rajshekhar

    2015-11-01

    Full Text Available : BACKGROUND AND OBJECTIVES: Duodenal ulcer perforation is one of the acute abdominal emergencies in the surgical field. Duodenal ulcers are often caused due to imbalance between mucosal defences and acid /peptic injury. the cases of duodenal ulcer perforation in surgically treated patients were thoroughly studied with respect to trends in age, distribution of occurance, risk factors, seasonal variation, outcome of operative and non-operative modalities of treatment and factors influencing the prognosis of the disease. The current study summarizes epidemiology, risk factors, Pathophysiology, pathogenesis, clinical features, investigations, modalities of treatment and prognostic determinents of duodenal ulcer perforation in BTGH, Gulbarga. MATERIAL AND METHODS: The study was conducted in the Department of Surgery, Basaveshwara Teaching and General Hospital, Gulbarga Karnataka during the period of Nov. 2011 - Sep.2013. The diagnosis of duodenal ulcer perforation was that established by the admitting surgeon, based on clinical features and supposed by radiological evidence and confirm at operation. Surgery was defined as urgent less as 4 hours between admission and surgery, same day (4-24 hours and delayed at a later time during the same admission. This study comprises of 60 cases of duodenal ulcer perforation admitted in the Department of Surgery, Basaveshwar Teaching & General Hospital. Operative details included the site and nature of operation performed. Mortality was defined as death following surgical procedure. Post-operative morbidity was defined in terms of duration of hospital stay and associated complications following surgery. INCLUSION CRITERIA: All patients in whom a diagnosis of duodenal ulcer perforation was established on admission and confirmed by investigations between November 2011-September 2013 are included in this study. EXCLUSION CRITERIA: 1. Cases of gastric antral perforation. 2. Cases of traumatic duodenal perforation

  18. Formulation and evaluation of omeprazole tablets for duodenal ulcer

    Directory of Open Access Journals (Sweden)

    Choudhury A

    2010-01-01

    Full Text Available Omeprazole pellets containing mucoadhesive tablets were developed by direct punch method. Three mucoadhesive polymers namely hydroxypropylemethylcellulose K4M, sodium carboxy methylcellulose, carbopol-934P and ethyl cellulose were used for preparation of tablets which intended for prolong action may be due to the attachment with intestinal mucosa for relief from active duodenal ulcer. Mucoadhesive tablets were coated with respective polymer and coated with Eudragit L100 to fabricate enteric coated tablets. The prepared tablets were evaluated for different physical parameters and dissolution study were performed in three dissolution mediums like 0.1N hydrochloric acid for 2h, pH 6.5 and pH 7.8 phosphate buffer solution for 12hr. Sodium carboxymethylcellulose showed above 95% release within 10 h where as carbopol-934P showed slow release about 88% to 92% over a period of 12 h. having excellent mucoadhesive strength but ethyl cellulose containing tablets showed less than 65% release. The release mechanism of all formulation was diffusion controlled confirmed from Higuchi′s plot. Thus, the present study concluded that, carbopol-934P containing mucoadhesive tablets of omeprazole pellets can be used for local action in the ulcer disease as well as for oral controlled release drug delivery.

  19. Duodenal metastasis of pulmonary pleomorphic carcinoma: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Jeong, Sun Hye; Paik, Sang Hyun; Koh, Eun Suk; Shin, Hwa Kyoon; Cha, Jang Gyu; Park, Jai Soung [Soonchunhyang University Bucheon Hospital, Bucheon (Korea, Republic of); Lee, Nam Seok [Purun Radiologic Clinic, Yesan (Korea, Republic of)

    2016-02-15

    Pulmonary pleomorphic carcinoma is an uncommon malignant lesion of the lung. A chest radiograph of 53-year-old man who was suffering from a cough revealed a well-defined mass-like opacity with a broad base on the pleura at the apico-posterior segment of the right upper lobe of the lung. The subsequent chest computed tomography (CT) scan demonstrated an inhomogeneous enhancing mass with central low-attenuation in the right upper lobe. A lobectomy was performed and the mass was determined to be a pleomorphic carcinoma with visceral pleura invasion. Forty days after the operation, the patient complained of melena and an abdominal CT revealed an intraluminal and extraluminal protruding mass around the prepyloric antrum and duodenal bulb. The mass was removed by en-block surgery and diagnosed as metastatic pleomorphic carcinoma from the lung. Previous articles reported a median survival time of 3–10 months for pleomorphic carcinoma, but in this case, the patient has continued to survive, 11 years after surgery. Chest and abdominal CTs have revealed no evidence of tumor recurrence or metastasis.

  20. Primary duodenal adenocarcinoma: case report of an infrequent tumor

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    Óscar Moreno-Loaíza

    2013-10-01

    Full Text Available Introduction. Primary duodenal adenocarcinoma is an infrequent tumor both in our environment and in the world. There is no conclusive evidence on its epidemiology, diagnostic criteria, treatment or prognosis. Clinical case. We report a 77 year-old female patient, of mixed racial origin, native of Cusco (Peru who consulted for abdominal pain, weight loss, nausea, postprandial vomiting and bloating of three months course. At the time of examination she had second to third degree protein malnutrition with a BMI of 16.88 kg/m2, signs of moderate to severe chronic anemia and an 8 cm abdominal tumor in the epigastrium and right hypochondrium. The multislice spiral abdominal CT and ultrasonography revealed the presence of a solid tumor in the second portion of the duodenum. The patient was submitted to a gastroenterostomy without tumor resection. Biopsy confirmed tubular adenocarcinoma. Furthermore, no other primary tumors were found in the stomach, pancreas, biliary tree and colon. The patient was stabilized and was treated with 5-fluorouracil, irinotecan and leucovorin. Literature review. The article includes a brief review on the diagnosis, treatment and prognosis of this condition. Discussion. Management is not straightforward. There is little literature on the subject leaving decisions up to the attending physician’s criteria. We believe that all cases of rare diseases should be studied in depth, give rise to a thorough review of literature and, above all, be brought to the attention of the medical community.

  1. Duodenal application of Li+ in a submaximal therapeutic dose inhibits exocrine pancreatic secretion and modulates gastro-duodenal myoelectrical activity in a conscious pig model

    DEFF Research Database (Denmark)

    Naughton, Violetta; Hedemann, Mette Skou; Naughton, Patrick Joseph;

    2013-01-01

    This study tested whether duodenal application of lithium inhibits gastroduodenal motility, and whether it suppresses secretion from the exocrine pancreas. Five suckling pigs, 16–18 days old, were surgically fitted with 3 serosal electrodes on the wall of the gastric antrum and the duodenum for e...

  2. Congenital duodenal obstruction in neonates:a decade's experience from one center

    Institute of Scientific and Technical Information of China (English)

    Qing-Jiang Chen; Zhi-Gang Gao; Jin-Fa Tou; Yun-Zhong Qian; Min-Ju Li; Qi-Xing Xiong; Qiang Shu

    2014-01-01

    Background: Congenital duodenal obstruction (CDO) is one of the most common anomalies in newborns, and accounting for nearly half of all cases of neonatal intestinal obstruction. This study aimed to review our single-center experience in managing congenital duodenal obstruction while evaluate the outcomes. Methods: We conducted a retrospective analysis of the records of all neonates dianogsed with congenital duodenal obstruction admitted to our center between January 2003 and December 2012. We analyzed demographic criteria, clinical manifestations, associated anomalies, radiologic findings, surgical methods, postoperative complications, and fi nal outcomes. Results: The study comprised 287 newborns (193 boys and 94 girls). Birth weight ranged from 950 g to 4850 g. Fifty-three patients were born prematurely between 28 and 36 weeks' gestation. Malrotation was diagnosed in 174 patients, annular pancreas in 66, duodenal web in 55, duodenal atresia or stenosis in 9, preduodenal portal vein in 2, and congenital band compression in 1. Twenty patients had various combinations of these conditions. Presenting symptoms included bilious vomiting, dehydration, and weight loss. X-rays of the upper abdomen demonstrated the presence of a typical doublebubble sign or air-fl uid levels in 68.64% of patients, and confi rmatory upper and/or lower gastrointestinal contrast studies were obtained in 64.11%. Multiple associated abnormalities were observed in 50.52% of the patients. Various surgical approaches were used, including Ladd's procedure, duodenoplasty, duodenoduodenostomy, duodenojejunostomy, or a combination of these. Seventeen patients died postoperatively and 14 required re-operation. Conclusions: Congenital duodenal obstruction is a complex entity with various etiologies and often includes multiple concomitant disorders. Timely diagnosis and aggressive surgery are key to improving prognosis. Care should be taken to address all of the causes of duodenal obstruction and

  3. A case report of a duodenal adenocarcinoma: a complication with Crohn's disease.

    Science.gov (United States)

    Sakakibara, Yuko; Yamada, Takuya; Kimura, Keiichi; Iwasaki, Ryuichirou; Iwasaki, Tetsuya; Ishihara, Akio; Nakazuru, Shoichi; Ishida, Hisashi; Kodama, Yoshinori; Mita, Eiji

    2016-03-01

    The prevalence of Crohn's disease (CD) in Japan is increasing, and so is the incidence of colorectal and small bowel cancers associated with CD. However, few reports have described the malignant transformation of duodenal lesions; moreover, such a diagnosis is rarely possible preoperatively. We present a case of malignant degeneration in the duodenal mucosa associated with CD. A 54-year-old man had been receiving treatment for CD for more than 20 years. Seven years ago, he was diagnosed with duodenal stenosis related to CD. He was asymptomatic, and biopsy results from the proximal stricture showed inflammatory changes without malignant transformation. The lesion was then monitored during follow-up. In 2013, he underwent an endoscopy, which revealed an ulcerated, nodular mucosa, immediately proximal to a high-grade obstruction of the descending duodenum. A biopsy of the ulcer lesion confirmed a diagnosis of adenocarcinoma. The patient then underwent duodenopancreatectomy. Histopathological results from the resected duodenum confirmed a poorly differentiated adenocarcinoma that had invaded the subserosa. The patient recovered, and no recurrence has been observed. Although the duodenum can be accessed without difficulty during endoscopy, it is challenging to preoperatively diagnose malignant transformation. There are only four reported cases of duodenal cancer stemming from CD-associated stricture, and only one of them received a preoperative diagnosis of malignancy based on endoscopic biopsy results. Progressive duodenal narrowing and ulceration in patients with CD should indicate a need for careful endoscopic evaluation and biopsy in order to exclude malignant degeneration of Crohn's duodenitis. Early diagnosis of cases of CD-associated cancers is necessary. We report the features of a rare and illustrative case of duodenal adenocarcinoma in a patient with CD.

  4. Long-term risk of gastrointestinal cancers in persons with gastric or duodenal ulcers.

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    Søgaard, Kirstine K; Farkas, Dóra K; Pedersen, Lars; Lund, Jennifer L; Thomsen, Reimar W; Sørensen, Henrik T

    2016-06-01

    Peptic ulcer predicts gastric cancer. It is controversial if peptic ulcers predict other gastrointestinal cancers, potentially related to Helicobacter pylori or shared lifestyle factors. We hypothesized that gastric and duodenal ulcers may have different impact on the risk of gastrointestinal cancers. In a nationwide cohort study using Danish medical databases 1994-2013, we quantified the risk of gastric and other gastrointestinal cancers among patients with duodenal ulcers (dominantly H. pylori-related) and gastric ulcers (dominantly lifestyle-related) compared with the general population. We started follow-up 1-year after ulcer diagnosis to avoid detection bias and calculated absolute risks of cancer and standardized incidence ratios (SIRs). We identified 54,565 patients with gastric ulcers and 38,576 patients with duodenal ulcers. Patient characteristics were similar in the two cohorts. The 1-5-year risk of any gastrointestinal cancer was slightly higher for gastric ulcers patients (2.1%) than for duodenal ulcers patients (2.0%), and SIRs were 1.38 (95% CI: 1.31-1.44) and 1.30 (95% CI: 1.23-1.37), respectively. The SIR of gastric cancer was higher among patients with gastric ulcer than duodenal ulcer (1.92 vs. 1.38), while the SIRs for other gastrointestinal cancers were similar (1.33 vs. 1.29). Compared with gastric ulcer patients, duodenal ulcer patients were at lower risk of smoking- and alcohol-related gastrointestinal cancers. The risk of nongastric gastrointestinal cancers is increased both for patients with gastric ulcers and with duodenal ulcers, but absolute risks are low. H. pylori may be less important for the development of nongastric gastrointestinal cancer than hypothesized.

  5. Divertículo gigante de colon: presentación de un caso Giant colonic diverticulum: case report

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    Ezequiel Ochoa

    2008-12-01

    Full Text Available El divertículo gigante de colon (DGC es una rara complicación de la enfermedad diverticular. Se considera divertículo gigante cuando su diámetro supera los 4 cm. Descrito por primera vez en la literatura francesa en el año 1946, se han publicado hasta la fecha 155 casos. Nuestro paciente, de 59 años, refirió clínica de dolor abdominal leve de 4 meses de evolución. Se le solicitó un estudio de colon por enema, el que reveló una formación sacular de 15 cm en colon sigmoideo, de contenido aéreo y cuello corto, a través del cual se opacificó la cavidad con la sustancia baritada, confirmando el diagnóstico de DGC. Al paciente se le realizó, además, tomografía computada y resonancia magnética. El diagnóstico se confirmó con cirugía y estudio histopatológico. Se practicó una resección sigmoidea con DGC y anastomosis colorrectal lateroterminal. El estudio anatomopatológico informó DGC tipo II.Giant colonic diverticulum is a rare diverticular disease complication. It is considered giant when its diameter is longer than 4 cms. It was reported the first time by french authors in 1946 and there is 155 cases reported in world literature. Our patient aged 59 years old, referred four month of abdominal pain. A barium enema was made showing a sigmoid cavity with air and fill of barium contrast with short neck continuing with the colon lumen. It was also studied with CT and MRI. The diagnosis was confirmed by surgery and histopathologic exam. The pathologic report informed giant colonic diverticulum type II.

  6. Association between idiopathic intracranial hypertension and sigmoid sinus dehiscence/diverticulum with pulsatile tinnitus: a retrospective imaging study

    Energy Technology Data Exchange (ETDEWEB)

    Zhaohui, Liu; Qing, Li [Capital Medical University, Beijing Tongren Hospital, Department of Radiology, Beijing (China); Cheng, Dong; Xiao, Wang; Xiaoyi, Han; Pengfei, Zhao; Han, Lv; Zhenchang, Wang [Capital Medical University, Beijing Friendship Hospital, Department of Radiology, Beijing (China)

    2015-07-15

    The mechanism of occurrence of sigmoid sinus dehiscence/diverticulum (SSDD) in pulsatile tinnitus (PT) patients remains under debate. Its association with idiopathic intracranial hypertension (IIH) lacks evidence, which is important for therapeutic planning and improving the clinical outcome. This study aimed to evaluate the association between SSDD and IIH by comparing the prevalence of several established imaging features of IIH between PT patients with SSDD and healthy volunteers. Thirty-three unilateral PT patients with SSDD identified on CT images and 33 age- and sex-matched healthy volunteers underwent T1-weighted volumetric magnetic resonance imaging (MRI). The optic nerve, pituitary gland, transverse sinus, and ventricles were assessed. The prevalence of established IIH imaging features was compared between the two groups. Furthermore, the PT patients were divided into two subgroups: PT patients with dehiscence only and PT patients with diverticulum. The same statistical analysis was performed on each pathophysiologic entity respectively. The PT patients with SSDD showed a significantly higher prevalence of empty sella (P < 0.001), flattened posterior sclera (P = 0.001), vertical tortuosity of the optic nerve (P = 0.001), protrusion of the optic nerve (P = 0.006), transverse sinus stenosis (P = 0.011), and distension of the optic nerve sheath (P = 0.000). There were no significant differences between the PT and control groups in the maximum widths of the third and fourth ventricles and the lateral ventricle size. In contrast to controls, the imaging findings persisted in both of pathophysiologic entities, except for transverse sinus stenosis. Several IIH imaging features occur more frequently in PT patients with SSDD than in healthy individuals, which suggests a potential correlation between SSDD with PT and IIH. (orig.)

  7. A Newly Designed Stent for Management of Malignant Distal Duodenal Stenosis

    Energy Technology Data Exchange (ETDEWEB)

    Zhou, Wei-Zhong, E-mail: xmjbq007@163.com; Yang, Zheng-Qiang, E-mail: ntdoctoryang@hotmail.com; Liu, Sheng, E-mail: liusheng1137@sina.com; Zhou, Chun-Gao, E-mail: zhouchungao@aliyun.com; Xia, Jin-Guo, E-mail: docjinguoxia@hotmail.com; Zhao, Lin-Bo, E-mail: linberzhao@hotmail.com; Shi, Hai-Bin, E-mail: shihb@njmu.edu.cn [The First Affiliated Hospital of Nanjing Medical University, Department of Interventional Radiology (China)

    2015-02-15

    PurposeTo evaluate the clinical effectiveness of a newly designed stent for the treatment of malignant distal duodenal stenosis.MethodsFrom March 2011 to May 2013, six patients with malignant duodenal stenosis underwent fluoroscopically guided placement of the new duodenal stent consisting of braided, nested stent wires, and a delivery system with a metallic mesh inner layer. Primary diseases were pancreatic cancer in three patients, gastric cancer in two patients, and endometrial stromal sarcoma in one patient. Duodenal obstructions were located in the horizontal part in two patients, the ascending part in two patients, and the duodenojejunal flexure in two patients. Technical success, defined as the successful stent deployment, clinical symptoms before and after the procedure, and complications were evaluated.ResultsTechnical success was achieved in all patients. No major complications were observed. Before treatment, two patients could not take any food and the gastric outlet obstruction scoring system (GOOSS) score was 0; the other four patients could take only liquids orally (GOOSS score = 1). After treatment, five patients could take soft food (GOOSS score = 2) and one patient could take a full diet (GOOSS score = 3). The mean duration of primary stent patency was 115.7 days.ConclusionsThe newly designed stent is associated with a high degree of technical success and good clinical outcome and may be clinically effective in the management of malignant distal duodenal obstruction.

  8. Endoscopic resection of duodenal bulb neuroendocrine tumor larger than 10 mm in diameter

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    Naka Teiji

    2011-06-01

    Full Text Available Abstract Background Endoscopic treatment for duodenal bulb neuroendocrine tumor larger than 10 mm is still controversial. This report presents four cases successfully treated with endosonography (EUS-assisted endoscopic mucosal resection (EMR procedure for duodenal bulb neuroendocrine tumor larger than 10 mm in diameter. Methods The case series of four patients diagnosed with neuroendocrine tumor from 2003 to 2008 were reviewed. EUS demonstrated well-defined hypoechoic tumors confined to the submucosal hyperechoic layer and the underlying hypoechoic muscularis propria was intact in all four patients. EMR were planned and performed for the duodenal bulb neuroendocrine tumors larger than 10 mm. Results En bloc resections with tumor free lateral and basal margins were accomplished using an endoscopic diathermic snare with forward-viewing instruments without any complications. Neither residual duodenal neuroendocrine tumors nor metastatic lesions were detected during the observation period ranging 19 to 78 months Conclusion Duodenal bulb neuroendocrine, larger than 10 mm in diameter, can be treated by endoscopic procedure, after confirming that the tumor confined to the submucosal layer in EUS examination, and no lymph node involvement by abdominal CT and US.

  9. Intramural Duodenal Haematoma after Endoscopic Biopsy: Case Report and Review of the Literature

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    Claudia Grasshof

    2012-01-01

    Full Text Available The development of intramural duodenal haematoma (IDH after small bowel biopsy is an unusual lesion and has only been reported in 18 children. Coagulopathy, thrombocytopenia and some special features of duodenal anatomy, e.g. relatively fixed position in the retroperitoneum and numerous submucosal blood vessels, have been suggested as a cause for IDH. The typical clinical presentation of IDH is severe abdominal pain and vomiting due to duodenal obstruction. In addition, it is often associated with pancreatitis and cholestasis. Diagnosis is confirmed using imaging techniques such as ultrasound, magnetic resonance imaging or computed tomography and upper intestinal series. Once diagnosis is confirmed and intestinal perforation excluded, conservative treatment with nasogastric tube and parenteral nutrition is sufficient. We present a case of massive IDH following endoscopic grasp forceps biopsy in a 5-year-old girl without bleeding disorder or other risk for IDH, which caused duodenal obstruction and mild pancreatitis and resolved within 2 weeks of conservative management. Since duodenal biopsies have become the common way to evaluate children or adults for suspected enteropathy, the occurrence of this complication is likely to increase. In conclusion, the review of the literature points out the risk for IDH especially in children with a history of bone marrow transplantation or leukaemia.

  10. Robotic-assisted repair of a duodenal diaphragm in a child

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    Jennifer H. Myszewski

    2015-08-01

    Full Text Available The retroperitoneal location of the duodenum and the small volume of the peritoneal cavity in pediatric patients make the laparoscopic repair of congenital duodenal anomalies challenging. As a result, robotic-assisted repair of duodenal atresia in a pediatric patient has been reported only once in the literature. This report describes the robotic-assisted laparoscopic repair of a congenital duodenal diaphragm in a 2-year-old, 8 kg patient who presented with vomiting and failure to thrive. An upper gastrointestinal series revealed partial obstruction at the second part of the duodenum with proximal dilatation. These findings are consistent with a duodenal diaphragm. Traditional laparoscopy was utilized to kocherize the first and second parts of the duodenum and to identify a loop of proximal jejunum for the proposed anastomosis. A duodeno-jejunal anastomosis was then performed using intra-corporeal suturing with a daVinci SI robotic system. The patient had a quick and uneventful post-operative course. At 6 month follow-up, she was asymptomatic and the surgical incisions had healed with excellent cosmetic appearance. A combination of laparoscopic and robotic techniques offers a promising alternative to open or purely laparoscopic repair of congenital duodenal anomalies.

  11. Duodenal ileus caused by a calf feeding nipple in a cow

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    Gerspach Christian

    2011-01-01

    Full Text Available Abstract Background The aim of this report was to describe duodenal obstruction caused by a rubber foreign body in a cow. Case Presentation The clinical, biochemical and ultrasonographic findings in a five-year-old Swiss Braunvieh cow with duodenal ileus caused by a calf feeding nipple are described. The main clinical signs were anorexia, ruminal tympany, decreased faecal output and abomasal reflux syndrome. Ultrasonographic examination revealed reticular hyperactivity and a dilated duodenum. A diagnosis of duodenal ileus was made and the cow underwent right-flank laparotomy, which revealed a dilation of the cranial part of the duodenum because of obstruction by a pliable foreign body. This was identified via enterotomy as a calf feeding nipple. The cow was healthy at the time of discharge four days after surgery and went on to complete a successful lactation. Conclusions To our knowledge, this is the first description of duodenal obstruction by a calf feeding nipple. This is an interesting case, which broadens the spectrum of the causes of duodenal ileus, which is usually caused by obstruction of the duodenum by a phytobezoar.

  12. Precise role of H pylori in duodenal ulceration

    Institute of Scientific and Technical Information of China (English)

    Michael Hobsley; Frank I Tovey; John Holton

    2006-01-01

    The facts that H pylori infection is commoner in duodenal ulcer (DU) patients than in the normal population, and that eradication results in most cases being cured,have led to the belief that it causes DU. However, early cases of DU are less likely than established ones to be infected. H pylori-negative cases are usually ascribed to specific associated factors such as non-steroidal anti-inflammatory drugs (NSAIDs), Crohn's disease,and hypergastrinaemia, but even after excluding these, several H pylori-negative cases remain and are particularly common in areas of low prevalence of H pylori infection. Moreover, this incidence of H pylori negative DU is not associated with a fall in overall DU prevalence when compared with countries with a higher H pylori prevalence. In countries with a high H pylori prevalence there are regional differences in DU prevalence, but no evidence of an overall higher prevalence of DU than in countries with a low H pylori prevalence. There is no evidence that virulence factors are predictive of clinical outcome. After healing following eradication of H pylori infection DU can still recur.Medical or surgical measures to reduce acid output can lead to long-term healing despite persistence of H pylori infection. Up to half of cases of acute DU perforation are H pylori negative. These findings lead to the conclusion that H pylori infection does not itself cause DU, but leads to resistance to healing, i.e., chronicity. This conclusion is shown not to be incompatible with the universally high prevalence of DU compared with controls.

  13. Pancreas duodenal homeobox-1 expression and significance in pancreatic cancer

    Institute of Scientific and Technical Information of China (English)

    Tao Liu; Shan-Miao Gou; Chun-You Wang; He-Shui Wu; Jiong-Xin Xiong; Feng Zhou

    2007-01-01

    AIM: To study the correlations of Pancreas duodenal homeobox-1 with pancreatic cancer characteristics,incluling pathological grading, TNM grading, tumor metastasis and tumor cell proliferation.METHODS: Reverse transcriptase-polymerase chain reaction (RT-PCR) was used to detect PDX-1 mRNA expression in pancreatic cancer tissue and normal pancreatic tissue. The expression of PDX-1 protein was measured by Western blot and immunohistochemistry.Immunohistochemistry was also used to detect proliferative cell nuclear antigen (PCNA). Correlations of PDX-1 with pancreatic cancer characteristics, including pathological grading, TNM grading, tumor metastasis and tumor cell proliferation, were analyzed by using χ2 test.RESULTS: Immunohistochemistry showed that 41.1% of pancreatic cancers were positive for PDX-1 expression,but normal pancreatic tissue except islets showed no staining for PDX-1. In consistent with the result of imunohistochemistry, Western blot showed that 37.5% of pancreatic cancers were positive for PDX-1. RT-PCR showed that PDX-1 expression was significantly higher in pancreatic cancer tissues than normal pancreatic tissues (2-3.56 ± 0.35 vs 2-8.76 ± 0.14, P< 0.01). Lymph node metastasis (P < 0.01), TNM grading (P < 0.05), pathological grading (P < 0.05) and tumor cell proliferation (P < 0.01) were significantly correlated with PDX-1 expression levels.CONCLUSION: PDX-1 is re-expressed in pancreatic cancer, and PDX-1-positive pancreatic cancer cells show more malignant potential compared to PDX-1-negative cells. Therefore, PDX-1-positive cells may be tumor stem cells and PDX-1 may act as alternate surface marker of pancreatic cancer stem cells.

  14. Look Out before Polypectomy in Patients with Diverticular Disease – A Case of a Large, Inverted Diverticulum of the Colon Resembling a Pedunculated Polyp

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    Omero Alessandro Paoluzi

    2010-01-01

    Full Text Available Diverticular disease of the colon may be responsible for abdominal symptoms requiring colonoscopy, which may reveal the presence of concomitant polyps. A polyp found during colonoscopy in patients with colonic diverticular disease may be removed by endoscopic polypectomy with electrosurgical snare, a procedure associated with an incidence of perforation of less than 0.05%. The risk of such a complication may be higher in the event of an inverted colonic diverticulum, which may be misinterpreted as a polypoid lesion at colonoscopy. To date, fewer than 20 cases of inverted colonic diverticula, diagnosed at colonoscopy or following air contrast barium enema, have been reported in the literature. The present report describes a 68-year-old woman who underwent a screening colonoscopy, which revealed a voluminous pedunculated polyp that was recognized to be an inverted giant colonic diverticulum before endoscopic polypectomy.

  15. A congenital anterior urethral diverticulum associated with obstructive urinary symptoms in a 1-year-old male child: A case report and review of the literature

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    Mehmet Hanifi Okur

    2015-05-01

    Full Text Available Congenital anterior urethral diverticula are rarely found in children. We present the case of a 1-year-old male child with a congenital anterior urethral diverticulum. This condition can lead to obstructive lower urinary tract symptoms and urosepsis. The clinical presentation, diagnosis, and management of this rare condition are discussed in this report. The diagnosis was made using retrograde urethrography. Patient was treated with open diverticulectomy and urethroplasty

  16. Acidic duodenal pH alters gene expression in the cystic fibrosis mouse pancreas.

    Science.gov (United States)

    Kaur, Simran; Norkina, Oxana; Ziemer, Donna; Samuelson, Linda C; De Lisle, Robert C

    2004-08-01

    The duodenum is abnormally acidic in cystic fibrosis (CF) due to decreased bicarbonate ion secretion that is dependent on the CF gene product CFTR. In the CFTR null mouse, the acidic duodenum results in increased signaling from the intestine to the exocrine pancreas in an attempt to stimulate pancreatic bicarbonate ion secretion. Excess stimulation is proposed to add to the stress/inflammation of the pancreas in CF. DNA microarray analysis of the CF mouse revealed altered pancreatic gene expression characteristic of stress/inflammation. When the duodenal pH was corrected genetically (crossing CFTR null with gastrin null mice) or pharmacologically (use of the proton pump inhibitor omeprazole), expression levels of genes measured by quantitative RT-PCR were significantly normalized. It is concluded that the acidic duodenal pH in CF contributes to the stress on the exocrine pancreas and that normalizing duodenal pH reduces this stress.

  17. Gardner’s syndrome presenting as duodenal carcinoma in a young male

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    Sarma YS

    2015-10-01

    Full Text Available Gardners syndrome (GS is a variant of familial adenomatous polyposis (FAP and presents with both colonic and extra colonic manifestations. It is an autosomal dominant disorder and results from mutations in adenomatous polyposis coli (APC gene. Patients with GS if not treated early will invariably develop colonic cancers at a much younger age than those with sporadic colonic carcinoma. These patients also develop other malignant tumours like duodenal cancers, gastric cancer, hepatoblastoma, papillary carcinoma of the thyroid and multifocal cholangiocarcinomas. With early diagnosis and treatment of colonic polyposis, adenocarcinoma of the duodenum has become the leading cause of death in FAP patients. The mean age at which duodenal carcinoma is diagnosed in FAP is 45-52 years. We report the rare occurrence of duodenal carcinoma as the presenting feature of Gardner’s syndrome in a young 25-year-old male with no obvious malignant changes in the colonic adenomas.

  18. Oral administration of synthetic human urogastrone promotes healing of chronic duodenal ulcers in rats

    DEFF Research Database (Denmark)

    Poulsen, Steen Seier; Nexø, Ebba

    1986-01-01

    The effect of oral administration of synthetic human epidermal growth factor/urogastrone (EGF/URO) on healing of chronic duodenal ulcers induced by cysteamine in rats was investigated and compared with that of cimetidine, a H2-receptor antagonist. After 25 and 50 days of treatment, synthetic human...... EGF/URO significantly increased healing of chronic duodenal ulcers to the same extent as cimetidine. Combined treatment with synthetic human EGF/URO and cimetidine for 25 days was more effective than synthetic human EGF/URO given alone, whereas combined treatment for 50 days was significantly more...... effective than cimetidine alone. These results show that a combination of an agent inhibiting gastric acid secretion and the cytoprotective and growth-stimulating peptide EGF/URO seems to be more effective with regard to duodenal ulcer healing than individual administration of the two substances. Synthetic...

  19. Predicting Chemically Induced Duodenal Ulcer and Adrenal Necrosis with Classification Trees

    Science.gov (United States)

    Giampaolo, Casimiro; Gray, Andrew T.; Olshen, Richard A.; Szabo, Sandor

    1991-07-01

    Binary tree-structured statistical classification algorithms and properties of 56 model alkyl nucleophiles were brought to bear on two problems of experimental pharmacology and toxicology. Each rat of a learning sample of 745 was administered one compound and autopsied to determine the presence of duodenal ulcer or adrenal hemorrhagic necrosis. The cited statistical classification schemes were then applied to these outcomes and 67 features of the compounds to ascertain those characteristics that are associated with biologic activity. For predicting duodenal ulceration, dipole moment, melting point, and solubility in octanol are particularly important, while for predicting adrenal necrosis, important features include the number of sulfhydryl groups and double bonds. These methods may constitute inexpensive but powerful ways to screen untested compounds for possible organ-specific toxicity. Mechanisms for the etiology and pathogenesis of the duodenal and adrenal lesions are suggested, as are additional avenues for drug design.

  20. Perforated duodenal ulcer in high risk patients: Is percutaneous drainage justified?

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    Aly Saber

    2012-01-01

    Full Text Available Background: Conservative treatment was recommended as the treatment of choice in perforated acute peptic ulcer. Here, we adjunct percutaneous peritoneal drainage with nonoperative conservative treatment in high risk elderly patients with perforated duodenal ulcer. Aim: The work was to study the efficacy of percutaneous peritoneal drainage under local anesthesia supported by conservative measures in high risk elderly patients, according to the American Society of Anesthesiologists grading, with perforated duodenal ulcer. Patients and Methods: Twenty four high risk patients with age >65 years having associated medical illness with evidence of perforated duodenal ulcer. Results: The overall morbidity and mortality were comparable with those treated by conservative measures alone. Conclusion: In high risk patients with perforated peptic ulcer and established peritonitis, percutaneous peritoneal drainage under local anesthesia seems to be effective with least operative trauma and mortality rate.

  1. A Rare Case of Solitary Peutz Jeghers Type Hamartomatous Duodenal Polyp with Dysplasia!

    Science.gov (United States)

    Rathi, Chetan Devendra; Solanke, Dattatray Balasaheb; Kabra, Nikita Lalitkumar; Ingle, Meghraj Ananda; Sawant, Prabha Dilip

    2016-07-01

    Solitary Peutz Jeghers (SPJ) type hamartomatous polyp is a rare and separate entity from classic Peutz Jeghers syndrome (PJS). A hamartomatous polyp without associated mucocutaneous pigmentations, any other gastrointestinal polyp or a family history of PJS is diagnosed as a SPJ type polyp. We described a case of 22-year-old young man in whom solitary duodenal polyp was incidentally detected and resected. Histopathological examination revealed PJ type hamartomatous polyp with foci of adenomatous and moderate dysplastic change. Very few cases of solitary duodenal PJ type hamartomatous polyps with malignant transformation have been reported. They can be treated with endoscopic or surgical resection. Endoscopic ultrasound can give an idea about the depth of involvement. This is a rare case of duodenal solitary PJ polyp with dysplasia in a young patient.

  2. The Helicobacter pylori theory and duodenal ulcer disease. A case study of the research process

    DEFF Research Database (Denmark)

    Christensen, A H; Gjørup, T

    1995-01-01

    OBJECTIVES: To describe the medical research process from the time of the generation of a new theory to its implementation in clinical practice. The Helicobacter pylori (H. pylori) theory, i.e. the theory that H. pylori plays a significant causal role in duodenal ulcer disease was chosen as a case....... MATERIAL: Abstracts from 1984 to 1993, identified in the CD-Rom, Medline system, ("Silverplatter"), using the search terms Campylobacter pylori and Helicobacter pylori, and reviews and editorials about H. pylori in some of the most widespread clinical journals. RESULTS: 2204 papers on H. pylori were....... pylori in duodenal ulcer disease had been published in some of the most widespread clinical journals. In half of the papers the authors were convinced of the causal role of H. pylori in duodenal ulcer disease, while in the remainder they were sceptical. In seven cases the authors stated which patients...

  3. Duodenal Duplication Cyst: A Rare Differential Diagnosis in a Neonate with Bilious Vomiting

    Science.gov (United States)

    Župančić, Božidar; Gliha, Andro; Fuenzalida, Jose Varas; Višnjić, Stjepan

    2015-01-01

    Bilious vomiting is a relevant sign in neonates that requires immediate evaluation and diagnosis. A duplication of the intestinal tract is a possible cause of obstruction if located distally to the major duodenal papilla of Vater and most of them involve the jejunum, stomach, or colon. Duodenal duplications are very rare and can have an endoscopic or surgical treatment after diagnosis. We present a case of a 16-day-old term newborn that consulted because of bilious vomiting and after evaluation with imaging and upper endoscopy, a duodenal duplication cyst was found at the level of the third portion causing compression of the intestinal lumen that required surgical resolution with duodenocystostomy. PMID:26788454

  4. Duodenal diverticulum treated with diverticulization technique:a report of 6 cases%憩室旷置术治疗十二指肠憩室6例分析

    Institute of Scientific and Technical Information of China (English)

    罗良禄; 罗宝华; 朱炳荣

    2004-01-01

    笔者采用憩室旷置术治疗6例症状性十二指肠憩室.6例均获随访,随访时间1~5年,均无症状复发和并发症.认为憩室旷置术是治疗症状性十二指肠憩室的一种简便、安全和有效的方法.

  5. Ursodeoxycholic acid counteracts celecoxib in reduction of duodenal polyps in patients with familial adenomatous polyposis : a multicentre, randomized controlled trial

    NARCIS (Netherlands)

    van Heumen, Bjorn W. H.; Roelofs, Hennie M. J.; Vink-Borger, M. Elisa; Dekker, Evelien; Mathus-Vliegen, Elisabeth M. H.; Dees, Jan; Koornstra, Jan J.; Langers, Alexandra M. J.; Nagtegaal, Iris D.; Kampman, Ellen; Peters, Wilbert H. M.; Nagengast, Fokko M.

    2013-01-01

    Background: Due to prophylactic colectomy, mortality in patients with familial adenomatous polyposis (FAP) has changed, with duodenal cancer currently being the main cause of death. Although celecoxib reduces duodenal polyp density in patients with FAP, its long-term use may increase the risk of car

  6. Ursodeoxycholic acid counteracts celecoxib in reduction of duodenal polyps in patients with familial adenomatous polyposis: a multicentre, randomized controlled trial

    NARCIS (Netherlands)

    Heumen, van B.W.; Roelofs, H.M.J.; Vink-Börger, M.E.; Dekker, E.; Mathus-Vliegen, E.M.; Dees, J.; Koornstra, J.J.; Langers, A.M.; Nagtegaal, I.D.; Kampman, E.; Peters, W.H.; Nagengast, F.M.

    2013-01-01

    Background Due to prophylactic colectomy, mortality in patients with familial adenomatous polyposis (FAP) has changed, with duodenal cancer currently being the main cause of death. Although celecoxib reduces duodenal polyp density in patients with FAP, its long-term use may increase the risk of card

  7. Lower Bifidobacteria counts in both duodenal mucosa-associated and fecal microbiota in irritable bowel syndrome patients

    NARCIS (Netherlands)

    Kerckhoffs, Angele P. M.; Samsom, Melvin; van der Rest, Michel E.; de Vogel, Joris; Knol, Jan; Ben-Amor, Kaouther; Akkermans, Louis M. A.

    2009-01-01

    AIM: To determine the composition of both fecal and duodenal mucosa-associated microbiota in irritable bowel syndrome (IBS) patients and healthy subjects using molecular-based techniques. METHODS: Fecal and duodenal mucosa brush samples were obtained from 41 IBS patients and 26 healthy subjects. Fec

  8. Acute duodenal Crohn's disease successfully managed with low-speed elemental diet infusion via nasogastric tube: A case report

    Institute of Scientific and Technical Information of China (English)

    Takayuki Yamamoto; Maki Nakahigashi; Satoru Umegae; Tatsushi Kitagawa; Koichi Matsumoto

    2006-01-01

    Duodenal Crohn's disease is rare, and patients without obstruction are treated medically. We herein report one case whose duodenal Crohn's disease was successfully managed with low-speed elemental diet infusion through a nasogastric tube. A 28-year-old female developed acute duodenal Crohn's disease. Upper GI radiologic and endoscopic examinations showed a stricture in the duodenal bulb. Using the duodenal biopsy specimens,mucosal cytokine levels were measured; interleukin (IL)-1β, IL-6, IL-8, and tumor necrosis factor-α levels were remarkably elevated. For initial 2 wk, powdered mesalazine was orally given but it was not effective. For the next 2 wk, she was treated with low-speed elemental diet therapy using a commercially available ElentalTM,which was infused continuously through a nasogastric tube using an infusion pump. The tip of the nasogastric tube was placed at an immediate oral side of the pylorus.The infusion speed was 10 mL/h (usual speed, 100 mL/h).After the 2-wk treatment, her symptoms were very much improved, and endoscopically, the duodenal stricture and inflammation improved. The duodenal mucosal cytokine levels remarkably decreased compared with those before the treatment. Although our experience was limited, lowspeed elemental diet infusion through a nasogastric tube may be a useful treatment for acute duodenal Crohn's disease.

  9. Usefulness of biopsying the major duodenal papilla to diagnose autoimmune pancreatitis: A prospective study using TgG4-immunostaining

    Institute of Scientific and Technical Information of China (English)

    Terumi Kamisawa; Yuyang Tu; Hitoshi Nakajima; Naoto Egawa; Kouji Tsuruta; Atsutake Okamoto

    2006-01-01

    AIM: To examine the histological and immunohistochemical findings of biopsy specimens taken from the major duodenal papilla of autoirnrnune pancreatitis (AIP)patients.METHODS: The major duodenal papilla in the resected pancreas of 3 patients with AIP and of 5 control patients [pancreatic carcinoma (n = 3) and chronic alcoholic pancreatitis (n = 2)] was irnrnunostained using anti-CD4-T cell, CD8-T cell and IgG4 antibodies. Forceps biopsy specimens taken from the major duodenal papilla of 2patients with AIP and 5 control patients with suspected papillitis were prospectively taken during duodenoscopy and immunohistochernically examined.RESULTS: Moderate or severe lyrnphoplasrnacytic infiltration including many CD4-positive or CD8-positive T lymphocytes and IgG4-positive plasma cells (≥10/HPF),was observed in the major duodenal papilla of all 3 patients with AIP. The same findings were also detected in the biopsy specimens taken from the major duodenal papilla of 2 patients with AIP, but in controls, there were only a few (≤3/HPF) IgG4-positive plasma cells infiltrating the major duodenal papilla.CONCLUSIONS: An abundant infiltration of IgG4-positive plasma cells is specifically detected in the major duodenal papilla of patients with AIP. Although this is a preliminary study, IgG4-irnmunostaining of biopsy specimens taken from the major duodenal papilla may support the diagnosis of AIP.

  10. Transarterial embolotherapy in patients with duodenal hemorrhage using microcoils and gelfoam particles

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Tae Beom [School of Medicine, Donga Univ., Busan (Korea, Republic of); Kim, Young Hwan; Seong, Chang Kyu [School of Medicine, Kyeongpook National Univ., Daegu (Korea, Republic of)] [and others

    2004-07-01

    To assess the efficacy and safety of arterial embolotherapy in patients with massive duodenal hemorrhage. Between January 1999 and June 2002, 25 patients (age: 34-81, mean 58, male: 19, female: 6) underwent arterial embolization for duodenal hemorrhage after failed endoscopic therapy. The hemorrhage originated from duodenal ulcer in sixteen patients, from cancer with duodenal invasion in five patients, from endoscopic sphincterectomy in two patients, and from pseudoaneurysm complicating acute pancreatitis in two patients. Hemorrhage was detected at endoscopy and an attempt was made to treat it endoscopically in all patients, but failed in each case. At angiography, direct bleeding signs such as contrast extravasation or pseudoaneurysm were demonstrated in nineteen patients. In the six patients without angiographic evidence of bleeding, blind embolization of the gastroduodenal artery was performed based on the endoscopic examination. Microcoil and gelfoam particles were used as embolic agents. Hemostasis was achieved immediately after embolotherapy in 21 patients (84%). Bleeding recurred in 4 patients (16%), and of these cases, one was successfully treated purely by endoscopic means, a second was reembolized three times due to bleeding from the collateral vessels of the tumor and the two others were treated by surgery. After the procedure, six patients died (24%). The causes of death were disseminated intravascular coagulopathy, multiorgan failure, sepsis and acute renal failure. The underlying diseases of the deceased patients were cancers with duodenal invasion (n=4) and abdominal aortic aneurysm with ischemic colitis (n=1). Transarterial embolotherapy in the case of massive duodenal hemorrhage is a safe and effective procedure. Even in the absence of angiographic evidence of bleeding, blind embolization of the gastroduodenal artery is effective for patients in the surgically high risk group.

  11. Duodenal Bulb Mucosa with Hypertrophic Gastric Oxyntic Heterotopia in Patients with Zollinger Ellison Syndrome

    Directory of Open Access Journals (Sweden)

    Emil Kohan

    2009-01-01

    Full Text Available Objectives. Zollinger-Ellison Syndrome (ZES results in hypersecretion of gastric acid (via gastrinoma leading to peptic ulcers, diarrhea, and abdominal pain. We describe the novel discovery of hypertrophic, heterotopic gastric mucosa in the proximal duodenal bulb in patients with ZES, which we hypothesize results in an increased incidence of postbulbar ulcers in patients with ZES (a mechanism previously unreported. We determined the incidence of the novel finding of duodenal gastric oxyntic hypertrophic heterotopia (GOH in patients with ZES. Methods. Seven patients with ZES were enrolled. The diagnosis of ZES was established by hypergastrinemia, gastric acid hypersecretion, and a positive secretin test or based on biopsy specimens (evaluated via tissue staining. Basal acid output (BAO and baseline gastrin secretion were determined by established methods. Endoscopic examinations with methylene blue staining and biopsy of the gastric and duodenal mucosa were conducted in all patients every 3–6 months for an average of 5 years. Results. The duodenal mucosa demonstrated hypertrophic GOH in 5 out of 7 patients with ZES and an intact stomach and duodenum. Biopsies from the bowel mucosa demonstrated patchy replacement of surface epithelium by gastric-type epithelium with hypertrophic oxyntic glands in the lamina propria in 5 patients. Two of the patients had no evidence of GOH in the duodenal bulb. Patients with GOH had an average serum gastrin level of 1245 pg/mL and BAO of 2.92 mEq/hr versus 724 pg/mL and 0.8 mEq/hr in patients without GOH. Conclusions. This study demonstrated the presence of duodenal mucosa with GOH in 5 out of 7 patients with ZES and an intact stomach and duodenum. The presence of hypertrophic and heterotopic gastric mucosa is proposed to result from increased gastrin levels and may contribute to the increased incidence of postbulbar ulcers in these patients.

  12. MR Cholangiography and Dynamic Examination of Duodenal Fluid in the Differential Diagnosis between Extrahepatic Biliary Atresia and Infantile Hepatitis Syndrome

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    In order to evaluate the value of magnetic resonance cholangiography (MRC) and dynamic examination of duodenal fluid in the differential diagnosis between extrahepatic biliary atresia (EHBA) and infantile hepatitis syndrome (IHS), 52 pa tients with infantile cholestatic jaundice were examined by MRC and duodenal fluid examination. Original interpretations were compared with clinical outcome. Calculated sensitivity of duodenal fluid examination in diagnosis of EHBA was 100%, and specificity was 91.1%. Sensitivity of MRC in the diagnosis of EHBA was 94.4 % and specificity 88.24 %. The sensitivity of MRC and examination of duodenal fluid combined in diagnosis of EHBA was 94.4 % and specificity 97.06 %. We are led to conclude that MRC and dynamic examination of duodenal fluid are useful in the differential diagnosis between IHS and EHBA and the combined use of the two techniques yield better resutls.

  13. A Child with Severe Malaria Presenting with Acute Surgical Abdomen (Duodenal Perforation

    Directory of Open Access Journals (Sweden)

    Tika Ram Bhandari

    2016-01-01

    Full Text Available Plasmodium falciparum, the commonest cause of severe malaria in children, is an important cause of mortality in developing nations like Nepal. Duodenal perforation in a case of complicated malaria, although a rare entity, can occur in children. Early diagnosis, proper medical treatment, and early surgical repair can be a lifesaving measure in such cases. Here, we report a case of a 5-year-old male child with falciparum malaria complicated by a duodenal perforation that was successively managed with appropriate antimalarial drugs and early surgical repair.

  14. A Child with Severe Malaria Presenting with Acute Surgical Abdomen (Duodenal Perforation).

    Science.gov (United States)

    Bhandari, Tika Ram; Shahi, Sudha; Poudel, Rajesh; Chaudhary, Nagendra

    2016-01-01

    Plasmodium falciparum, the commonest cause of severe malaria in children, is an important cause of mortality in developing nations like Nepal. Duodenal perforation in a case of complicated malaria, although a rare entity, can occur in children. Early diagnosis, proper medical treatment, and early surgical repair can be a lifesaving measure in such cases. Here, we report a case of a 5-year-old male child with falciparum malaria complicated by a duodenal perforation that was successively managed with appropriate antimalarial drugs and early surgical repair.

  15. Treatment of a duodenal perforation secondary to an endoscopic sphincterotomy with clips

    Institute of Scientific and Technical Information of China (English)

    Panagiotis Katsinelos; George Paroutoglou; Basilios Papaziogas; Athanasios Beltsis; Stavros Dimiropoulos; Konstantinos Atmatzidis

    2005-01-01

    Perforation is one of the most serious complications of endoscopic sphincterotomy (ES) necessitating immediate surgical intervention. We present a case of successful management of such a complication with endoclipping. A85-year-old woman developed duodenal perforation after ES. The perforation was identified early and its closure was achieved using three metallic clips in a single session.There was no procedure-related morbidity or complications and our patient was discharged from hospital 10 d later.Endoclipping of duodenal perforation induced by ES is a safe, effective and alternative to surgery treatment.

  16. Aneurysm of the Superior Posterior Pancreatic-Duodenal Artery Presenting with Recurrent Syncopes

    Directory of Open Access Journals (Sweden)

    I.A.J. van Doesburg

    2009-08-01

    Full Text Available We present a 61-year-old woman with hypovolemic shock due to a ruptured aneurysm of the superior posterior pancreatic-duodenal artery in whom recurrent syncopes were the first presenting sign of pancreatic-duodenal artery aneurysm (PDAA. PDAA is a rare but life-threatening condition. The widely varying symptomatology may lead to a delay in diagnosis and treatment. Patients with atypical symptoms, such as vague abdominal pain, recurrent dizziness or syncope, may actually suffer from a sentinel bleeding of the vascular malformation. Radiological imaging, especially selective angiography, may provide a diagnostic as well as a therapeutic tool in these patients.

  17. Tratamento cirúrgico do divertículo de zenker Surgical treatment of the zenker's diverticulum

    Directory of Open Access Journals (Sweden)

    Nelson Adami Andreollo

    1998-02-01

    estudo. Concluindo, os resultados mostram que tanto a diverticulectomia como a diverticulopexia podem ser utilizadas, ambas seguidas de miotomia do músculo cricofaríngeo. A diverticulopexia mostrou ser uma opção muito satisfatória para os divertículos de tamanhos pequenos e médios.The Zenker’s diverticulum is a not frequent disease and the main symptom is the cervical dysfagia. The aspects of the pathophysiology had motivated many researchs in the literature, using manometric and cinerradiographic studies. The surgical treatment is most commonly employed, favouring the most number of patients, with low recurrence rates. However, some publications show the advantages of the endoscopic treatment. Thirty nine patients with Zenkers diverticulum were operated on in the last 15 years, being 28 males (71.8%, with the age ranging from 18 to 86 years (mean 54.5 years. The main symptoms were: cervical dysphagia (89.8%, food regurgitation (71.8%, cough (30.7% and losting weight (25.6%. Two patients presented diverticulitis and perforated diverticulum (5.1%. The diagnosis were established using esophagogram in 37 patients (94.8% and digestive endoscopy in 28 (71.7%. The manometric studies were performed in 13 cases (33.3%. The treatment consisted of diverticulectomy followed by the cricopharyngeal sphyncter myotomy in 24 patients (61.5% or diverticulopexy also followed by the same myotomy in 15 patients (38.5%. The late follow-up of 35 patients (89.8% ranging from five months to 12 years (mean 4.5 years showed that all oft hem were without symptoms of dysphagia. Three patients (7. 7% presented light and inconstant dysphagia. One patient died due to pulmonary and cardiac problems (2.5%. The histopathology studies of the diverticulum showed a malignant tumor in one case (2.5%. The patients submitted to diverticulopexy were discharged early. The authors discuss the modern aspects of the physiopathology of the Zenker’s diverticulum, they analyse the choices of treatment and

  18. Obstrução duodenal congênita do tipo veia porta pré-duodenal em recém-nascido

    Directory of Open Access Journals (Sweden)

    Willy Marcus França

    2016-10-01

    Full Text Available Introdução: A obstrução duodenal congênita manifesta-se tipicamente no período intrauterino e neonatal. Todavia, uma apresentação mais tardia e diversa pode ocorrer nos raros casos de veia porta pré-duodenal (VPPD. A identificação de achados radiológicos, como o sinal de dupla bolha, é determinante para a hipótese diagnóstica de oclusão ou sub-oclusão duodenal e a utilização de ultrassom com Doppler pode auxiliar na suspeita de obstrução duodenal tipo veia porta. Entretanto, o diagnóstico final da causa do quadro obstrutivo só pode ser confirmado mediante ao procedimento de laparotomia exploratória; Objetivos: Destacar o tratamento realizado, a evolução e o prognóstico do caso reportado de VPPD em recém-nascido; Metodologia: Acompanhamento clínico e cirúrgico, baseado na análise de prontuário do recém-nascido, incluindo registro fotográfico dos métodos diagnósticos e procedimentos cirúrgicos, com suporte de uma ampla revisão da literatura; Relato de caso: RN do sexo feminino, de gestação e parto sem complicações, apresentou, ao nascer, 55 ml de conteúdo gástrico após aspiração e exame físico sem alterações. Paciente evoluiu com vômitos após mamadas e significativa perda de peso, sendo prescrita nutrição parenteral, jejum e sonda orogástrica aberta. Foi realizado RX de trânsito intestinal contrastado, apresentando o sinal de dupla bolha, sendo indicada laparotomia exploratória, com achados de VPPD. Paciente evoluiu bem no pós- operatório, iniciando dieta enteral e posterior evacuação. Conclusões: O caso relatado traz à luz a discussão da terapêutica de VPPD associada à doença sub- oclusiva duodenal, e evidencia que é possível obter resultados satisfatórios e duradouros no que diz respeito ao alívio sintomático e melhoria da qualidade de vida.

  19. A Metagenomic Investigation of the Duodenal Microbiota Reveals Links with Obesity.

    Directory of Open Access Journals (Sweden)

    Emmanouil Angelakis

    Full Text Available Few studies have tested the small intestine microbiota in humans, where most nutrient digestion and absorption occur. Here, our objective was to examine the duodenal microbiota between obese and normal volunteers using metagenomic techniques.We tested duodenal samples from five obese and five normal volunteers using 16S rDNA V6 pyrosequencing and Illumina MiSeq deep sequencing. The predominant phyla of the duodenal microbiota were Firmicutes and Actinobacteria, whereas Bacteroidetes were absent. Obese individuals had a significant increase in anaerobic genera (p < 0.001 and a higher abundance of genes encoding Acyl-CoA dehydrogenase (p = 0.0018 compared to the control group. Obese individuals also had a reduced abundance of genes encoding sucrose phosphorylase (p = 0.015 and 1,4-alpha-glucan branching enzyme (p = 0.05. Normal weight people had significantly increased FabK (p = 0.027, and the glycerophospholipid metabolism pathway revealed the presence of phospholipase A1 only in the control group (p = 0.05.The duodenal microbiota of obese individuals exhibit alterations in the fatty acid and sucrose breakdown pathways, probably induced by diet imbalance.

  20. Acute pancreatitis as an adverse event in patients with the duodenal-jejunal bypass liner

    NARCIS (Netherlands)

    Betzel, B; Homan, J.; Aarts, E.; Janssen, I.; Spanier, M.; Wahab, P.J.; Groenen, M.; Berends, F.

    2015-01-01

    Placement of the duodenal-jejunal bypass liner (DJBL) is a minimally invasive technique for the management of patients with type 2 diabetes mellitus and obesity. Acute pancreatitis was seen in 5 of 167 patients (3 %) in our series. It is suggested that acute pancreatitis in patients with the DJBL re

  1. Primary Duodenal Adenocarcinoma without Stenosis: A Case Report with a Brief Literature Review

    Directory of Open Access Journals (Sweden)

    Daisuke Usuda

    2014-07-01

    Full Text Available This article focuses on the symptomatic and diagnostic problems of primary duodenal adenocarcinoma (PDA by way of two case reports and a literature review. An 85-year-old woman with an adenocarcinoma in the 1st duodenal portion was offered palliative care. A 90-year-old woman with an adenocarcinoma in the 3rd duodenal portion was also offered palliative care. A unique finding in the two cases reported herein is that PDA did not cause stenosis and occlusion of the lumen. As no reports of PDA without stenosis have been published so far, these cases may add to our knowledge of PDA. The diagnosis of PDA is often delayed because its symptoms may be absent until the tumor has progressed, thus leading to a delay of several months. Patients typically present with a long history of variable and vague symptoms, and many are diagnosed with advanced disease. As regards clinical manifestations, abdominal pain is the most frequent symptom. The majority of these tumors are found to have infiltrated the duodenal wall at presentation, with many being unresectable due to local and distal invasion. Esophagogastroduodenoscopy and gastrointestinal barium radiography are the main diagnostic tests for PDA, detecting 88.6 and 83.3% of tumors, respectively. In some cases, ultrasonography or computed tomography are useful for detecting PDA and determining vascular invasion.

  2. The personality pattern of duodenal ulcer patients in relation to spontaneous ulcer healing and relapse

    DEFF Research Database (Denmark)

    Jess, P; von der Lieth, L; Matzen, Peter;

    1989-01-01

    stressful life events before entrance to the study (P less than 0.05) and, like the neurotic patients, they had lower ego-strength to cope with such events (P less than 0.05). The results indicate that personality assessments make it possible to distinguish between subgroups of duodenal ulcer patients...

  3. Duodenal-jejunal bypass sleeve - a potential alternative to bariatric surgery?

    DEFF Research Database (Denmark)

    Rohde, Ulrich; Gylvin, Silas; Vilmann, Peter;

    2014-01-01

    Overweight and obesity are risk factors for several co-morbidities reducing life expectancy. Conservative treatment of obesity is generally ineffective in the long-term. Bariatric surgery has proven effective, but is associated with potential complications. Duodenal-jejunal bypass sleeve is a novel...

  4. Duodenal myotomy blocks reduction of meal size and prolongation of intermeal interval by cholecystokinin.

    Science.gov (United States)

    Lateef, Dalya M; Washington, Martha C; Raboin, Shannon J; Roberson, Allison E; Mansour, Mahmoud M; Williams, Carol S; Sayegh, Ayman I

    2012-02-01

    We have shown that vagotomy (VGX) attenuates the reduction of meal size (MS) produced by cholecystokinin (CCK) -8 and -33 and that celiaco-mesenteric ganglionectomy (CMGX) attenuates the prolongation of the intermeal interval (IMI) produced by CCK-33. Here, we report the following novel data. First, by determining the distribution of CCK(1) receptor messenger RNA, which mediates reduction of MS and prolongation of IMI by CCK, in seven regions of the gastrointestinal tract in the adult rat we found that the duodenum contains the highest concentration of this receptor in the gut. Second, based on the previous finding we performed a unique surgical technique known as duodenal myotomy (MYO), which severs all the nerves of the gut wall in the duodenum including vagus, splanchnic and enteric nerves. Third, we determined MS and IMI in duodenal MYO rats in responses to endogenous CCK-58 released by the non-nutrient, trypsin inhibitor, camostat and CCK-8 to test the possibility that the duodenum is the site of action for reduction of MS and prolongation of IMI. We found that, similar to the previous work reported by using CCK-8 and MS, duodenal MYO also blocked reduction of MS by camostat. Forth, duodenal MYO blocked prolongation of IMI by camostat. As such, our current results suggest that the duodenum is the gut site that communicates both feeding signals of endogenous CCK, MS and IMI, with the brain through vagal and splanchnic afferents.

  5. Peripheral neuropathy in Parkinson's disease : Levodopa exposure and implications for duodenal delivery [Universally Available

    NARCIS (Netherlands)

    Mueller, Thomas; van Laar, Teus; Cornblath, David R.; Odin, Per; Klostermann, Fabian; Grandas, Francisco J.; Ebersbach, Georg; Urban, Peter P.; Valldeoriola, Francesc; Antonini, Angelo

    2013-01-01

    In advanced Parkinson's disease (PD) patients, continuous intra-duodenal infusion of levodopa/carbidopa intestinal gel (LCIG) is an established approach in the management of motor complications that cannot be further improved by conventional oral therapy. In general, tolerability of LCIG has resembl

  6. [Periodontal status in children with various morphological forms of chronic gastritis and duodenitis].

    Science.gov (United States)

    Romanenko, E G

    2014-01-01

    The purpose of the study was to determine the condition of the periodontal tissues in 80 children with various morphological forms of gastritis and duodenitis. The examination included determination of oral hygiene and periodontal status by the simplified Green-Vermillion index, Silness-Low index, papillary-marginal-alveolar index, gingival Muhlemann-Cowell bleeding index, Schiller-Pisarev iodine index. In children with chronic gastritis and duodenitis high incidence of chronic catarrhal gingivitis (85.0%) was revealed. At the same time it was pointed out that inflammation in the periodontal tissues correlated with changes in the gastroduodenal mucosa. In 65.4% of children with superficial gastritis and duodenitis, chronic catarrhal gingivitis (localized in 38.5% of cases, generalized in 26.9%) was observed. In 94.4% of all children with diffuse and erosive gastritis and duodenitis, chronic generalized catarrhal gingivitis was observed, and low oral hygiene level was revealed. The severity and duration of the underlying disease aggravated clinical manifestations of chronic catarrhal gingivitis in children with lesions of the upper gastrointestinal tract.

  7. Migration of a biliary stent causing duodenal perforation and biliary peritonitis.

    Science.gov (United States)

    Issa, Hussain; Nahawi, Mamdouh; Bseiso, Bahaa; Al-Salem, Ahmed

    2013-10-16

    Migration of endoscopically placed biliary stents is a well-recognized complication of endoscopic retrograde cholangiopancreatography. Less than 1% of migrated stents however cause intestinal perforation. We present a case of a migrated biliary stent that resulted in duodenal perforation and biliary peritonitis.

  8. Migration of a biliary stent causing duodenal perforation and biliary peritonitis

    OpenAIRE

    Issa, Hussain; Nahawi, Mamdouh; Bseiso, Bahaa; Al-Salem, Ahmed

    2013-01-01

    Migration of endoscopically placed biliary stents is a well-recognized complication of endoscopic retrograde cholangiopancreatography. Less than 1% of migrated stents however cause intestinal perforation. We present a case of a migrated biliary stent that resulted in duodenal perforation and biliary peritonitis.

  9. Mortality in perforated duodenal ulcer depends upon pre-operative risk: a retrospective 10-year study.

    LENUS (Irish Health Repository)

    Larkin, J O

    2012-01-31

    INTRODUCTION: Most patients presenting with acutely perforated duodenal ulcer undergo operation, but conservative treatment may be indicated when an ulcer has spontaneously sealed with minimal\\/localised peritoneal irritation or when the patient\\'s premorbid performance status is poor. We retrospectively reviewed our experience with operative and conservative management of perforated duodenal ulcers over a 10-year period and analysed outcome according to American Society of Anesthesiologists (ASA) score. METHODS: The records of all patients presenting with perforated duodenal ulcer to the Department of Surgery, Mayo General Hospital, between January 1998 and December 2007 were reviewed. Age, gender, co-morbidity, ASA-score, clinical presentation, mode of management, operative procedures, morbidity and mortality were considered. RESULTS: Of 76 patients included, 48 (44 operative, 4 conservative) were ASA I-III, with no mortality irrespective of treatment. Amongst 28 patients with ASA-score IV\\/V, mortality was 54.5% (6\\/11) following operative management and 52.9% (9\\/17) with conservative management. CONCLUSION: In patients with a perforated duodenal ulcer and ASA-score I-III, postoperative outcome is uniformly favourable. We recommend these patients have repair with peritoneal lavage performed, routinely followed postoperatively by empirical triple therapy. Given that mortality is equivalent between ASA IV\\/V patients whether managed operatively or conservatively, we suggest that both management options are equally justifiable.

  10. The use of pyloric exclusion for treating duodenal trauma: case series

    Directory of Open Access Journals (Sweden)

    Gustavo Pereira Fraga

    Full Text Available CONTEXT AND OBJECTIVES: Significant controversy exists regarding the best surgical treatment for complex duodenal injuries. The aims of this study were to report on a series of eight cases of duodenal repairs using pyloric exclusion and to describe reported complications or improvements in clinical outcomes among patients with complex duodenal trauma. DESIGN AND SETTING: Cross-sectional study followed by a case series in a university hospital. METHODS: Data on eight patients with duodenal trauma who underwent pyloric exclusion over a 17.5 year period were collected and analyzed. RESULTS: The causes of the injuries included penetrating gunshot wounds (GSW in five patients and motor vehicle accidents (blunt trauma in three patients. The time elapsed until surgery was longer in the blunt trauma group, while in one patient, the gunshot injury was initially missed and thus the procedure was carried out 36 hours after the original injury. The injuries were grade III (50% or IV (50% and the morbidity rate was 87.5%. Four patients (50% died during the postoperative period from complications, including hypovolemic shock (one patient, sepsis (peritonitis following the missed injury and pancreatitis with an anastomotic fistula (two patients. CONCLUSIONS: Pyloric exclusion was associated with multiple complications and a high mortality rate. This surgical technique is indicated for rare cases of complex injury to the duodenum and the surgeon should be aware that treatment with a minimalistic approach, with only primary repair, may be ideal.

  11. Duodenal-jejunal bypass sleeve - a potential alternative to bariatric surgery?

    DEFF Research Database (Denmark)

    Rohde, Ulrich; Gylvin, Silas; Vilmann, Peter;

    2014-01-01

    Overweight and obesity are risk factors for several co-morbidities reducing life expectancy. Conservative treatment of obesity is generally ineffective in the long-term. Bariatric surgery has proven effective, but is associated with potential complications. Duodenal-jejunal bypass sleeve is a nov...

  12. Duodenal stenosis resulting from a preduodenal portal vein and an operation for scoliosis

    Institute of Scientific and Technical Information of China (English)

    Kouji Masumoto; Risa Teshiba; Genshiro Esumi; Kouji Nagata; Takanori Nakatsuji; Yuko Nishimoto; Sadako Yamaguchi; Kenzo Sumitomo; Tomoaki Taguchi

    2009-01-01

    A preduodenal portal vein (PDPV) is known to be a rare cause of duodenal stenosis. We treated a 22-yearold male patient with malnutrition as a result of PDPV and a previously performed operation for scoliosis,who showed an improvement in quality of life after being treated with a combination of nutritional support and surgery. The patient with PDPV had been admitted to our department with duodenal stenosis, ranging from the first to third portions. He had suffered from vomiting since 1 year of age, and he developed malnutrition during the last 6-mo period after orthopedic surgery for scoliosis. The stenosis was related to both the PDPV and the previously performed operation for scoliosis. After receiving nutritional support for 6 mo, a gastrojejunostomy with Braun's anastomosis for the first portion and a duodenojejunostomy for the second and third portions were performed. The postoperative course was almost uneventful. Three months later, he was discharged and able to attend university. In patients with widespread duodenal stenosis, there may be a complicated cause,such as PDPV and duodenal stretching induced by previous spinal surgery.

  13. Morphological, immunophenotypic and clinical characteristics of dogs with lymphocytic - plasmacytic duodenitis

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    Đorđević Milena

    2012-01-01

    Full Text Available The most important morphological feature of the immune response in lymphocytic-plasmacytic duodenitis (LPD in dogs is the presence of a mononuclear infiltrate in the duodenal mucosa. The ethiopatogenesis of this disease is still unknown, nor are known all the immunophenotypic characteristics of the infiltrate cells, which would be of help in the elucidation of the pathogenesis of LPD. The study involved 60 adult dogs of different breeds and both sexes: 54 dogs with symptoms of diarrhea and vomiting that lasted longer than three weeks and six clinically healthy dogs that served as controls. Hematological and biochemical analysis of blood, radiology, ultrasound and endoscopic diagnosis were carried out. Samples of duodenal mucosal biopta were examined by histopathological and immunohistochemical methods. During endoscopic examination, duodenal wall thickening, mucosal edema and hyperemia were observed in 46 dogs. Microscopic studies showed on the epithelial cells of the duodenum degenerative changes, and sometimes desquamation. Most of the intestinal crypts were dilated, irregularly shaped and filled with detritus. On immunohistochemical examination of samples of the duodenum in a number of dogs with LPD a predominant expression of CD3 + T lymphocytes was observed. [Projekat Ministarstva nauke Republike Srbije, br. III 46002

  14. Cystic dystrophy of the duodenal wall is not always associated with chronic pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Raffaele Pezzilli; Roberto Corinaldesi; Donatella Santini; Lucia Calculli; Riccardo Casadei; Antonio Maria Morselli-Labate; Andrea Imbrogno; Dario Fabbri; Giovanni Taffurelli; Claudio Ricci

    2011-01-01

    Cystic dystrophy of the duodenal wall is a rare form of the disease which was described in 1970 by French authors who reported the presence of focal pancreatic disease localized in an area comprising the C-loop of the duodenum and the head of the pancreas. German authors have defined this area as a "groove". We report our recent experience on cystic dystrophy of the paraduodenal space and systematically review the data in the literature regarding the alterations of this space. A MEDLINE search of papers published between 1966 and 2010 was carried out and 59 papers were considered for the present study; there were 19 cohort studies and 40 case reports. The majority of patients having groove pancreatitis were middle aged. Mean age was significantly higher in patients having groove carcinoma. The diagnosis of cystic dystrophy of the duodenal wall can now be assessed by multidetector computer tomography, magnetic resonance imaging and endoscopic ultrasonography. These latter two techniques may also add more information on the involvement of the remaining pancreatic gland not involved by the duodenal malformation and they may help in differentiating "groove pancreatitis" from "groove adenocarcinoma". In conclusion, chronic pancreatitis involving the entire pancreatic gland was present in half of the patients with cystic dystrophy of the duodenal wall and, in the majority of them, the pancreatitis had calcifications.

  15. Traumatic duodenal lesions in children due to two-point seat-belt: the seat-belt syndrome.

    Science.gov (United States)

    Guanà, R; Sangiorgio, L; Tessiatore, P; Seymandi, P

    2012-02-01

    Two consecutive children, motor vehicle accident victims, were treated between December 2006 and January 2007. They reported duodenal perforations due to lap-belt action. In the first case (a 9-year-old boy), symptoms became immediately evident after the trauma. Early computerized tomography (CT) scan demonstrated biliaryhemoperitonitis and free sub-diaphragmatic air. At the laparotomy a complete duodenal transection, at the level of duodenal bulb, was found. In the second patient, early X-ray and CT scan revealed no free abdominal air; only the second CT scan, repeated after 48 hours, when general conditions of the girl become critical, demonstrated biliary peritonitis and aerial extraluminal gas image in the right peri-kidney space. At the surgical exploration a duodenal laceration was noted, at the passage between the second and the third duodenal portion, in the postero-lateral wall, with an extension of 6 cm. In both children direct suture of duodenal injury without stoma construction was performed. Not early or late postoperative complications were registered (follow-up: 18 months). In the traumatic duodenal lesions an early diagnosis is not always possible because of the paucity of the clinical signs. Tightened clinical and radiological monitoring of the patient is fundamental in the successive hours to the trauma. Early diagnosis and high level of suspicious rest crucial for better prognosis in this group of patients.

  16. Expression of macrophage migration-inhibitory factor in duodenal ulcer and its relation to Helicobacter pylori infection.

    Science.gov (United States)

    Yu, X H; Zhang, Q; Yang, X P; Yang, W; Dai, F; Qian, Z; Wang, Z L; Wu, C F; Zhao, H Z; Wang, G H

    2015-10-30

    The aim of this study was to examine the expression of macrophage migration-inhibitory factor (MIF) in duodenal ulcer epithelial cells and its relation to Helicobacter pylori (Hp) infection, and to discuss the pathogenic roles of MIF expression and Hp infection in duodenal ulcer. MIF protein and mRNA expression was examined in samples from patients with duodenal ulcer with and without Hp infection (N = 40 each, experimental group), and in normal duodenal bulb mucosal tissue (N = 40, control group) using immunohistochemistry and in situ hybridization. Patients without Hp infection received routine treatment, and treatment was provided to the patients positive for Hp to eradicate Hp infection. Hp and MIF expression levels before treatment and after the ulcer had been cured were compared. The positive rates of MIF protein and mRNA in patients with Hp infection before treatment were 67.5 and 65%, respectively, and were 18.9 and 21.6% in the 37 patients from whom Hp was eliminated. These were statistically different both before and after treatment compared with controls (P 0.05). The results of this study suggested that MIF is related to the development of duodenal ulcer, and that the presence of Hp is closely related with the expression of MIF in the duodenal mucosa and the development of duodenal ulcer.

  17. History of Helicobacter pylori, duodenal ulcer, gastric ulcer and gastric cancer.

    Science.gov (United States)

    Graham, David Y

    2014-05-14

    Helicobacter pylori (H. pylori) infection underlies gastric ulcer disease, gastric cancer and duodenal ulcer disease. The disease expression reflects the pattern and extent of gastritis/gastric atrophy (i.e., duodenal ulcer with non-atrophic and gastric ulcer and gastric cancer with atrophic gastritis). Gastric and duodenal ulcers and gastric cancer have been known for thousands of years. Ulcers are generally non-fatal and until the 20th century were difficult to diagnose. However, the presence and pattern of gastritis in past civilizations can be deduced based on the diseases present. It has been suggested that gastric ulcer and duodenal ulcer both arose or became more frequent in Europe in the 19th century. Here, we show that gastric cancer and gastric ulcer were present throughout the 17th to 19th centuries consistent with atrophic gastritis being the predominant pattern, as it proved to be when it could be examined directly in the late 19th century. The environment before the 20th century favored acquisition of H. pylori infection and atrophic gastritis (e.g., poor sanitation and standards of living, seasonal diets poor in fresh fruits and vegetables, especially in winter, vitamin deficiencies, and frequent febrile infections in childhood). The latter part of the 19th century saw improvements in standards of living, sanitation, and diets with a corresponding decrease in rate of development of atrophic gastritis allowing duodenal ulcers to become more prominent. In the early 20th century physician's believed they could diagnose ulcers clinically and that the diagnosis required hospitalization for "surgical disease" or for "Sippy" diets. We show that while H. pylori remained common and virulent in Europe and the United States, environmental changes resulted in changes of the pattern of gastritis producing a change in the manifestations of H. pylori infections and subsequently to a rapid decline in transmission and a rapid decline in all H. pylori-related diseases.

  18. A novel dynamic scintigraphic technique for assessing duodenal contractions during gastric emptying in humans: a feasibility study.

    Science.gov (United States)

    Kubo, Tadeu T A; Moraes, Eder R; Secaf, Marie; Troncon, Luiz E A

    2015-01-01

    Duodenal contractions are thought to play a role in the control of gastric emptying. Although noninvasive techniques, such as ultrasonography and MRI, have been proposed for studying duodenal contractile activity in humans, there are no reports on the use of scintigraphy for this purpose. This work aimed to describe a novel scintigraphic technique for assessing duodenal contractility during gastric emptying in humans, and to present preliminary data on the frequency and amplitude of contractions detected in three different duodenal segments. Fasted young healthy volunteers (N=12) were given either a liquid or a solid test meal of similar calorie content (400 kcal) labeled with 99mTc-phytate. Static images were collected to determine gastric emptying. Dynamic images of the anterior aspect of the abdomen (1 frame/s) were also acquired periodically in a standard position for 256 s at 15-30 min intervals. 'Activity versus time' curves were generated for regions of interest corresponding to the proximal, middle, and distal duodenal segments. Curves were digitally filtered and processed to estimate both dominant frequency (fast Fourier transform) and amplitude (mean ejection fraction) of postprandial duodenal contractions. There were no significant differences regarding dominant frequency among proximal, middle, and distal duodenal regions of interest. In addition, there were no significant differences between the liquid and the solid meal in terms of either frequency or amplitude of duodenal contractions. Characterization of duodenal contractions in humans using scintigraphy is feasible and yields consistent data for both the frequency and the amplitude of postprandial contractions, which seems to be rather independent of meal consistency.

  19. Cat scratch disease, a rare cause of hypodense liver lesions, lymphadenopathy and a protruding duodenal lesion, caused by Bartonella henselae.

    Science.gov (United States)

    van Ierland-van Leeuwen, Marloes; Peringa, Jan; Blaauwgeers, Hans; van Dam, Alje

    2014-10-29

    A 46-year-old woman presented with right upper abdominal pain and fever. At imaging, enlarged peripancreatic and hilar lymph nodes, as well as hypodense liver lesions, were detected, suggestive of malignant disease. At endoscopy, the mass adjacent to the duodenum was seen as a protruding lesion through the duodenal wall. A biopsy of this lesion, taken through the duodenal wall, showed a histiocytic granulomatous inflammation with necrosis. Serology for Bartonella henselae IgM was highly elevated a few weeks after presentation, consistent with the diagnosis of cat scratch disease. Clinical symptoms subsided spontaneously and, after treatment with azithromycin, the lymphatic masses, liver lesions and duodenal ulceration disappeared completely.

  20. LA ASOCIACIÓN DE DIVERTÍCULO DE ZENKER Y ACALASIA Zenker`s diverticulum and acalasia

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    Juan David Martínez Marín

    2008-03-01

    Full Text Available Se presenta el caso de un paciente de 88 años, con disfagia y antecedentes de acalasia no tratada de veinte años de evolución y síntomas de disfagia oro faríngea. Los exámenes radiológicos y endoscópicos identificaron además de la acalasia un divertículo de Zenker. Se realizó terapia paliativa con inyección de toxina botulínica en el esfínter esofágico inferior, con mejoría de los síntomas. Se hace una revisión de la rara coexistencia de estas dos patologías.An 88 year old patient has been observed. He is suffering from dysphagia and has a medical history of achalasia, which has had an evolution and has not bee treated for twenty years. He also has oropharynx dysphagia symptoms. In addition to the achalasia, the X-ray and endoscopy exams identified a Zenker diverticulum. Palliative or mitigating therapy was realized using botulinum toxin injection in the lower esophageal sphincter, with symptom improvement. A study is being made concerning the rare co-existence of these two pathologies.

  1. Divertículo ventricular congênito associado à taquicardia ventricular Congenital ventricular diverticulum associated with ventricular tachycardia

    Directory of Open Access Journals (Sweden)

    Ranieli Pitol

    2005-02-01

    Full Text Available Divertículos ventriculares congênitos são raros. Clinicamente, podem ser assintomáticos ou causa de embolização sistêmica, insuficiência cardíaca, insuficiência valvar, ruptura ventricular, arritmia ventricular ou morte súbita. Apresentamos caso de uma mulher de 56 anos com taquicardia ventricular sustentada, na qual, durante a investigação, foi diagnosticada a presença de um divertículo na posição ínfero-basal do ventrículo esquerdo. Comentam-se as características clínicas e o tratamento desta doença infreqüente.Congenital ventricular diverticula are rare. Clinically, they may be asymptomatic or cause systemic embolization, heart failure, valvular regurgitation, ventricular rupture, ventricular arrhythmia, or sudden death. We report the case of a 56-year-old woman with sustained ventricular tachycardia, who, during investigation, was diagnosed with a diverticulum in the inferobasal portion of the left ventricle. The clinical characteristics and treatment of this rare disease are discussed.

  2. 小肠憩室的临床诊断与治疗(附6例分析)%Diagnosis and treatment of small intestine diverticulum (analysis of 6 cases)

    Institute of Scientific and Technical Information of China (English)

    朱丽丹; 王恒建; 汪宏

    2013-01-01

    目的 探讨小肠憩室的诊断与治疗.方法 对我院2010年10月至2012年5月收治的小肠憩室6例临床资料进行回顾性分析,比较术前及术后诊断,归纳小肠憩室的并发症及治疗方法.结果 均经手术诊断,病理为憩室.结论 小肠憩室主要并发症为急性憩室炎或伴穿孔、肠梗阻、消化道出血,易与其他疾病混淆,对于原因不明的急腹症,消化道出血应考虑小肠憩室,手术治疗效果好.%Objective To discuss the diagnosis and treatments of small intestine diverticulum. Methods The clinical data of 5 cases of small intestine diverticulum from October 2010 to May 2012 were analyzed retrospectively. A comparison of their diagnosis before operation and after operation was performed; the complications and treatment were conducted. Results All patients were diagnosed by surgical treatments. Pathological examination revealed that all cases had diverticulum. Conclusion Complications of small intestine diverticulum are mainly acute diverticulitis or perforation, hemorrhage of digestive duct and intestinal obstruction, which are easy to be confounded with other diseases. Small intestine diverticulum should be allowed for acute abdomen and hemorrhage of digestive duct. It is suggested that early operation of adult small intestine diverticulum should be done.

  3. 多排螺旋CT后处理技术在胆源性胆囊-十二指肠瘘诊断中的应用%Multi-slice CT in diagnosing cholecysto-duodenal fistula

    Institute of Scientific and Technical Information of China (English)

    王均庆; 陆风旗; 张雷; 张追阳; 丁忠; 余迅

    2015-01-01

    the duodenal bulb in 15 patients (45.5%) , the junction of the bulb and the descending part of the duodenum in 3 patients (9.1%) , the horizontal part in 5 patients (15.1%) and the ascending of the duodenum in 10 patients (30.3%).The CT signs of cholecysto-duodenum fistula included in 16 cases.The fistulae were clearly displayed including some fistulae being dumbbell-shaped.The indirect signs of cholecysto-duodenum fistula included in 2 cases the gallbladders were unclearly shown.In 1 case the gallbladder volume increased because of cancer and in another case because of acute cholecystitis.In 29 cases, the gallbladder volume was significantly reduced,with an average volume which ranged from 6 cm × 2 cm to 2 cm × 1 cm, and an average gallbladder wall thickening of 5 cm.There were extensive adhesions between the gallbladder and duodenum with visible effusion.In 26 cases, gas was present in the biliary system with 22 cases showing gallbladder gas, and 19 cases showing biliary pneumatosis.Biliary stones were present in 26 patients (gallbladder stones in 22 cases, gallbladder neck stones in 6 cases, common bile duct stones in 13 cases).At the site between the duodenum and the gallbladder there were radiological changes simulating a diverticulum.In 11 cases the changes were like a duodenal diverticula.The complications of cholecysto-duodenal fistula included 5 cases of gallstone ileus and 2 cases of multiple liver abscesses.Conclusions MSCT is important in depicting presence and location of cholecysto-duodenal fistula.The morphology and shape of the gallbladder, the presence of gas in the biliary system, the presence of stones and the surrounding adhesions could be fully demonstrated by MSCT.MSCT are important for diagnosing cholecysto-duodenal fistula and in the planning of surgery.

  4. Hybrid repair of penetrating aortic ulcer associated with right aortic arch and aberrant left innominate artery arising from aneurysmal Kommerell's diverticulum with simultaneous repair of bilateral common iliac artery aneurysms.

    Science.gov (United States)

    Guo, Yuanyuan; Yang, Bin; Cai, Hongbo; Jin, Hui

    2014-02-01

    We present the first case of a hybrid endovascular approach to a penetrating aortic ulcer on the left descending aorta with a right aortic arch and aberrant left innominate artery arising from an aneurysmal Kommerell's diverticulum. The patient also had bilateral common iliac artery aneurysms. The three-step procedure consisted of a carotid-carotid bypass, followed by endovascular exclusion of the ulcer and the aneurysmal Kommerell's diverticulum, and then completion by covering the iliac aneurysms. The patient had no complications at 18 months after surgery. In such rare configurations, endovascular repair is a safe therapeutic option.

  5. Giant duodenal ulcer perforation: a case of innovative repair with an antrum gastric patch Perforación de ulcus gigante duodenal: reparación innovadora mediante una plastia del antro gástrico

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    Javier A. Cienfuegos

    2012-08-01

    Full Text Available Backgrounds: the treatment of a perforated giant duodenal ulcer (GUDs represents a formidable surgical challenge regarding the duodenal wall defect repair in severe peritonitis setting. A high incidence of dehiscence and hospital mortality (15-40%- has been reported with the majority of the techniques. We report a case of GUDs perforation successfully treated with a subtotal gastrectomy and a gastric patch with the remnant antrum, for repairing the duodenal defect. Case report: a 63-years-old man with antecedents of peptic ulcer disease presents a large duodenal ulcer perforation with 48 hrs delay and associated with severe peritonitis and a retroperitoneal collection. A subtotal gastrectomy with Billroth II reconstruction and reconstruction of the duodenal defect with a patch of the remnant antrum was carried out. The patient was discharged at 17th postoperative day with good tolerance. Discussion: the duodenal defect repair with a patch of the remant antrum, represents a valid alternative in similar circumstances. To our knowledge, it appears to be the first clinical description of this technique.Antecedentes: el tratamiento de un ulcus duodenal gigante (UDG; > 2 cm perforado entraña una gran dificultad técnica, por la reparación del gran defecto duodenal; y por la peritonitis sobreañadida. Todas las técnicas descritas se asocian con un índice elevado de dehiscencias y una mortalidad del 15-40%. Describimos por primera vez el caso de un UDG perforado, tratado mediante una gastrectomía subtotal y con una plastia del antro gástrico remanente. Caso clínico: varón de 63 años que se interviene de un UDG perforado en la 2ª porción duodenal asociado con peritonitis severa y disección de la gotiera parieto-cólica derecha retroperitoneo. Se realiza gastrectomía tipo Bilroth II y reparación del defecto duodenal mediante una plastia con la pared del antro gástrico remanente. El paciente fue dado de alta a los 17 días. Discusión: la

  6. Anomalous opening of the common bile duct into the duodenal bulb: endoscopic treatment

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    Oguz Dilek

    2007-07-01

    Full Text Available Abstract Background Anomalous biliary opening especially the presence of the ampulla of Vater in the duodenal bulb is a very rare phenomenon. We report clinical implications, laboratory and ERCP findings and also therapeutic approaches in 53 cases. Methods The data were collected from the records of 12.158 ERCP. The diagnosis was established as an anomalous opening of the common bile duct (CBD into the duodenal bulb when there is an orifice observed in the bulb with the absence of a papillary structure at its normal localization and when the CBD is visualized by cholangiography through this orifice without evidence of any other opening. Results A total of 53 cases were recruited. There was an obvious male preponderance (M/F: 49/4. Demographic data and ERCP findings were available for all, but clinical characteristics and laboratory findings could be obtained from 39 patients with full records. Thirty – seven of 39 cases had abdominal pain (95% and 23 of them (59% had cholangitis as well. Elevated AP and GGT were found in 97.4% (52/53. History of cholecystectomy was present in 64% of the cases, recurrent cholangitis in 26% and duodenal ulcer in 45%. Normal papilla was not observed in any of the patients and a cleft-like opening was evident instead. The CBD was hook shaped at the distal part that opens to the duodenal bulb. Pancreatic duct (PD was opening separately into the bulb in all the cases when it was possible to visualize. Dilated CBD in ERCP was evident in 94% and the CBD stone was demonstrated in 51%. PD was dilated in four of 12 (33% cases. None of them has a history of pancreatitis. Endoscopically, Papillary Balloon Dilatation instead of Sphincterotomy carried out in 19 of 27 patients (70% with choledocholithiazis. Remaining eight patients had undergone surgery (30%. Clinical symptoms were resolved with medical treatment in 16(32% patients with dilated CBD but no stone. Perforation and bleeding were occurred only in two patients

  7. [Utility of the WallFlexTM duodenal stent for unresectable advanced gastric cancer related to gastric outlet obstruction].

    Science.gov (United States)

    Aoki, Taro; Hyuga, Satoshi; Kato, Aya; Chono, Teruhiro; Watanabe, Risa; Komori, Takamichi; Matsumoto, Takashi; Takachi, Kou; Nishioka, Kiyonori; Uemura, Yoshio; Kobayashi, Kenji

    2012-11-01

    Duodenal stenting for malignant disease related to gastric outlet obstruction(GOO) has been covered by health insurance in Japan since April 2010. We inserted WallFlexTM duodenal stents(WDS) in 4 patients with GOO caused by unresectable gastric cancer. WDS insertion was successful in all 4 cases. Duodenal perforation occurred in 1 case. One case each of stent obstruction and stent migration occurred. All patients could eat a soft-food diet for 3-6 months (median, 5.3 months). Survival time ranged between 5 and 14 months (median, 6 months). Three patients underwent S-1 combination chemotherapy. Duodenal stenting is expected to be effective for advanced gastric cancer related to GOO.

  8. Effect of curing Helicobacter pylori infection on intragastric acidity during treatment with ranitidine in patients with duodenal ulcer.

    OpenAIRE

    Labenz, J; Tillenburg, B; Peitz, U; Verdú, E.; Stolte, M; Börsch, G; Blum, A L

    1997-01-01

    BACKGROUND: In patients with duodenal ulcer cure of Helicobacter pylori infection resulted in a pronounced decrease in intragastric pH during treatment with omeprazole. AIM: To test the hypothesis that treatment of H pylori adversely affects the pH response to ranitidine. PATIENTS: Eighteen patients with duodenal ulcer who were infected with H pylori were studied. METHODS: Twenty four hour pH recordings were performed during treatment with ranitidine (300 mg) at night before and four to six w...

  9. Role of Melatonin, Neuropeptide S and Short Chain Fatty Acids in Regulation of Duodenal Mucosal Barrier Function and Motility

    OpenAIRE

    Wan Saudi, Wan Salman

    2015-01-01

    The duodenal epithelium is regularly exposed to HCl, digestive enzymes, bacteria and toxins, and sometimes also to ethanol and drugs. The imbalance of aggressive factors in the intestinal lumen and mucosal barrier function increases the risk of tissue injury and inflammation. The key components of the duodenal barrier function include mucosal permeability, bicarbonate transport and the secretion or absorption of fluids. This thesis aims to elucidate the role of melatonin, neuropeptide S (NPS)...

  10. Treatment of duodenal ulceration with Furazolidine in China preceded the discovery of its association with H pylori

    Institute of Scientific and Technical Information of China (English)

    Frank Ivor Tovev

    2007-01-01

    @@ It is not generally known that patients with duodenal ulceration were being treated with an antibiotic, Furazolidone, in China five or more years before Marshall and Warren published their seminal paper in 1984 about the association between duodenal ulceration and Campylobacter like organisms in the stomach, later named Hpylori. Marshall and Warren won the 2005 Nobel Prize in physiology or medicine for their work on how a bacterium can relate to gastric inflammation or peptic ulceration.

  11. EUS mini probes in diagnosis of cystic dystrophy of duodenal wall in heterotopic pancreas:A case report

    Institute of Scientific and Technical Information of China (English)

    Ivan Jovanovic; Srbislav Knezevic; Marjan Micev; Miodrag Krstic

    2004-01-01

    Cystic dystrophy of the duodenal wall is a rare condition characterized by the development of cysts in heterotopic pancreatic tissue localized in the duodenal wall. A 38-yearold man was admitted to the hospital for abdominal pain and vomiting after food intake. lhe diagnosis of acute pancreatitis was initially suspected. Abdominal ultrasound examination revealed thickening of the second portion of duodenal wall within which, small cysts (diameter, less than 1 cm) were present in the vicinity of pancreatic head.The head of pancreas appeared enlarged (63 mm×42 mm)and hypoechoic. Upper endoscopy and barium X-ray series were performed revealing a severe circumferential deformation, as well as 4 cm long stenosis of the second portion of the duodenum. CT examination revealed multiple cysts located in an enlarged, thickened duodenal wall with moderate to strong post-contrast enhancement. We suspected that patient had cystic dystrophy of duodenal wail developed in the heterotopic pancreas and diagnosis was confirmed by endoscopic ultrasound (EUS). Endoscopic ultrasound (EUS) revealed circular stenosis from the duodenal bulb onwards. A twenty megaHertz mini-probe examination further showed diffuse (intramural) infiltration of duodenal wall limited to the submucosa and muscularis propria of the second portion of duodenum with multiple microoysts within the thickened mucosa and submucosa. Patient was successfully surgically treated and pancreatoduodenectomy was performed. The pathological examination confirmed a diagnosis of cystic dystrophy of a heterotopic pancreas.Endoscopic ultrasonography features allow preoperative diagnosis of cystic dystrophy of a heterotopic pancreas in duodenal wall, with intraluminal 20 MHz mini probe sonography being more efficient in cases of luminal stenosis.

  12. Is Helicobacter pylori Infection the Primary Cause of Duodenal Ulceration or a Secondary Factor? A Review of the Evidence

    Directory of Open Access Journals (Sweden)

    Vikram Kate

    2013-01-01

    Full Text Available Helicobacter pylori (H. pylori has a role in the multifactorial etiology of peptic ulcer disease. A link between H. pylori infection and duodenal ulcer disease is now established. Other contributing factors and their interaction with the organism may initiate the ulcerative process. The fact that eradication of H. pylori infection leads to a long-term cure in the majority of duodenal ulcer patients and the fact that the prevalence of infection is higher in ulcer patients than in the normal population are cogent arguments in favor of it being the primary cause of the ulceration. Against this concept there are issues that need explanation such as the reason why only a minority of infected persons develop duodenal ulceration when infection with H. pylori is widespread. There is evidence that H. pylori infection has been prevalent for several centuries, yet duodenal ulceration became common at the beginning of the twentieth century. The prevalence of duodenal ulceration is not higher in countries with a high prevalence of H. pylori infection. This paper debate puts forth the point of view of two groups of workers in this field whether H. pylori infection is the primary cause of duodenal ulcer disease or a secondary factor.

  13. Partial characterization of pyloric-duodenal lipase of gilthead seabream (Sparus aurata).

    Science.gov (United States)

    Nolasco, Héctor; Moyano-López, Francisco; Vega-Villasante, Fernando

    2011-03-01

    In the present study, we report the isolation and characterization of seabream Sparus aurata pyloric caeca-duodenal lipase. Optimum activity was found at pH 8.5 and salinity of 50 mM NaCl. Lipase activity was sensitive to divalent ions, and extreme pH values (4, 5, and 12), being more stable at alkaline than acid pH. Optimum temperature was found at 50°C, but lipase was stable at temperatures below 40°C. Lipase has a bile salt sodium taurocholate requirement for increased activity. Gradient PAGE electrophoresis revealed the presence of four isoforms with apparent molecular masses of 34, 50, 68, and 84 KDa, respectively. Pyloric-duodenal lipase was able to hydrolyze emulsified alimentary oils. Results confirm the presence of true lipases in Sparus aurata digestive tract.

  14. [Prospective study of 420 biopsies realised in patients with duodenal ulcer with positive Helicobacter pylori].

    Science.gov (United States)

    Khayat, Olfa; Kilani, Afef; Chedly-Debbiche, Achraf; Zeddini, Abdelfattah; Gargouri, Dalila; Kharrat, Jamel; Souissi, Adnene; Ghorbel, Abdel Jabbar; Ben Ayed, Mohamed; Ben Khelifa, Habib

    2006-06-01

    It's a prospective study leaded between September 1997 and july 1999 (23 months ) in 75 patients with duodenal ulcer and positif for Helicobacter pylori. All patients had a first endoscopy with antral, fundic and duodenal biopsies, followed one month later by a second control fibroscopy with biopsies of the same sites. A total of 420 biopsies was realised. Chronic gastritis was evaluated according to sydney system. Patients was divided by randomisation in 4 groups. Every group was received a different therapeutic association. The results was conform to liberation concering activity 80%, intestinal metaplasia 12%. inflammation 100%. Atrophy was observed in 56% of cases, this percentage is variable in literature; chronic gastritis was predominant in antre relatively to fundus (pomeprazol, amoxcillin, metronidazol by comparison with the others 3 groups (p<0.005).

  15. New H2-receptor antagonist--roxatidine acetate--in treatment of duodenal ulcer.

    Science.gov (United States)

    Amarapurkar, D N; Parikh, S S; Desai, H G

    1993-08-01

    A double blind randomised trial, comparing a new H2-receptor antagonist, Roxatidine acetate, with Cimetidine was carried out in 47 patients of uncomplicated, endoscopically proven duodenal ulcer. Twenty seven patients were treated with Roxatidine 75 mg twice daily and 20 patients were treated with Cimetidine 200 mg 3 times a day and 400 mg at bed time for 4 weeks. At the end of 4 weeks, total pain relief was obtained in 74% and 70% patients receiving Roxatidine and Cimetidine respectively. Complete endoscopic healing at the end of 4 weeks was observed in 92.3% patients receiving Roxatidine and 85% patients receiving Cimetidine. These differences were statistically not significant. No significant side effects were observed in either group. We conclude that Roxatidine acetate is comparable to cimetidine in relieving pain and endoscopic healing of duodenal ulcer and has an excellent safety profile.

  16. [Surgical management of duodenal ulcer with hemorrhage from the gastroduodenal artery: antrectomy versus conservative surgery?].

    Science.gov (United States)

    Brehant, O; Fuks, D; Sabbagh, C; Wouters, A; Mention, C; Dumont, F; Regimbeau, J M

    2008-01-01

    When surgery is indicated for bleeding duodenal ulcer, the traditional standard of care has been "radical surgical treatment is preferable to conservative therapy since the risk of rebleeding is reduced without an augmentation in morbidity and mortality". This principle is based on two prospective studies published before 1995. Radical surgery at that time consisted of antrectomy, while conservative therapy included oversewing of the bleeding vessel in the ulcer bed and ligation of the gastroduodenal artery (Weinberg procedure). This strategy must be re-evaluated in 2008 in view of our better understanding of the role of Helicopacter pylori in the causation of duodenal ulceration and the decreased risk of post-operative re-bleeding with the use of proton pump inhibitors. The role of surgery has changed. Its aim is no longer to cure the ulcer diathesis but rather to urgently control bleeding in anticipation of ulcer cure with medical therapy.

  17. Biodistribution of the radiopharmaceutical sodium pertechnetate after biliopancreatic bypass with a duodenal switch

    Energy Technology Data Exchange (ETDEWEB)

    Araujo-Filho, Irami; Rego, Amalia Cinthia Meneses; Brandao-Neto, Jose; Villarim-Neto, Arthur; Egito, Eryvaldo Socrates Tabosa; Azevedo, Italo Medeiros; Medeiros, Aldo Cunha [Universidade Federal do Rio Grande do Norte, Natal, RN (Brazil). Programa de Pos-graduacao em Ciencias da Saude]. E-mail: aldo@ufrnet.br

    2007-09-15

    Study with the purpose to examine the effects of duodenal switch (DS), regularly performed in morbidly obese patients, on biodistribution of sodium pertechnetate in several organs of rats. There was no early or late mortality in either rats groups. The values of percent radioactivity per gram of tissue (%ATI/g), showed no significant difference in liver, stomach, small bowel, duodenum, kidney, heart, bladder, bone and brain, when compared the DS rats with sham and controls rats. A postoperative significant increase (p<0.05) in mean %ATI/g levels was observed in spleen, pancreas and muscle in group DS rats, as compared to group S and C rats. In the lung there was an increase and in thyroid a decrease in mean %ATI/g of DS rats, when compared to sham rats (p<0.05). In conclusion, the biliopancreatic diversion with duodenal switch in rats modified the biodistribution of sodium pertechnetate in thyroid, lung, pancreas, spleen and muscle. (author)

  18. Clinical and histological features of duodenal ulcer in children and adolescents

    OpenAIRE

    Elisabete Kawakami; Machado, Rodrigo S. [UNIFESP; Fonseca,Jacqueline A.; Francy R. S. PATRÍCIO

    2004-01-01

    OBJETIVO: Avaliar as características clínicas e histológicas de crian��as e adolescentes com úlcera duodenal. MÉTODOS: Foram avaliadas prospectiva e consecutivamente 43 pacientes com úlcera duodenal ao longo de 6 anos (7,2 pacientes por ano). A avaliação consistiu de questionário clínico de sintomas dispépticos, exame físico e endoscopia digestiva com biópsias gástricas para exame histológico e detecção do Helicobacter pylori. RESULTADOS: A idade no diagnóstico variou de 4 anos e 8 meses a 17...

  19. Cysteamine-induced duodenal ulcer and acid secretion in the rat

    DEFF Research Database (Denmark)

    Poulsen, Steen Seier

    1980-01-01

    Duodenal ulcers can be produced in rats within 24 h by a single subcutaneous administration of cysteamine. To determine the role of gastric acid secretion in the pathogenesis of these ulcers, secretory and pathoanatomic studies were performed in chronic fistula rats ater an ulcerogenic dose...... of cysteamine. A prolonged increase of acid secretion was seen after cysteamine, reaching fourfold the basal level after 5 h. The acid response lasted for 10 to 11 h. After vagotomy cysteamine-induced acid secretion was markedly reduced. Ulcer formation was prevented by vagotomy and by drainage of the gastric...... for ulcer formation, the hypersecretion of acid induced by cysteamine is not the only factor responsible for the development of duodenal ulcer....

  20. The role of colloidal bismuth subcitrate in the short-term treatment of duodenal ulcer.

    Science.gov (United States)

    Barbara, L; Corinaldesi, R; Rea, E; Paternicò, A; Stanghellini, V

    1986-01-01

    Colloidal bismuth subcitrate (CBS) is a drug used in the treatment of duodenal ulcer; it acts mainly by increasing mucosal resistance against endoluminal aggressive agents, without inhibiting gastric secretion. In previous clinical trials, CBS solution induced healing rates significantly higher than placebo and similar to those observed with cimetidine. In spite of these promising results, the drug has never been widely employed, mainly because of its unpleasant taste, which greatly reduced patient compliance. For this reason, chewing tablets have been introduced. CBS tablets have been reported to induce healing rates significantly higher than placebo and similar to those obtained with CBS solution, cimetidine, and ranitidine. CBS may therefore represent an important alternative to antisecretory drugs in the therapy of duodenal ulcer patients.

  1. Surgical management of duodenal obstruction in older children in Kaduna, Nigeria.

    Science.gov (United States)

    Udezue, N O

    1993-08-01

    Twenty children, aged between six years and fourteen years were seen and treated for duodenal obstruction at the Department of Surgery, Ahmadu Bello University Teaching Hospital, Kaduna, Nigeria, between 1st January 1990 and 31st December, 1990. Both extrinsic and intrinsic factors caused the duodenal obstruction. All the patients were surgically treated and all survived. The main presenting clinical features, diagnosis and treatment are discussed. Follow up on some of the patients has been erratic because of patients defaulting on clinic appointments. In spite of successful surgical treatment and relief of symptoms, growth retardation, as shown by height and weight measurements, persisted relatively in patients in whom it was present at the time of diagnosis and treatment.

  2. Down syndrome: Molecular mapping of the congenital heart disease and duodenal stenosis

    Energy Technology Data Exchange (ETDEWEB)

    Korenburg, J.R. (University of California, Los Angeles (United States)); Bradley, C.; Disteche, C.M. (University of Washington, Seattle (United States))

    1992-02-01

    Down syndrome (DS) is a major cause of congenital heart and gut disease and mental retardation. DS individuals also have characteristic facies, hands, and dermatoglyphics, in addition to abnormalities of the immune system, and increased risk of leukemia, and an Alzheimer-like dementia. Although their molecular basis is unknown, recent work on patients with DS and partial duplications of chromosome 21 has suggested small chromosomal regions located in band q22 that are likely to contain the genes for some of these features. The authors now extend these analyses to define molecular markers for the congenital heart disease, the duodenal stenosis, and an 'overlap' region for the facial and some of the skeletal features. They report the clinical, cytogenetic, and molecular analysis of two patients. These studies provide the molecular basis for the construction of a DS phenotypic map and focus the search for genes responsible for the physical features, congenital heart disease, and duodenal stenosis of DS.

  3. Novel oesophago-gastro-duodenal stenting for gastric leaks after laparoscopic sleeve gastrectomy.

    Science.gov (United States)

    Liu, Shirley Yuk-Wah; Wong, Simon Kin-Hung; Ng, Enders Kwok-Wai

    2015-01-01

    The management of gastric leak after laparoscopic sleeve gastrectomy (LSG) can be complex and challenging. Whilst operative interventions are mostly complicated and reserved for unstable or refractory cases, endoscopic self-expandable metal stenting (SEMS) is increasingly preferred as a safer treatment option. Yet, SEMS carries the problems of frequent stent migration and inconsistent healing as ordinary SEMS is designed mainly for stenotic disease. We hereby present two cases of early and chronic post-LSG leakage that were respectively failed to be treated by surgery and ordinary SEMS but were successfully managed by a dedicated extra-long oesophago-gastro-duodenal stent. In oesophago-gastro-duodenal stenting, the characteristics of extra-long stent length allow total gastric exclusion between the mid-oesophagus and the first part of duodenum to prevent stent migration and to equalise high pressure gradient within the gastric sleeve to promote fistula healing.

  4. The р53 expression in cells of marginal zone of duodenal ulcers during acute bleeding

    Directory of Open Access Journals (Sweden)

    Sulayeva O.N.

    2009-01-01

    Full Text Available The aim of the work was to estimate the intensity and tissue distribution of proapoptogen p53 expression in duodenal mucosa in patients with acute bleeding caused by peptic ulcers. In 31 patients (1st group the healing of ulcer was detected after effective endoscopic hemostasis and in 15 patients rebleeding took place (2nd group. Performed immunocytochemical investigation allow to determine that acute ulcer bleeding was associated with activation of marginal zone cells apoptosis which was maximal in covering epithelium, vascular endothelium and regions infiltrated by lymphocytes. In patients with rebleeding the higher values of р53 expression were detected in crypts epithelium and in endothelium of dilatating vessels accompanied with intensive edema and lymphocytes infiltration of lamina propria and muscularis mucosae with perifocal activation of cells death. Additionally to apoptosis in 2nd group duodenum the necrosis of cells and epithelium desquamation were found, reflecting the tissue disintegration of duodenal mucosa.

  5. Conservative Management of Duodenal Perforation with Toothpick in a 9- Year Old Girl; a Case Report

    Directory of Open Access Journals (Sweden)

    Shahsanam Gheibi

    2016-10-01

    Full Text Available Background Foreign body ingestion is a relatively common in children. Most ingested foreign bodies spontaneously pass out of the body via the gastrointestinal (GI system but sharp materials may perforate the GI tract and need to surgical intervention. Case Presentation  The patient was a 9-year-old girl with progressive abdominal pain for one month and admitted with acute abdomen impression. She underwent esogastroduodenoscopy (EGD due to severe epigastric tenderness. Upper GI endoscopy revealed duodenal ulceration and perforation by a toothpick while she had no history of foreign body ingestion. Toothpick was removed by endoscopy. She was successfully managed conservatively and had no abdominal pain during the one month follow-up period. Conclusion We recommend the endoscopic approach as the preferable method for the extraction of duodenal foreign bodies in children, even in the case of intestinal perforation.

  6. Gastric and Duodenal Pseudomelanosis: An Extended Unusual Finding in a Patient with End Stage Kidney Disease

    Directory of Open Access Journals (Sweden)

    Noor Ul Ain Qureshi

    2016-01-01

    Full Text Available Gastric and duodenal pseudomelanosis is a rare endoscopic mucosal finding, characterized by the accumulation of iron in macrophages of the lamina propria of the stomach and duodenum. The clinical significance and long term sequelae have not been clarified yet. However, this benign condition is associated with a variety of clinical conditions, such as essential hypertension, chronic renal failure, diabetes mellitus, long term intake of iron supplements, and furosemide. Duodenal pseudomelanosis appears to be more common than gastric pseudomelanosis given the fact that a few cases of gastric pseudomelanosis have been reported in the literature so far. We report a case of 88-year-old lady with ESRD who is maintained on hemodialysis and presented with abdominal pain. An upper GI endoscopy showed discoloration of the antrum of the stomach and most portion of her duodenum. Histopathology report confirmed the presence of iron laden macrophages in the lamina propria of both stomach and duodenum.

  7. Gastric and Duodenal Pseudomelanosis: An Extended Unusual Finding in a Patient with End Stage Kidney Disease

    Science.gov (United States)

    Qureshi, Noor Ul Ain; Younus, Muhammad Faraz; Alavi, Kourosh

    2016-01-01

    Gastric and duodenal pseudomelanosis is a rare endoscopic mucosal finding, characterized by the accumulation of iron in macrophages of the lamina propria of the stomach and duodenum. The clinical significance and long term sequelae have not been clarified yet. However, this benign condition is associated with a variety of clinical conditions, such as essential hypertension, chronic renal failure, diabetes mellitus, long term intake of iron supplements, and furosemide. Duodenal pseudomelanosis appears to be more common than gastric pseudomelanosis given the fact that a few cases of gastric pseudomelanosis have been reported in the literature so far. We report a case of 88-year-old lady with ESRD who is maintained on hemodialysis and presented with abdominal pain. An upper GI endoscopy showed discoloration of the antrum of the stomach and most portion of her duodenum. Histopathology report confirmed the presence of iron laden macrophages in the lamina propria of both stomach and duodenum. PMID:27042366

  8. Immunopathology of the duodenal mucosa of HIV-positive patients during combined antiretroviral therapy

    Directory of Open Access Journals (Sweden)

    F.R. Machado

    2006-01-01

    Full Text Available The objective of the present study was to evaluate the duodenal mucosa of HIV-infected patients during antiretroviral therapy. This was an observational study conducted on HIV-positive patients and a control group. Group 1 comprised 22 HIV-negative individuals while 38 HIV-positive individuals were classified according to the CDC 1993 classification into group 2 (A1 or A2 or group 3 (B2, A3, B3, C2, C3. All subjects were submitted to upper gastrointestinal endoscopy with duodenal biopsies. Qualitative, semi-quantitative and quantitative histological analyses were performed. Results were considered significant when P < 0.05. A higher prevalence of inflammatory infiltrate and eosinophilia was observed in the HIV group, together with a reduction in mucosal CD4+ lymphocyte (L counts [median (lower-upper quartiles, 12.82 (8.30-20.33, 6.36 (1.75-11.66 and 1.75 (0.87-3.14 in groups 1, 2 and 3, respectively] which was not correlated with disease stage. The extent of CD4+L count reduction was similar in blood and duodenal mucosa. Normal CD8+L and CD45RO+L counts, and normal numbers of macrophages and antigen-presenting cells were also found in the HIV patients. The cytokine pattern did not differ among groups. Tissue HIV, assessed by p24 antigen, correlated with a higher CD45RO+L count (77.0 (61-79.8 and 43.6 (31.7-62.8 in p24+ and p24-, respectively, P = 0.003, and IL-4 positivity (100 and 48.2% in p24+ and p24-, respectively, P = 0.005. The duodenal mucosa of HIV+ patients showed a relatively preserved histological architecture. This finding may be characteristic of a population without opportunistic infections and treated with potent antiretroviral therapy, with a better preservation of the immune status.

  9. Usefulness of duodenal biopsy during routine upper gastrointestinal endoscopy for diagnosis of celiac disease

    Institute of Scientific and Technical Information of China (English)

    S Riestra; F Domínguez; E Fernández-Ruiz; E García-Riesco; R Nieto; E Fernández; L Rodrigo

    2006-01-01

    AIM: To describe the trend in duodenal biopsy performance during routine upper gastrointestinal endoscopy in an adult Spanish population, and to analyze its value for the diagnosis of celiac disease in clinical practice.METHODS: A 15 year-trend (1990 to 2004) in duodenal biopsy performed when undertaking upper gastrointestinal endoscopy was studied. We analysed the prevalence of celiac disease in the overall group, and in the subgroups with anaemia and/or chronic diarrhoea.RESULTS: Duodenal biopsy was performed in 1033of 13 678 upper gastrointestinal endoscopies (7.6%);an increase in the use of such was observed over the study period (1.9% in 1990-1994, 5% in 1995-1999 and 12.8% in 2000-2004). Celiac disease was diagnosed in 22 patients (2.2%), this being more frequent in women than in men (3% and 1% respectively). Fourteen out of 514 (2.7%) patients with anaemia, 12 out of 141(8.5%) with chronic diarrhoea and 8 out of 42 (19%)with anaemia plus chronic diarrhoea had celiac disease.A classical clinical presentation was observed in 55% of the cases, 23% of the patients had associated dermatitis herpetiformis and 64% presented anaemia; 9% were diagnosed by familial screening and 5% by cryptogenetic hypertransaminasaemia.CONCLUSION: Duodenal biopsy undertaken during routine upper gastrointestinal endoscopy in adults, has been gradually incorporated into clinical practice, and is a useful tool for the diagnosis of celiac disease in high risk groups such as those with anaemia and/or chronic diarrhoea.

  10. Fluctuating functions related to quality of life in advanced Parkinson disease: effects of duodenal levodopa infusion

    DEFF Research Database (Denmark)

    Isacson, D; Bingefors, K; Sønbø Kristiansen, Ivar

    2008-01-01

    followed for up to 6 months and assessed using electronic diaries and the PD Questionnaire-39 (PDQ-39). RESULTS: During the trial and follow-up, major diurnal fluctuations were observed, especially for hyperkinesia, 'off' time, ability to walk and depression. Duodenal infusion was associated...... and patient's QoL. The potential for daily fluctuation in PD symptoms means single measures of treatment effectiveness can result in bias in effect estimates and hence repeated measures are recommended....

  11. A Rare Case of Hepatitis C-Associated Cryoglobulinemic Duodenal Vasculitis

    Science.gov (United States)

    Gomez, Alexandra; Dholaria, Kevin; Arosemena, Leopoldo R.; Ladino-Avellaneda, Marco A.; Barisoni, Laura; Bhamidimarri, Kalyan R.

    2016-01-01

    Intestinal involvement of cryoglobulinemia is an uncommon manifestation and marker of severe vasculitis. We describe the case of a woman admitted to our service for management of acute renal failure and progressive gastrointestinal symptoms after initiating hepatitis C virus treatment with ribavirin and sofosbuvir 4 weeks prior. With an undetectable hepatitis C viral load and persistent symptoms despite hepatitis C virus therapy cessation, an upper endoscopy revealed duodenal sloughing, erythema, and bleeding, sparking suspicion for recurrence of cryoglobulinemic vasculitis.

  12. The personality pattern of duodenal ulcer patients in relation to spontaneous ulcer healing and relapse

    DEFF Research Database (Denmark)

    Jess, P; von der Lieth, L; Matzen, Peter

    1989-01-01

    One hundred consecutive out-patients with duodenal ulceration from a hospital and a gastroenterological clinic were tested with the Minnesota Multiphasic Personality Inventory (MMPI). This was carried out in order to investigate whether neuroticism or other personality disorders were characterist......One hundred consecutive out-patients with duodenal ulceration from a hospital and a gastroenterological clinic were tested with the Minnesota Multiphasic Personality Inventory (MMPI). This was carried out in order to investigate whether neuroticism or other personality disorders were...... characteristics of duodenal ulcer patients, and whether the presence of such possible personality disorders might influence the prognosis of the disease. Neuroticism occurred in 53% of the patients, but only in 5% of controls (P less than 0.0001). Overall, personality disorders were present in 69% of the patients...... compared with 30% of the controls (P less than 0.0001). Neuroticism was connected with a high frequency of relapse (P less than 0.05) whereas failure of spontaneous ulcer healing had no certain relation to personality disorders. Patients with non-neurotic personality disorders had more frequently suffered...

  13. Duodenal diaphragm diagnosis in a school-aged child and minimally invasive treatment: case report

    Directory of Open Access Journals (Sweden)

    Andrea Barrueto Barrera

    2017-03-01

    Full Text Available Resumen La atresia duodenal corresponde a la tercera causa de obstrucción intestinal intrínseca en período neonatal. El cuadro típico corresponde a vómitos de contenido gástrico o bilioso, de inicio temprano, distensión abdominal y mal incremento ponderal. En caso de que la obstrucción sea incompleta, como ocurre con el diafragma duodenal perforado, las manifestaciones suelen ser más tardías e inespecíficas, por lo que el diagnóstico suele retrasarse. Se presenta el caso de una escolar de nueve años, con antecedente de vómitos postprandiales biliosos desde el período de lactante, sin repercusión en estado nutricional, manejada sintomáticamente. Previamente, se realizó estudio a los dos años con endoscopía digestiva alta, la cual resultó frustra por abundante contenido gástrico. Se estudia nuevamente a los nueve años de edad con tránsito digestivo superior contrastado y endoscopía digestiva alta, los que sugieren el diagnóstico de membrana duodenal fenestrada. Se realiza duodeno-yeyuno anastomosis en Y de Roux, evolucionando favorablemente.

  14. Duodenal ulcer penetration into the liver at the previous left hemihepatectomy site☆

    Science.gov (United States)

    Hayashi, Hironori; Kitagawa, Hirohisa; Shoji, Masatoshi; Nakanuma, Shin-ichi; Makino, Isamu; Oyama, Katsunobu; Inokuchi, Masafumi; Nakagawara, Hisatoshi; Miyashita, Tomoharu; Tajima, Hidehiro; Takamura, Hiroyuki; Ninomiya, Itasu; Fushida, Sachio; Fujimura, Takashi; Tani, Takashi; Ohta, Tetsuo

    2013-01-01

    INTRODUCTION Duodenal ulcer penetration into the liver is a rare, but serious complication. Its frequency was thought to have decreased owing to advances in therapies for peptic ulcers. However, we encountered a case in which the duodenal ulcer had penetrated into a previous hemihepatectomy site. PRESENTATION OF CASE A 69-year-old man with a history of left hemihepatectomy 20 months previously presented to the emergency room with sudden-onset abdominal pain and nausea. An upper gastrointestinal examination with a fiberscope revealed a giant ulcer in the duodenal bulb. In addition, a foreign body was detected at the ulcer floor and was strongly suspected of being a ligature from previous hemihepatectomy. DISCUSSION The presence of a gas-filled liver mass and bowel wall thickening with inflammatory changes are important imaging findings for prompt diagnosis of such a condition, but in this case, none of these were reported. Further, no definite abscess was found. Thus, the patient was treated conservatively with a proton pump inhibitor. CONCLUSION This case demonstrates the importance of using absorbable suture materials, adequate lavage in the postoperative peritoneal space and gastroduodenal mucosal protection postoperatively. PMID:24240081

  15. Omeprazole maintenance therapy prevents recurrent ulcer bleeding after surgery for duodenal ulcer

    Institute of Scientific and Technical Information of China (English)

    Konstantinos Demertzis; Dimitrios Polymeros; Theodoros Emmanuel; Konstantinos Triantafyllou; Pericles Tassios; Spiros D Ladas

    2006-01-01

    AIM: To evaluate the omeprazole maintenance therapy in patients with recurrent ulcer bleeding after surgery for duodenal ulcer.METHODS: We studied 15 consecutive patients with recurrent ulcer bleeding after surgery for duodenal ulcer.Omeprazole (20 mg/d) maintenance therapy was given after ulcer healing. In addition to clinical follow-up, ambulatory 24-h gastric pH assay was performed before and during omeprazole therapy in those patients and controls with previous duodenal ulcer surgery but no ulcer recurrence.RESULTS: All the 15 ulcers were healed after being treated with omeprazole (40 mg/d) for 2 mo. Eleven patients with two (1-9) episodes of recurrent ulcer bleeding completed the follow-up (43, 12-72 mo). None of them had a bleeding episode while on omeprazole. One patient discontinued the therapy and had recurrent bleeding. The median 24-h fraction time of gastric pH <4 in patients was 80, 46-95% , and was reduced to 32, 13-70% by omeprazole (P = 0.002).CONCLUSION: Long-term maintenance therapy with omeprazole (20 mg/day) is effective in preventing recurrent ulcer bleeding.

  16. Clinical, endoscopic and histopathological profiles of parasitic duodenitis cases diagnosed by upper digestive endoscopy

    Directory of Open Access Journals (Sweden)

    Reinaldo Benevides dos Santos

    2011-12-01

    Full Text Available CONTEXT: Intestinal parasites induce detectable histopathological changes, which have been studied in groups with known diagnosis of parasitic disease. There is no available study with a larger base without previous diagnosis. OBJECTIVE: To describe clinical and histopathological findings of parasitosis diagnosed by endoscopic biopsy in patients submitted to upper digestive endoscopy. METHODS: Recorded biopsies archive at "Complexo Hospitalar Professor Edgar Santos" , a general teaching Hospital in the state of Bahia, Northeast Brazil, from January 1995 to January 2009, were reviewed. One thousand ten duodenal biopsy reports were found. Reports positive for parasites had their specimens reviewed and photographed. All blocks of biopsy selected as case were retrieved and reviewed by an experienced pathologist. Clinical, laboratorial and endoscopic data were collected. RESULTS: Eleven biopsies showed parasites, including cases of Cryptosporidium sp. and Strongyloides stercoralis. Vomiting (91%, abdominal pain (78%, diarrhea (78% and weight loss (78% were usual symptoms. Seventy-five percent had duodenal mucosa changes on endoscopy, while 25% have no changes. Anemia and low serum albumin were important laboratorial data. HIV infection association was observed. Villus atrophy and reactive epithelium were usual in Strongyloides cases. CONCLUSIONS: No endoscopic or histopathologic finding was pathognomonic. One percent of duodenal endoscopic biopsies showed parasites.

  17. Hepatothorax due to a right diaphragmatic rupture related to duodenal ulcer perforation

    Institute of Scientific and Technical Information of China (English)

    Se-Jin Baek; Jin Kim; Sung-Ho Lee

    2012-01-01

    Here,we present the case of a 53-year-old man with a hepatothorax due to a right diaphragmatic rupture related to duodenal ulcer perforation.On admission,the patient complained of severe acute abdominal pain,with physical examination findings suspicious for a perforated peptic ulcer.Of note,the patient had no history of other medical conditions or recent trauma,and the initial chest radiography and laboratory findings were not specific.A subsequent abdominal computed tomography revealed intrathoracic displacement of the liver,gallbladder,transverse colon and omentum through a right diaphragmatic defect.The patient then underwent an explorative laparotomy that confirmed duodenal ulcer perforation.A primary repair of the duodenal perforation was performed,and the diaphragmatic defect was repaired using a polytetrafluoroethylene patch after the organs were reduced and the cavity irrigated.This particular case proves interesting as right-sided spontaneous diaphragmatic ruptures are very rare and difficult to diagnose.Additionally,the best treatment for such large diaphragmatic defects is still controversial,especially in cases of intrathoracic or intra-abdominal contamination.

  18. Iron Deposition in Duodenal Mucosa; A Review and Report of Three Cases in Pediatric Age Group

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    Farzaneh Moatamed

    2011-06-01

    Full Text Available Background:Ferrous sulfate drops are routinely used in Iran in infants older than 6 months of age. Effect of ferrous sulfate drops in preventive or therapeutic doses on gastrointestinal mucosa of infants is not studied as yet. Upper gastrointestinal complications due to acute iron poisoning are well known in this age group. In this article, we reviewed published articles on iron deposition in upper gastro-intestinal tract and also introduce clinical, endoscopic and histological findings in three cases with iron deposition in duodenal mucosa. Cases Presentation:We encountered three cases of iron deposition in duodenal mucosa among about 8000 biopsies during a 10 year period which is a very low incidence despite routine use of iron supplement in children above 6 months of age in this country. One of our cases suffered from steatorrhea and another from failure to thrive, which raises concern about effects of iron deposition in small intestine. Conclusion:The clinical significance and effects of iron deposition in pediatric age group is yet to be elucidated. Iron deposition as a solitary finding is not reported in duodenal biopsies of infants as yet. Since iron supplement is widely used in this age group, it is justified to consider its deposition and possible effects on absorption.

  19. Duodenal variceal bleeding after balloon-occluded retrograde transverse obliteration: Treatment with transjugular intrahepatic portosystemic shunt

    Institute of Scientific and Technical Information of China (English)

    Min Joung Kim; Byoung Kuk Jang; Woo Jin Chung; Jae Seok Hwang; Young Hwan Kim

    2012-01-01

    We report a case of duodenal varix bleeding as a long term complication of balloon occluded retrograde transvenous obliteration (BRTO),which was successfully treated with a transjugular intrahepatic portosystemic shunt (TIPS).A 57-year-old man was admitted to the emergency room suffering from melena.He had undergone BRTO to treat gastric varix bleeding 5 mo before admission.Endoscopy and a computed tomography (cr) scan showed complete obliteration of the gastric varix,but the nodular varices in the second portion of the duodenum expanded after BRTO,and spurting blood was seen.TIPS was performed for treatment of duodenal variceal bleeding,because attempts at endoscopic varix ligation were unsuccessful.The postoperative course was uneventful and the patient was discharged without complications.A follow up CT scan obtained 21 mo after TIPS revealed a patent TIPS tract and complete obliteration of duodenal varices,but multinodular hepatocellular carcinoma had developed.He died of hepatic failure 28 mo after TIPS.

  20. Endovascular obliteration of bleeding duodenal varices in patients with liver cirrhosis

    Energy Technology Data Exchange (ETDEWEB)

    Zamora, Carlos Armando; Sugimoto, Koji; Tsurusaki, Masakatsu; Izaki, Kenta; Fukuda, Tetsuya; Matsumoto, Shinichi; Kawasaki, Ryota; Taniguchi, Takanori; Sugimura, Kazuro [Kobe University School of Medicine, Department of Radiology, Kobe-shi, Hyogo-ken (Japan); Kuwata, Yoichiro [Nishi-Kobe Medical Center, Department of Radiology, Kobe-shi, Hyogo-ken (Japan); Hirota, Shozo [Hyogo Medical College, Department of Radiology, Nishinomiya-shi, Hyogo-ken (Japan)

    2006-01-01

    The purpose of this paper is to describe our experience with endovascular obliteration of duodenal varices in patients with liver cirrhosis and portal hypertension. Balloon-occluded transvenous retrograde and percutaneous transhepatic anterograde embolizations were performed for duodenal varices in five patients with liver cirrhosis, portal hypertension, and decreased liver function. All patients had undergone previous endoscopic treatments that failed to stop bleeding and were poor surgical candidates. Temporary balloon occlusion catheters were used to achieve accumulation of an ethanolamine oleate-iopamidol mixture inside the varices. Elimination of the varices was successful in all patients. Retrograde transvenous obliteration via efferent veins to the inferior vena cava was enough to achieve adequate sclerosant accumulation in three patients. A combined anterograde-retrograde embolization was used in one patient with balloon occlusion of afferent and efferent veins. Transhepatic embolization through the afferent vein was performed in one patient under balloon occlusion of both efferent and afferent veins. There was complete variceal thrombosis and no bleeding was observed at follow-up. No major complications were recorded. Endovascular obliteration of duodenal varices is a feasible and safe alternative procedure for managing patients with portal hypertension and hemorrhage from this source. (orig.)

  1. In Vivo Risk Analysis of Pancreatic Cancer Through Optical Characterization of Duodenal Mucosa

    Science.gov (United States)

    Mutyal, Nikhil N.; Radosevich, Andrew J.; Bajaj, Shailesh; Konda, Vani; Siddiqui, Uzma D.; Waxman, Irving; Goldberg, Michael J.; Rogers, Jeremy D.; Gould, Bradley; Eshein, Adam; Upadhye, Sudeep; Koons, Ann; Gonzalez-Haba Ruiz, Mariano; Roy, Hemant K.; Backman, Vadim

    2015-01-01

    Objectives To reduce pancreatic cancer mortality, a paradigm shift in cancer screening is needed. Our group pioneered the use of low-coherence enhanced backscattering (LEBS) spectroscopy to predict the presence of pancreatic cancer by interrogating the duodenal mucosa. A previous ex vivo study (n = 203) demonstrated excellent diagnostic potential: sensitivity, 95%; specificity, 71%; and accuracy, 85%. The objective of the current case-control study was to evaluate this approach in vivo. Methods We developed a novel endoscope-compatible fiber-optic probe to measure LEBS in the periampullary duodenum of 41 patients undergoing upper endoscopy. This approach enables minimally invasive detection of the ultrastructural consequences of pancreatic field carcinogenesis. Results The LEBS parameters and optical properties were significantly altered in patients harboring adenocarcinomas (including early-stage) throughout the pancreas relative to healthy controls. Test performance characteristics were excellent with sensitivity = 78%, specificity = 85%, and accuracy = 81%. Moreover, the LEBS prediction rule was not confounded by patients’ demographics. Conclusion We demonstrate the feasibility of in vivo measurement of histologically normal duodenal mucosa to predict the presence of adenocarcinoma throughout the pancreas. This represents the next step in establishing duodenal LEBS analysis as a prescreening technique that identifies clinically asymptomatic patients who are at elevated risk of PC. PMID:25906443

  2. Advances in diagnosis of tracheal and bronchial diverticulum%气管支气管憩室的诊断进展

    Institute of Scientific and Technical Information of China (English)

    谢冬; 姜格宁; 徐志飞

    2012-01-01

    Tracheal and bronchial diverticulum is a rare benign entity,characterized by round or spherical outpouchings of the tracheal and bronchial wall. Tracheal diverticulum is commonly seen on right side,containing air or fluids.The development of new techniques such as thin-layer CT and multidetector computed tomography have led increasingly reports of incidental findings of this entity. This paper reviews the classification,diagnosis and therapy of this entity.%气管支气管憩室是一种少见的良性气管疾病,气管憩室多数位于胸廓入口处气管右后侧,表现为圆形或卵圆形囊泡,内含气体或液体.近年来,随着薄层CT及多层螺旋CT的应用,气管支气管憩室的报道日趋增多,该文综述了气管支气管憩室分类及诊断治疗进展.

  3. Gastro-duodenal perforations: conventional plain film, US and CT findings in 166 consecutive patients

    Energy Technology Data Exchange (ETDEWEB)

    Grassi, Roberto; Romano, Stefania E-mail: stefromano@libero.it; Pinto, Antonio; Romano, Luigia

    2004-04-01

    Introduction: Gastro-duodenal perforations may be suspected in patients with history of ulceration, who present with acute pain and abdominal wall rigidity, but radiological findings in these cases may be unable to confirm a clinical diagnosis. The aim of our study was to report our experience in the diagnosis of gastro-duodenal perforation by conventional radiography, US and CT examinations. Material and methods: We retrospectively reviewed medical records of 166 consecutive patients who presented in the last 2 years to our institutions with symptoms of acute abdomen and submitted to surgery at the Emergency Unit of the ''A.Cardarelli'' Hospital of Naples with a surgical finding of perforated gastro-duodenal ulcer. The evidence of free intraperitoneal air on abdominal plain film was considered as a direct or suggestive finding of perforation. Evidence of intraperitoneal free fluid and/or reduced intestinal peristalsis at sonographic examination were considered indirect signs of gastro-duodenal perforation. Evidence of free peritoneal gas at CT was considered as a direct evidence of gastro-duodenal perforation. Results: Twenty patients underwent immediate surgery with no preoperative imaging evaluation, in 10 of them the site of perforation was found in a juxta-pyloric region and in the others at level of duodenum. In 146 patients submitted to serial radiological investigations before surgery, the site of perforation was in 56 (38.3%) duodenal, in 52 (35.6%) juxta-pyloric, in 28 (19.1%) gastric and in 10 (6.8%) pyloric. The cause of perforation was in all cases gastric or duodenal ulceration, in seven cases involving pancreatic parenchyma. In 110 (75.4%) patients with direct findings of perforation, in 94 cases (85.5%) the correct diagnosis was established on abdominal plain film, in two (1.8%) with radiographic and sonographic examinations and in 14 (12.7%) on CT findings. In 36 (24,6%) patients with no direct findings of perforation, only 24

  4. A 56-year-old woman with ampullary adenocarcinoma and acute pancreatitis Mujer de 56 años con adenocarcinoma de la ampolla de Vater y pancreatitis aguda

    Directory of Open Access Journals (Sweden)

    V. M. Santos

    2012-12-01

    Full Text Available A 56-year-old woman was admitted with jaundice, and laboratory data were indicative of pancreatitis, which recurred in spite of adequate clinical and nutritional management. The patient was an overweight diabetic using metformin, who had antecedents of cholelithiasis and recent cholecystectomy. Clinical and laboratory features were not conclusive about the cause of this acute pancreatitis. However, imaging data contributed to diagnosis suspicion, and the histopathology study of the transpapillary biopsy confirmed the ampullary adenocarcinoma. Whipple´s surgery was the procedure of choice, associated with radical lymphadenectomy, followed by an uneventful outcome. Recrudescence of signs and symptoms of acute pancreatitis, with elevated serum levels of bilirrubins and of hepatic canalicular enzymes, should enhance the suspicion index about periampullary tumors. High levels of CA 19-9 can constitute a useful marker of this condition. Transpapillary biopsy can characterize the diagnosis of ampullary malignancies.Se presenta el caso de una mujer de 56 años, que presentaba ictericia y cuyos exámenes de laboratorio fueran indicativos de pancreatitis. Presentó recurrencia a pesar de las medidas clínicas y nutricionales adecuadas. La paciente era diabética, con sobrepeso, tomaba metformina y con antecedentes de colelitiasis y reciente colecistectomía. Los datos clínicos y del laboratorio no fueron concluyentes acerca del origen de esta pancreatitis aguda. Sin embargo, los estudios de imagen contribuyeron a la sospecha del diagnóstico; los estudios de citologia exfoliativa y de biopsia transpapilar confirmaron un adenocarcinoma ampular. La cirugía de Whipple fue el procedimiento de opción, asociado con linfadenectomía radical, con resultado favorable. El recrudecimiento de señales y síntomas de pancreatitis aguda, con niveles séricos elevados de bilirrubina y de enzimas hepáticos debe reforzar el índice de sospecha acerca de tumores

  5. Lower Bifidobacteria counts in both duodenal mucosa-associated and fecal microbiota in irritable bowel syndrome patients

    Institute of Scientific and Technical Information of China (English)

    Angèle PM Kerckhoffs; Melvin Samsom; Michel E van der Rest; Joris de Vogel; Jan Knol; Kaouther Ben-Amor; Louis MA Akkermans

    2009-01-01

    AIM: To determine the composition of both fecal and duodenal mucosa-associated microbiota in irritable bowel syndrome (IBS) patients and healthy subjects using molecular-based techniques. METHODS: Fecal and duodenal mucosa brush samples were obtained from 41 IBS patients and 26 healthy subjects. Fecal samples were analyzed for the composition of the total microbiota using fluorescent in situ hybridization (FISH) and both fecal and duodenal brush samples were analyzed for the composition of bifidobacteria using real-time polymerase chain reaction. RESULTS: The FISH analysis of fecal samples revealed a 2-fold decrease in the level of bifidobacteria (4.2 ± 1.3 vs 8.3 ± 1.9, P < 0.01) in IBS patients compared to healthy subjects, whereas no major differences in other bacterial groups were observed. At the species level, Bifidobacterium catenulatum levels were significantly lower (6 ± 0.6 vs 19 ± 2.5, P < 0.001) in the IBS patients in both fecal and duodenal brush samples than in healthy subjects. CONCLUSION: Decreased bifidobacteria levels in both fecal and duodenal brush samples of IBS patients compared to healthy subjects indicate a role for microbiotic composition in IBS pathophysiology.

  6. Effect of simulated gastro-duodenal digestion on the allergenic reactivity of beta-lactoglobulin

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    Bossios Apostolos

    2011-08-01

    Full Text Available Abstract Background Cow's milk (CM allergy affects about 2% of infants. The allergenicity of dietary proteins, including those from CM, has been related to their digestibility although the generality of the link and its causality remains to be demonstrated. In this study we use an in vitro digestion system, to investigate the digestibility of β-lactoglobulin (blg during gastrointestinal transit and to assess the impact of this process on blg allergenic reactivity in CM allergic children. Methods Blg digesta were prepared using an in vitro digestion protocol simulating either gastric digestion alone or followed by duodenal digestion with or without phosphatidylcholine (PC. Biochemical analysis of blg digesta was performed by SDS-PAGE and their concentration was measured by a sandwich ELISA. Assessment of their allergenic reactivity was done in vitro by EAST inhibition, specific basophil activation (basotest and lymphocyte proliferation (PCNA-flow cytometry assays using sera and cells from patients allergic to blg and in vivo by skin prick testing (SPT of these patients. Results Blg was only broken down to smaller peptides after gastro-duodenal digestion although a sizeable amount of intact protein still remained. Digestion did not modify the IgE binding capacity of blg except for gastro-duodenal digestion performed in the absence of PC. These results are consistent with the quantity of intact blg remaining in the digesta. Overall both gastric and gastroduodenal digestion enhanced activation of sensitized basophils and proliferation of sensitized lymphocytes by blg. However, there was a tendency towards reduction in mean diameter of SPT following digestion, the PC alone during phase 1 digestion causing a significant increase in mean diameter. Conclusions Digestion did not reduce the allergenic reactivity of blg to a clinically insignificant extent, PC inhibiting digestion and thereby protecting blg allergenic reactivity. SPT reactivity was

  7. Acid suppression increases rates of Barrett's esophagus and esophageal injury in the presence of duodenal reflux.

    LENUS (Irish Health Repository)

    2012-01-31

    BACKGROUND: The contribution of gastric acid to the toxicity of alkaline duodenal refluxate on the esophageal mucosa is unclear. This study compared the effect of duodenal refluxate when acid was present, decreased by proton pump inhibitors (PPI), or absent. METHODS: We randomized 136 Sprague-Dawley rats into 4 groups: group 1 (n = 33) were controls; group 2 (n = 34) underwent esophagoduodenostomy promoting "combined reflux"; group 3 (n = 34) underwent esophagoduodenostomy and PPI treatment to decrease acid reflux; and group 4, the \\'gastrectomy\\' group (n = 35) underwent esophagoduodenostomy and total gastrectomy to eliminate acid in the refluxate. Esophaguses were examined for inflammatory, Barrett\\'s, and other histologic changes, and expression of proliferative markers Ki-67, proliferating cell nuclear antigen (PCNA), and epidermal growth factor receptor (EGFR). RESULTS: In all reflux groups, the incidence of Barrett\\'s mucosa was greater when acid was suppressed (group C, 62%; group D, 71%) than when not suppressed (group B, 27%; P = 0.004 and P < .001). Erosions were more frequent in the PPI and gastrectomy groups than in the combined reflux group. Edema (wet weight) and ulceration was more frequent in the gastrectomy than in the combined reflux group. Acute inflammatory changes were infrequent in the PPI group (8%) compared with the combined reflux (94%) or gastrectomy (100%) groups, but chronic inflammation persisted in 100% of the PPI group. EGFR levels were greater in the PPI compared with the combined reflux group (P = .04). Ki-67, PCNA, and combined marker scores were greater in the gastrectomy compared with the combined reflux group (P = .006, P = .14, and P < .001). CONCLUSION: Gastric acid suppression in the presence of duodenal refluxate caused increased rates of inflammatory changes, intestinal metaplasia, and molecular proliferative activity. PPIs suppressed acute inflammatory changes only, whereas chronic inflammatory changes persisted.

  8. Anterior seromyotomy with posterior truncal vagotomy in uncomplicated chronic duodenal ulcer.

    Directory of Open Access Journals (Sweden)

    Supe A

    1995-07-01

    Full Text Available Thirty cases of uncomplicated duodenal ulcer treated by anterior superficial lesser curvature seromyotomy and posterior truncal vagotomy were studied to evaluate the efficacy of this procedure. There was completeness of vagotomy in all the cases as shown by endoscopic Congo Red test. Twenty-seven cases were asymptomatic at 1-48 months (Mean 22.3 follow up, while 3 patients had controllable side effects such as dumping and diarrhoea. There was no mortality. This procedure is safe, effective and is a favourable alternative to highly selective vagotomy.

  9. Amylase: creatinine clearance ratio and urinary excretion of lysozyme in acute pancreatitis and acute duodenal perforation.

    Science.gov (United States)

    Berger, G M; Cowlin, J; Turner, T J

    1976-09-18

    The amylase:creatinine clearance ratio in patients suffering from acute pancreatitis or acute duodenal perforation was higher than normal in both groups of patients. These findings cast doubt on the value of this parameter as a specific index of acute pancreatitis. The mechanism or mechanisms underlying the increased amylase excretion have not been determined. However, the markedly elevated urinary excretion of lysozyme observed in some patients suggests, by analogy, that diminished tubular reabsorption of amylase may contribute towards the elevated amylase:creatinine ratio.

  10. Study of nerve fibers nature reinforcing duodenal contractions by electrical stimulation of sympathetic nerve

    Directory of Open Access Journals (Sweden)

    Sveshnikov D.S.

    2011-09-01

    Full Text Available The subject of the article is to investigate the mechanism of increased reactions by electrical stimulation of the sympathetic nerve. Materials and methods: Experiments on dogs have shown that stimulant reactions during blockade of a-adrenergic by phentolamine and (3-adrenergic receptors with propranolol were completely eliminated by lizer-gol —the blocker of 5-HT12-receptors. Results: Infusion of lizergol did not influence on duodenal motor activity and the function of the vagus nerve. Conclusion: Effector neuron is found out to be serotonergic and its action is provided by 5-HT1 2 receptors

  11. Severe duodenal hemorrhage induced by Lugol's solution administered for thyroid crisis treatment.

    Science.gov (United States)

    Kinoshita, Hiroyuki; Yasuda, Mutsuko; Furumoto, Youhei; Watanabe, Naoko; Horiuchi, Takao; Murayama, Minekazu; Kitamura, Mari; Kaneko, Shingo; Inoshita, Seiji; Maruyama, Yasuki; Suenaga, Matsuhiko; Fujita, Hiroshi; Fujiki, Kazuhiko; Yakushiji, Fumiatsu

    2010-01-01

    Lugol's solution is an iodinated agent used for treating thyroid crisis. It is primarily used in diagnostic tests for esophageal diseases. However, Lugol's solution can cause local mucosal injury and hemorrhage. We report, for the first time, a case of 34-year-old man who exhibited severe duodenal hemorrhage induced by Lugol's solution that was used to treat thyroid crisis. The quantity of Lugol's solution used for treating thyroid crisis is much higher than that used for mucosal disease investigation. Clinical practitioners should be aware of gastrointestinal hemorrhage when using Lugol's solution for the treatment of thyroid crisis.

  12. Congenital Pyloric Atresia with Distal Duodenal Atresia- Role of CT Scan

    Directory of Open Access Journals (Sweden)

    Yogender Singh Kadian

    2014-07-01

    Full Text Available The mainstay of diagnosis of congenital pyloric atresia is by plain X-ray of the abdomen showing a large gas bubble with no gas distally. But very rarely it can be associated with distal duodenal atresia when the baby may present as lump abdomen. In such a situation apart from the X-ray, another radiological investigation is needed to delineate the exact nature of the lump. Since the role of ultrasonography is limited in intestinal pathologies and contrast studies are not informative in atresias, the CT scan is the ideal choice. We had managed a case of pyloric atresia with similar presentation with preoperative CT scan.

  13. An Intraductal Papillary Neoplasm of the Bile Duct at the Duodenal Papilla

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    Yoshiaki Kawaguchi

    2014-07-01

    Full Text Available In recent years, the disease concept of intraductal papillary neoplasm of the bile duct (IPNB has been attracting attention as a biliary lesion that is morphologically similar to intraductal papillary mucinous neoplasm (IPMN, which is considered to be a counterpart of IPMN. However, there are few reports on IPNB, and a consensus regarding the features of this disease is thus lacking. We experienced an extremely rare case of IPNB occurring in the bile duct at the duodenal papilla, which is a tumor presentation that has not previously been reported. Herein, we report this interesting case and discuss the possible association between IPMN and IPNB.

  14. Life threatening bleeding from duodenal ulcer after Roux-en-Y gastric bypass: Case report and review of the literature

    Institute of Scientific and Technical Information of China (English)

    Arpad; Ivanecz; Marko; Sremec; Davorin; ?erani?; Stojan; Potr?; Pavel; Skok

    2014-01-01

    Acute upper gastrointestinal bleeding is a rare, but serious complication of gastric bypass surgery. The inaccessibility of the excluded stomach restrains postoperative examination and treatment of the gastric remnant and duodenum, and represents a major challenge, especially in the emergency setting. A 59-year-old patient with previous history of peptic ulcer disease had an upper gastrointestinal bleeding from a duodenal ulcer two years after having a gastric bypass procedure for morbid obesity. After negative upper endoscopy finding, he was urgently evaluated for gastrointestinal bleeding. At emergency laparotomy, the bleeding duodenal ulcer was identified by intraoperative endoscopy through gastrotomy. The patient recovered well after surgical hemostasis, excision of the duodenal ulcer and completion of the remnant gastrectomy. Every general practitioner, gastroenterologist and general surgeon should be aware of growing incidenceof bariatric operations and coherently possible complications after such procedures, which modify patient’s anatomy and physiology.

  15. Roxatidine versus ranitidine in the treatment of patients with duodenal ulcer: a randomized, double-masked, multicenter study.

    Science.gov (United States)

    Zuberi, S J; Khan, A Q; Irshad-ul-Haque, I; Hussain, A; Hasnain, S S; Shah, S; Sadick, A; Yusuf, M Z; Reuter, M

    1996-01-01

    The comparative efficacy of roxatidine and ranitidine in the treatment of patients with acute duodenal ulcer was assessed at 4 and 6 weeks in this multicenter study. Ninety-four of 192 patients were given roxatidine in a single nightly dose of 150 mg, and 98 patients were given ranitidine in a single nightly dose of 300 mg. All the patients had endoscopically proven duodenal ulcer. Of the 171 assessable patients, ulcers were healed in 88% of the roxatidine group (73 of 83) and in 84% of the ranitidine group (74 of 88). No serious adverse events were reported in either group. We conclude that roxatidine 150 mg once daily is as effective and safe for the treatment of acute duodenal ulcer as ranitidine 300 mg once daily.

  16. Perforated peptic duodenal ulcer in a paraesophageal hernia – a case report of a rare surgical emergency

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    Willner Julian

    2006-01-01

    Full Text Available Abstract Background Paraesophageal hernias are quite common and sometimes feared due to the risk of incarceration and strangulation of any herniated organ. The hereby reported combination of an incarcerated paraesophageal hernia containing a perforated peptic ulcer is extremely rare. Case presentation An elderly man with multiple medical conditions was admitted due to severe upper abdominal pain. The patient was found to have a paraesophageal hernia and underwent a laparotomy. In the hernia, a perforated benign peptic duodenal ulcer was found. The duodenal defect was over-sewn, the hernial defect was closed and the former hernial cavity was drained by a right-sided chest tube. The patient was discharged one month after surgery and was found to do well at follow-up one month after discharge. Conclusion This is the first report of a patient surviving the extremely rare and life-threatening combination of a perforated peptic duodenal ulcer in a paraesophageal hernia.

  17. Non-operative treatment for perforated gastro-duodenal peptic ulcer in Duchenne Muscular Dystrophy: a case report

    Directory of Open Access Journals (Sweden)

    Wever Jan

    2004-01-01

    Full Text Available Abstract Background Clinical characteristics and complications of Duchenne muscular dystrophy caused by skeletal and cardiac muscle degeneration are well known. Gastro-intestinal involvement has also been recognised in these patients. However an acute perforated gastro-duodenal peptic ulcer has not been documented up to now. Case presentation A 26-year-old male with Duchenne muscular dystrophy with a clinical and radiographic diagnosis of acute perforated gastro-duodenal peptic ulcer is treated non-operatively with naso-gastric suction and intravenous medication. Gastrointestinal involvement in Duchenne muscular dystrophy and therapeutic considerations in a high risk patient are discussed. Conclusion Non-surgical treatment for perforated gastro-duodenal peptic ulcer should be considered in high risk patients, as is the case in patients with Duchenne muscular dystrophy. Patients must be carefully observed and operated on if non-operative treatment is unsuccessful.

  18. Do clinicians accept the role of Helicobacter pylori in duodenal ulcer disease: a survey of European gastroenterologists and general practitioners

    DEFF Research Database (Denmark)

    Christensen, A H; Logan, R P; Noach, L A;

    1994-01-01

    OBJECTIVES. To examine to what extent clinicians in Europe accepted the theory of the casual role of Helicobacter pylori (H.pylori) in duodenal ulcer disease in the year 1992, and to what extent the theory had influenced their diagnostic and therapeutic habits in the management of duodenal ulcer...... patients at that time. DESIGN. Postal questionnaire. SETTING. Three European countries: the UK, the Netherlands, and Denmark. SUBJECTS. Three hundred and three gastroenterologists, 250 general practitioners, 83 junior hospital doctors. MAIN OUTCOME MEASURES. Number of doctors believing H. pylori...... to be a significant cause of duodenal ulcer disease, use of diagnostic tests for detection of H. pylori and therapeutic regimens for eradicating H. pylori. RESULTS. Four hundred and forty-two doctors replied. Eighty-four per cent of the British doctors, 73% of the Dutch doctors, and 47% of the Danish doctors accepted...

  19. Duodenal Acidity May Increase the Risk of Pancreatic Cancer in the Course of Chronic Pancreatitis: An Etiopathogenetic Hypothesis

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    Talamini G

    2005-03-01

    Full Text Available Chronic pancreatitis patients have an increased risk of developing pancreatic cancer. The cause of this increase has yet to be fully explained but smoking and inflammation may play an important role. To these, we must now add a new potential risk factor, namely duodenal acidity. Patients with chronic pancreatitis very often present pancreatic exocrine insufficiency combined with a persistently low duodenal pH in the postprandial period. The duodenal mucosa in chronic pancreas patients with pancreatic insufficiency has a normal concentration of s-cells and, therefore, the production of secretin is preserved. Pancreatic ductal cells are largely responsible for the amount of bicarbonate and water secretion in response to secretin stimulation. When gastric acid in the duodenum is not well-balanced by alkaline pancreatic secretions, it may induce a prolonged secretin stimulus which interacts with the pancreatic ductal cells resulting in an increased rate of ductular cell activity and turnover. N-Nitroso compounds from tobacco, identified in human pancreatic juice and known to be important carcinogens, may then act on these active cells, thereby increasing the risk of cancer. Duodenal acidity is probably of particular concern in patients who have undergone a duodenum-preserving pancreatic head resection, since, in this anatomic situation, pancreatic juice transits directly via the jejunal loop, bypassing the duodenum. Patients undergoing a Whipple procedure or side-to-side pancreaticojejunostomy are probably less critically affected because secretions transit, at least in part, via the papilla. If the duodenal acidity hypothesis proves correct, then, in addition to stopping smoking, reduction of duodenal acid load in patients with pancreatic insufficiency may help decrease the risk of pancreatic cancer.

  20. Application mexidol in treatment patients of inflammatory periodontal diseases in the combination to peptic ulcer of stomach and duodenal intestine

    Directory of Open Access Journals (Sweden)

    Charish N.A.

    2011-03-01

    Full Text Available For the purpose to determine the clinical pathogenetic efficacy of Mexidol in the combined therapy of parodontitis in patients with peptic ulcer of stomach and duodenal intestine medical examination and treatment of 296 patients was carried out. It was established that use of Mexidol in the combined treatment of patients with parodontitis against peptic ulcer of stomach and duodenal intestine allowed to decrease infection load (Helicobacter pylori in parodontal recess and evidence of local inflammation with reduction of activity of interleukin-6, -10, -18, that provided acceleration of recovery processes, lowering in frequency of periodontitis recurrences