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Sample records for ampullary duodenal diverticulum

  1. 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.

  2. 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.

  3. Intraluminal duodenal diverticulum: radiological and endoscopic ultrasonography findings of an unusual cause of acute pancreatitis

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    Tasu, J.P.; Rocher, L.; Rondeau, Y.; Blery, M. [Dept. of Radiology, Bicetre Hospital, Le Kremlin-Bicetre (France); Amouyal, P.; Buffet, C. [Department of Gastro-enterology, Bicetre Hospital, 78 rue du General Leclerc, F-94275 Le Kremlin-Bicetre cedex (France); Lorand, I. [Department of Surgery, Bicetre Hospital, 78 rue du General Leclerc, F-94275 Le Kremlin-Bicetre cedex (France)

    1999-07-01

    Intraluminal duodenal diverticulum is a rare congenital web of membrane which may be symptomatic when it becomes distended. This report describes a case revealed by presenting as an acute pancreatitis. The radiological findings are reported. The findings at CT, upper gastro-intestinal series, endoscopic ultrasound and endoscopic retrograde cholangiopancreatography are described and differential diagnostic features from choledochocele and duodenal duplication are discussed. By endoscopic ultrasonography, observation of a thin wall, without different layers such as choledochocele or duodenal duplication, may be useful for diagnosis. (orig.)

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

    Institute of Scientific and Technical Information of China (English)

    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.

  5. 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.

  6. 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.

  7. [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.

  8. 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.

  9. 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.

  10. 十二指肠乳头旁憩室致复发性胆管结石40例疗效%Surgical treatment of recurrent cholelithiasis caused by peripapillary duodenal diverticulum

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    闫宏宪; 田建国

    2016-01-01

    Objective To study the diagnosis and therapy of recurrent cholelithiasis caused by peripapillary duodenal diverticulum.Methods The clinical data of 40 patients with repeated formation of bile duct stones caused by peripapillary duodenal diverticulum were retrospectively reviewed,and the data on surgical treatment were analyzed.Results All the patients underwent duodenal diverticulum operation and subtotal gastrectomy (Billroth Ⅱ).Twenty-one patients in addition underwent R-Y cholangiojejunostomy,14 patients and 5 patients underwent choledochotomy with T-tube drainage and duodenotomy with Oddi sphincterotomy,respectively.In forty patients,three patients presented temporarily biliary fistula,two patients lost touch,three-eighty fully recover from an illness in three years.Conclusion Recurrence of bile duct stones caused by peripapillary diverticulum may be cured by duodenal diverticulum operation combined with bile duct surgery,which is a feasible and efficacious treatment.%目的 探讨十二指肠乳头旁憩室致复发性胆管结石的诊断和治疗.方法 回顾性分析2010年11月至2014年11月河南省人民医院收治的40例因十二指肠乳头旁憩室致反复胆管结石发作患者的临床资料,并对相关治疗情况进行归纳总结.结果 所有患者均行十二指肠憩室化手术,其中21例加行胆管空肠R-Y吻合术;14例行胆管切开探查取石T管引流术,5例行十二指肠切开术和Oddi括约肌切开成形术.40例患者术后临床症状基本消失,行胆管空肠肠吻合患者有3例出现一过性胆漏,通畅引流后痊愈.除2例失联外,所有患者经3年随访,余38例并未见结石复发,患者主观感觉良好,疗效满意.结论 十二指肠乳头旁憩室是复发性胆管结石的一个不可忽视的病因,在十二指肠憩室化基础上的胆道相关手术是治疗此种疾病的有效方法.

  11. 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。

  12. Meckel's Diverticulum

    International Nuclear Information System (INIS)

    The primary application of techetium-99m (Tc-99m) pertechnetate scintigraphy of the abdomen is in the diagnosis of Meckel's diverticulum. Some years ago the authors reviewed the records of all patients with Meckel's diverticulum under 2 years of age undergoing operation at the Children's Hospital in Boston between 1951 and 1972. Among 60 infants under 2 years of age, 32 had painless rectal bleeding. Of these 32,56% presented before reaching 1 year of age and the remaining 44% before 2 years of age. Among those symptomatic patients, 91% (29 of 32 patients) had ectopic gastric mucosa in their Meckel's diverticula. The differential diagnosis of rectal bleeding in infants <2 years of age includes Meckel'd diverticulum, anal fissure, volvulus, intussusception, peptic ulcer, and colonic polyp. Of these, only colonic polyp and Meckel's diverticulum usually cause painless bleeding. Radiologic studied using barium by mouth or by rectum only exceptionally demonstrate Meckel's diverticula, as this contrast material rarely enters the lesion

  13. Adult duodenal intussusception associated with congenital malrotation

    OpenAIRE

    Gardner-Thorpe, J; Hardwick, RH; Carroll, NR; Gibbs, P.; Jamieson, NV; Praseedom, RK

    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. Duodeno-duodenal 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 intussusc...

  14. 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.

  15. Imaging features of benign and malignant ampullary and periampullary lesions.

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    Nikolaidis, Paul; Hammond, Nancy A; Day, Kevin; Yaghmai, Vahid; Wood, Cecil G; Mosbach, David S; Harmath, Carla B; Taffel, Myles T; Horowitz, Jeanne M; Berggruen, Senta M; Miller, Frank H

    2014-01-01

    The ampulla of Vater is an important anatomic landmark where the common bile duct and main pancreatic duct converge in the major duodenal papilla. Imaging evaluation of the ampulla and periampullary region poses a unique diagnostic challenge to radiologists because of the region's complex and variable anatomy and the variety of lesions that can occur. Lesions intrinsic to the ampulla and involved segment of the biliary tree can be neoplastic, inflammatory, or congenital. Neoplastic lesions include ampullary adenocarcinomas and adenomas, which often are difficult to differentiate, as well as pancreatic or duodenal adenocarcinomas, pancreatic neuroendocrine tumors, and cholangiocarcinomas. Ultrasonography (US), computed tomography, magnetic resonance (MR) imaging, and MR cholangiopancreatography are commonly used to evaluate this region. Endoscopic retrograde cholangiopancreatography or endoscopic US examination may be necessary for more definitive evaluation. Periampullary conditions in the duodenum that may secondarily involve the ampulla include neoplasms, duodenitis, duodenal diverticula, and Brunner's gland hyperplasia or hamartomas. Because these lesions can exhibit a wide overlap of imaging features and subtle or nonspecific imaging findings, diagnosis is made on the basis of patient age, clinical history, and imaging and laboratory findings. Given the complexity of imaging evaluation of the ampulla and periampullary region, it is essential for radiologists to understand the variety of lesions that can occur and recognize their imaging characteristics. PMID:24819785

  16. 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

  17. Ampullary Adenoma Treated by Endoscopic Double-Snare Retracting Papillectomy.

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    Soma, Hiromitsu; Miyata, Naoteru; Hozawa, Shigenari; Higuchi, Hajime; Yamagishi, Yoshiyuki; Nakamura, Yuji; Saeki, Keita; Kameyama, Kaori; Masugi, Yohei; Yahagi, Naohisa; Kanai, Takanori

    2015-09-23

    We report herein improved methods for the safe and successful completion of endoscopic papillectomy (EP). Between January 2008 and November 2011, 12 patients underwent double-snare retracting papillectomy for the treatment of lesions of the major duodenal papilla. The main outcomes were en bloc resection rates, pathological findings, and adverse events. All of the patients (mean age, 60.1 years; range, 38 to 80 years) were diagnosed with ampullary adenoma by endoscopic forceps biopsies prior to endoscopic snare papillectomy. En bloc resection by double-snare retracting papillectomy was successfully performed for all lesions (median size, 12.3 mm), comprising six tubular adenomas, one tubulovillous adenoma, three cases of epithelial atypia, one hamartomatous polyp, and one case of duodenitis with regenerative change. Significant hemorrhage and pancreatitis were observed in one case after EP. Adenoma recurrence occurred in three patients during follow-up (median, 28.5 months) at a mean interval of 2 months postoperatively (range, 1 to 3 months). No serious adverse events were observed. Double-snare retracting papillectomy is effective and feasible for treating lesions of the major duodenal papilla. Further treatment experience, including a single-arm phase II study, needs to be accumulated before conducting a randomized controlled study. PMID:26087781

  18. 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...

  19. Bone and brain metastases from ampullary adenocarcinoma

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    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.

  20. Common Bile Duct Obstruction Secondary to a Periampullary Diverticulum

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    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.

  1. 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.

  2. Congenital anterior urethral diverticulum.

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    Singh, Sanjeet Kumar; Ansari, Ms

    2014-09-01

    Congenital anterior urethral diverticulum (CAUD) may be found all along the anterior urethra and may present itself at any age, from infant to adult. Most children with this condition present with difficulty in initiating micturition, dribbling of urine, poor urinary stream, or urinary tract infection. A careful history will reveal that these children never had a good urinary stream since birth, and the telltale sign is a cystic swelling of the penile urethra. In this paper, we present two cases of CAUD that were managed by excision of the diverticulum with primary repair. PMID:26328174

  3. 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.

  4. 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

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

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    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.

  6. Intraluminal esophageal diverticulum.

    Science.gov (United States)

    Funakoshi, O; Soma, Y; Takasugi, T; Munakata, A; Yoshida, Y

    1990-02-01

    An intraluminal esophageal diverticulum (IED) is an uncommon entity defined as a double-layered mucosal pouch lying within the lumen of the esophagus. Its characteristic radiological finding is an intraluminal barium collection surrounded by a radiolucent halo. True IED, which is different from a transient radiological artifact, has not been previously reported in the international literature. This article describes the first case of true IED. Differential diagnosis between a true lesion and a transient flow artifact on barium meal is discussed. PMID:2106464

  7. 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.

  8. Ampullary Cancers Harbor ELF3 Tumor Suppressor Gene Mutations and Exhibit Frequent WNT Dysregulation

    Directory of Open Access Journals (Sweden)

    Marie-Claude Gingras

    2016-02-01

    Full Text Available The ampulla of Vater is a complex cellular environment from which adenocarcinomas arise to form a group of histopathologically heterogenous tumors. To evaluate the molecular features of these tumors, 98 ampullary adenocarcinomas were evaluated and compared to 44 distal bile duct and 18 duodenal adenocarcinomas. Genomic analyses revealed mutations in the WNT signaling pathway among half of the patients and in all three adenocarcinomas irrespective of their origin and histological morphology. These tumors were characterized by a high frequency of inactivating mutations of ELF3, a high rate of microsatellite instability, and common focal deletions and amplifications, suggesting common attributes in the molecular pathogenesis are at play in these tumors. The high frequency of WNT pathway activating mutation, coupled with small-molecule inhibitors of β-catenin in clinical trials, suggests future treatment decisions for these patients may be guided by genomic analysis.

  9. Duodenal bulb plasma cells in duodenitis and duodenal ulceration.

    OpenAIRE

    Scott, B B; Goodall, A; Stephenson, P.; D. Jenkins(University of York, UK)

    1985-01-01

    Using an immunoperoxidase technique IgA, IgM, IgE and IgG plasma cells were studied in endoscopic duodenal bulb biopsies taken from 14 controls, 25 patients with grade 1 duodenitis (Whitehead classification), 12 patients with grade 2 duodenitis and three with grade 3 duodenitis. The control counts were compared with those in the jejunum and rectum. In addition cell counts were compared in 16 pairs of patients, with and without duodenal ulcer, exactly matched for grade of duodenitis. The contr...

  10. Linear endoscopic ultrasonography vs magnetic resonance imaging in ampullary tumors

    Institute of Scientific and Technical Information of China (English)

    Raffaele; Manta; Rita; Conigliaro; Danilo; Castellani; Alessandro; Messerotti; Helga; Bertani; Giuseppe; Sabatino; Elena; Vetruccio; Luisa; Losi; Vincenzo; Villanacci; Gabrio; Bassotti

    2010-01-01

    AIM:To assess linear endoscopic ultrasound (L-EUS) and magnetic resonance imaging (MRI) in biliary tract dilation and suspect small ampullary tumor.METHODS:L-EUS and MRI data were compared in 24 patients with small ampullary tumors;all with subsequent histological confirmation.Data were collected prospectively and the accuracy of detection,histological characterization and N staging were assessed retrospectivelyusing the results of surgical or endoscopic treatment as a benchmark.RESULTS:A suspicion of ampul...

  11. Duodenal varices

    OpenAIRE

    Yu-Peng, L; Yi-Lan, L; Wen-Ko, S

    2011-01-01

    A 76-year-old man had a history of liver cirrhosis secondary to chronic hepatitis B infection. A hepatoma had also been noted 2 years previously. This time, he presented initially at the emergency department because of dysuria and fever for 2 days and tarry stool since the afternoon. The initial upper gastrointestinal endoscopy revealed esophageal varices, gastric ulcer, and duodenitis that was not actively bleeding. Proton pump inhibitors were prescribed. Unfortunately, massive blood stools ...

  12. Acquired Pharyngeal Diverticulum after Anterior Cervical Fusion Operation Misdiagnosed as Typical Zenker Diverticulum.

    Science.gov (United States)

    Park, Jong Myung; Kim, Chang Wan; Kim, Do Hyung

    2016-08-01

    A pharyngeal diverticulum is a rare complication of an anterior cervical discectomy and fusion (ACDF). We present a case of a pharyngeal diverticulum after an ACDF, which was misdiagnosed as a typical Zenker diverticulum. A 54-year-old woman presented with dysphagia and a sense of irritation in the neck following C5 through C7 cervical fusion 3 years prior. The patient underwent open surgery to resect the diverticulum with concurrent cricopharyngeal myotomy. An ACDF-related diverticulum is difficult to distinguish from a typical Zenker diverticulum. PMID:27525244

  13. 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

  14. Management of duodenal trauma

    OpenAIRE

    Chen, Guo-Qing; Hua YANG

    2011-01-01

    【Abstract】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...

  15. 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.

  16. 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.

  17. Duodenal duplication cyst causing severe pancreatitis:Imaging findings and pathological correlation

    Institute of Scientific and Technical Information of China (English)

    Alessandro Guarise; Niccolo' Faccioli; Mauro Ferrari; Luigi Romano; Alice Parisi; Massimo Falconi

    2006-01-01

    We here report a case of a 18-year-old man with a history of recurrent abdominal pain and a previous episode of severe acute pancreatitis. Abdominal ultrasonography,contrast enhanced multislice computer tomography,endoscopic retrograde cholangiopancreatography, endoscopic ultrasonography and magnetic resonance imaging demonstrated a cystic mass lesion. Only on delayed phase magnetic resonance images after GadoliniumBOPTA injection, it was possible to demonstrate the lesion's relationship with the biliary tree, differentiating the lesion from intraluminal duodenal diverticulum, and to achieve the diagnosis of duodenal duplication cyst, a recognized rare cause of acute pancreatitis. The diagnosis was confirmed by histology.

  18. AN UNUSUALLY LONG MECKEL’S DIVERTICULUM

    Directory of Open Access Journals (Sweden)

    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.

  19. 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.

  20. Endovascular Management of Sigmoid Sinus Diverticulum.

    Science.gov (United States)

    Paramasivam, Srinivasan; Furtado, Sunil; Shigamatsu, Tomoyoshi; Smouha, Eric

    2016-06-01

    Sigmoid sinus diverticulum (SSD) is a rare vascular disorder due to dehiscence of the sigmoid plate. It may be associated with prediverticular venous sinus stenosis (SS) and usually presents as pulsatile tinnitus. The mechanism of development of the SSD and tinnitus from a sinus diverticulum and associated SS is unclear. Previous case reports have suggested that remodeling of the venous system targeting the stenosis, elimination of the diverticulum, or both, have resulted in symptom relief. We present a case of SSD with SS, treated by stenting of the stenosis along with coil embolization of the diverticulum, resulting in complete relief of symptoms. We have also reviewed the literature and discussed the evolution of management from open surgical treatment to endovascular treatment. PMID:27610124

  1. Transperineal Ultrasonographic findings of female urethral diverticulum

    International Nuclear Information System (INIS)

    The purpose of the study was to explore the role of sonography for women with a suspected urethral diverticulum and to evaluate the transperineal ultrasonographic findings of female urethral diverticulum. Eight women (mean age, 44 years) who presented with urethral symptoms and clinically suspected urethral diverticula underwent transperineal ultrasonography; sagittal and coronal images were obtained. Sonography was done with either a 7-5 MHz curved array transducer or 10-5 MHz linear transducer, placed on the perineum at the level of the urethra. Ultrasonograms were assessed for the presence, size, location, shape, echogenicity, and septum. Five patients underwent voiding cystourethrography (VCUG). Results of the sonograms and VCUGs were compared with each other and with surgical findings. Longitudinally, all lesions were located in a middle third of the urethra. In axial plane, 4 diverticula wrapped around 50-100% of the urethra. 3 cases located posteriorly, and 1 case laterally. Seven diverticula contained echogenic debris. Three cases have septa in the diverticulum. The outer margin of the diverticula was smooth in 2 patients and was lobulated in 6 patients. In 3 of 5 cases who underwent VCUG, diverticula were filled with contrast, and appeared to be smaller than those of ultrasonography. In addition, all were single diverticulum in VCUG. Most urethral diverticulum were located in a middle third of the urethra, wrapped around the urethra or round posteriorly. Many cases appear unilocular or multilocular with echogenic debris. Transperineal ultrasonography is easy to operate and accurate for showing urethral diverticulum, and it may be useful for diagnosing this group of women with urethral symptoms and suspected urethral diverticulum. It provides information on the extent and location of the diverticulum, which are important in surgical excision.

  2. Transperineal Ultrasonographic findings of female urethral diverticulum

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Jin Han; Koo, Bong Sik; Nam, Ki Dong; Choi, Jong Cheol; Park, Byeong Ho; Nam, Kyung Jin; Kweon, Heon Young [Dong-A University College of Medicine, Pusan (Korea, Republic of)

    1999-09-15

    The purpose of the study was to explore the role of sonography for women with a suspected urethral diverticulum and to evaluate the transperineal ultrasonographic findings of female urethral diverticulum. Eight women (mean age, 44 years) who presented with urethral symptoms and clinically suspected urethral diverticula underwent transperineal ultrasonography; sagittal and coronal images were obtained. Sonography was done with either a 7-5 MHz curved array transducer or 10-5 MHz linear transducer, placed on the perineum at the level of the urethra. Ultrasonograms were assessed for the presence, size, location, shape, echogenicity, and septum. Five patients underwent voiding cystourethrography (VCUG). Results of the sonograms and VCUGs were compared with each other and with surgical findings. Longitudinally, all lesions were located in a middle third of the urethra. In axial plane, 4 diverticula wrapped around 50-100% of the urethra. 3 cases located posteriorly, and 1 case laterally. Seven diverticula contained echogenic debris. Three cases have septa in the diverticulum. The outer margin of the diverticula was smooth in 2 patients and was lobulated in 6 patients. In 3 of 5 cases who underwent VCUG, diverticula were filled with contrast, and appeared to be smaller than those of ultrasonography. In addition, all were single diverticulum in VCUG. Most urethral diverticulum were located in a middle third of the urethra, wrapped around the urethra or round posteriorly. Many cases appear unilocular or multilocular with echogenic debris. Transperineal ultrasonography is easy to operate and accurate for showing urethral diverticulum, and it may be useful for diagnosing this group of women with urethral symptoms and suspected urethral diverticulum. It provides information on the extent and location of the diverticulum, which are important in surgical excision.

  3. CT findings in children with Meckel diverticulum

    Energy Technology Data Exchange (ETDEWEB)

    Olson, Doug E.; Donnelly, Lane F. [Cincinnati Children' s Hospital Medical Center, Department of Radiology, Cincinnati, OH (United States); University of Cincinnati, College of Medicine, Cincinnati, OH (United States); Kim, Yong-Woo [Cincinnati Children' s Hospital Medical Center, Department of Radiology, Cincinnati, OH (United States)

    2009-07-15

    Approximately 0.04% of the general population will present with a complication related to Meckel diverticulum. The classic teaching is that symptomatic children with Meckel diverticulum present with painless rectal bleeding and are evaluated with a radionuclide scan. Our subjective experience is that we see children with Meckel diverticulum who present with abdominal pain and are evaluated by CT. We reviewed the findings on CT in children with pathologically proven Meckel diverticulum to identify characteristic patterns of presentation. Databases were searched (2004-2008) for all children who had a pathologic diagnosis of Meckel diverticulum and a CT scan performed prior to surgery. Demographics, pathology, and CT features were reviewed. CT features reviewed included: soft-tissue stranding, abnormal calcifications, bowel obstruction, free air, free peritoneal fluid, cystic mass, intussusception, obvious lead point, location, and whether a normal appendix was identified. The frequency of Meckel diverticulum encountered on CT scans was compared to that found during the same period of time on technetium pertechnetate studies. The review identified 16 subjects (mean age 9.5 years, M:F 9:7). CT findings included: soft-tissue stranding in nine (56%), small-bowel obstruction (SBO) in nine (56%), intussusception in three (19%), free fluid in ten (63%), cystic mass in four (25%), calcification in none (0%), free air in one (6%), and no abnormalities in two (13%). A normal appendix was identified in only five children (31%). There were three basic patterns of presentation of abnormalities: SBO only in five, intussusception with SBO in three, or cystic mass with inflammatory stranding in four (one with SBO). Also, 2.3 times more Meckel diverticulum was encountered on CT than on technetium pertechnetate studies. Meckel diverticulum is currently more commonly encountered in children on CT performed for abdominal pain than on technetium pertechnetate studies. There are three

  4. CT findings in children with Meckel diverticulum

    International Nuclear Information System (INIS)

    Approximately 0.04% of the general population will present with a complication related to Meckel diverticulum. The classic teaching is that symptomatic children with Meckel diverticulum present with painless rectal bleeding and are evaluated with a radionuclide scan. Our subjective experience is that we see children with Meckel diverticulum who present with abdominal pain and are evaluated by CT. We reviewed the findings on CT in children with pathologically proven Meckel diverticulum to identify characteristic patterns of presentation. Databases were searched (2004-2008) for all children who had a pathologic diagnosis of Meckel diverticulum and a CT scan performed prior to surgery. Demographics, pathology, and CT features were reviewed. CT features reviewed included: soft-tissue stranding, abnormal calcifications, bowel obstruction, free air, free peritoneal fluid, cystic mass, intussusception, obvious lead point, location, and whether a normal appendix was identified. The frequency of Meckel diverticulum encountered on CT scans was compared to that found during the same period of time on technetium pertechnetate studies. The review identified 16 subjects (mean age 9.5 years, M:F 9:7). CT findings included: soft-tissue stranding in nine (56%), small-bowel obstruction (SBO) in nine (56%), intussusception in three (19%), free fluid in ten (63%), cystic mass in four (25%), calcification in none (0%), free air in one (6%), and no abnormalities in two (13%). A normal appendix was identified in only five children (31%). There were three basic patterns of presentation of abnormalities: SBO only in five, intussusception with SBO in three, or cystic mass with inflammatory stranding in four (one with SBO). Also, 2.3 times more Meckel diverticulum was encountered on CT than on technetium pertechnetate studies. Meckel diverticulum is currently more commonly encountered in children on CT performed for abdominal pain than on technetium pertechnetate studies. There are three

  5. Parabronchial Diverticulum of Esophagus: Report of a Case

    Directory of Open Access Journals (Sweden)

    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.

  6. 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

  7. 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.

  8. Sonographic diagnosis features of Zenker diverticulum

    Energy Technology Data Exchange (ETDEWEB)

    Jiang Lixin, E-mail: jinger_28@sina.com [Department of Ultrasonography, Shanghai Jiaotong University Affiliated No. 6 Hospital, Yishan Road 600, Shanghai 200233 (China); Hu Bing, E-mail: hubingshanghai@163.com [Department of Ultrasonography, Shanghai Jiaotong University Affiliated No. 6 Hospital, Yishan Road 600, Shanghai 200233 (China); Wang Zhigang, E-mail: zhangmin2@medmail.com.cn [Surgical Department, Shanghai Jiaotong University Affiliated No. 6 Hospital, Yishan Road 600, Shanghai 200233 (China); Zhao Binghui, E-mail: binghuizhao@163.com [Department of Radiology, Shanghai Jiaotong University Affiliated No. 6 Hospital, Yishan Road 600, Shanghai 200233 (China)

    2011-11-15

    Objective: The purpose of this study was to analyze the image of the lesion and give the sonographic diagnosis features of Zenker diverticulum. Methods: Sonography was performed with a high-frequency linear array probe. The location, size, shape, and echogenicity of the Zenker diverticulum were recorded. To find the lesion whether to be connected with the adjacent esophageal wall. During compressing with a probe, to detect the changes of the lesion shape and echogenicity. As swallowing or drinking water, to detect the fluid whether to enter into the lesions. All patients were given barium swallow test. Results: All nine Zenker diverticulum were all located at the posterolateral aspect of the left lobe. The long diameters of all Zenker diverticulum measured by sonography ranged from 9.6 mm to 45 mm (average 16.4 {+-} 11 mm). There were four types of sonogram features of Zenker diverticulum in our study: (1) The lesion was isoechoic mass with boundary hypoechoic rim and internal small, punctuate, echogenic foci. (2) The lesion contained a central hyperechoic area associated with a comet-tail artifact. (3) The lesion was hyperechoic and heterogeneous, with stronger echoes anteriorly, but there was no acoustic shadowing or reverberation artifacts. (4) The lesion was oval-shaped mixed nodule, with unclear border and relatively multiple punctuate strong echoes. During the patient's ingestion of water, an increase in the lesion's size, a reduction in the definition of the margins, and heterogeneous echogenicity of the lesion's contents are observed. Barium-swallow images of the upper esophagus demonstrate an out-pouching at the posterior aspect of the pharyngoesophageal junction. Conclusion: The sign of air in the Zenker diverticulum is the most important sonographic feature for differential diagnosis from thyroid nodules. It was useful to diagnosis and prevents patients from invasive procedure such as aspiration and unnecessary operation.

  9. 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.

  10. Embryologic and anatomic basis of duodenal surgery.

    Science.gov (United States)

    Androulakis, J; Colborn, G L; Skandalakis, P N; Skandalakis, L J; Skandalakis, J E

    2000-02-01

    the duct is catastrophic. With the Kocher maneuver, surgeons reconstruct the primitive mesoduodenum and achieve mobilization of the duodenum, which is useful for some surgical procedures. Surgeons should not skeletonize more than 2 cm of the first part of the duodenum. If more than 2 cm of skeletonization is done, a duodenostomy using a Foley catheter may be necessary to avoid blow-up of the stump secondary to poor blood supply. Proximal duodenojejunostomy is advised for the safe management of patients with difficult duodenal stumps. Roux-en-Y choledochojejunostomy and duodenojejunostomy divert bile and food in the treatment of the complicated duodenal diverticulum. The suspensory ligament may be transected with impunity. It should be ligated before being sectioned so that bleeding from small vessels contained within can be avoided. Failure to sever the suspensory muscle completely, which is possible if the insertion is multiple, fails to relieve the symptoms of vascular compression of the duodenum (Fig. 18). Mobilization, resection, and end-to-end anastomosis of the duodenal flexure have been performed as a uniform surgical procedure, avoiding the conventional gastrojejunostomy. With a large, penetrating posterior duodenal or pyloric ulcer, surgeons should remember that The proximal duodenum shortens because of the inflammatory process (duodenal shortening) The anatomic topography of the distal common bile duct and the opening of the duct of Santorini and the ampulla of Vater is distorted Leaving the ulcer in situ is wise Careful palpation for or visualization of the location of the ampulla of Vater or common bile duct exploration with a catheter insertion into the common bile duct and the duodenum are useful procedures In most cases, the common bile duct is located to the right of the gastroduodenal artery at the posterior wall of the first part of the duodenum. (ABSTRACT TRUNCATED) PMID:10685148

  11. CONGENITAL DUODENAL OBSTRUCTIONS

    Directory of Open Access Journals (Sweden)

    S.G. Aprodu

    2005-07-01

    Full Text Available The purpose of this study is to analyze a cohort of 46 cases of congenital duodenal obstruction, operated on between 1996 and 2002, 23 of them being diagnosed in neonatal period. In one case, the diagnosis was made antenatally, by ultrasonography. There were 15 males and 8 females, 17 with duodenal atresia and 6 with duodenal diaphragmatic stenosis. Surgery was performed in all cases, consisting in lateral duodeno-duodenal anastomosis in 5 cases and "diamond-shape" duodeno-duodenal anastomosis in 18 cases. The survival rate in this study was 69.5%. 12 cases (52,1% had other congenital pathologies: trisomy 21 (6 cases, multiple ileal atresia (2 cases, dextrocardy (2 cases, omphalocel (1 case, situs inversus (1 case. The complications of surgery were: anastomotic leaking with peritonitis, biliary fistula, intestional adhesions with occlusion. Congenital duodenal obstruction (midgut volvulus, atresia, stenosis remains a challenging issue for pediatric surgeons, especially in our country, due to limited possibilities of quick diagnosis and treatment of associated anomalies.

  12. 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

  13. 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.

  14. A perforated diverticulum in Cushing's disease

    OpenAIRE

    de Havenon, Adam; Ehrenkranz, Joel

    2011-01-01

    We report a case of perforated colonic diverticulum in Cushing's disease. Although perforated diverticuli have been described in patients with Cushing's syndrome secondary to exogenous glucocorticoids, this complication has not been described in patients with Cushing's disease. Patients with hypercortisolism, from either exogenous or endogenous sources, should be monitored for diverticular perforation.

  15. 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.

  16. Gastric diverticulum and halitosis - A case for surgery?

    OpenAIRE

    Muis, Marius Osaland; Leitao, Kristian Øgreid; Havnen, Jorunn; Glomsaker, Tom Birger; Søreide, Jon Arne

    2014-01-01

    INTRODUCTION Gastric diverticulum is a rare and frequently asymptomatic condition. Symptoms include vague pain, fullness, dyspepsia, vomiting, hemorrhage and perforation. Occasionally, the patient can present with belching and oral fetor. PRESENTATION OF CASE We report a 58-year-old woman with a gastric diverticulum who was suffering from a socially disabling oral fetor. After a thorough evaluation, a laparoscopic resection of the diverticulum was offered and completed successfully. At fol...

  17. Giant duodenal ulcers

    Institute of Scientific and Technical Information of China (English)

    Eric Benjamin Newton; Mark R Versland; Thomas E Sepe

    2008-01-01

    Giant duodenal ulcers (GDUs) are a subset of duodenal ulcers that have historically resulted in greater morbidity than usual duodenal ulcers. Until recently,few cases had been successfully treated with medical therapy. However, the widespread use of endoscopy,the introduction of H-2 receptor blockers and proton pump inhibitors, and the improvement in surgical techniques all have revolutionized the diagnosis,treatment and outcome of this condition. Nevertheless,GDUs are still associated with high rates of morbidity,mortality and complications. Thus, surgical evaluation of a patient with a GDU should remain an integral part of patient care. These giant variants, while usually benign, can frequently harbor malignancy. A careful review of the literature highlights the important differences when comparing GDUs to classical peptic ulcers and why they must be thought of differently than their more common counterpart.

  18. A rare entity in adults: Bilateral Hutch diverticulum with calculi.

    Science.gov (United States)

    Telli, Onur; Guclu, Adil Gucal; Haciyev, Perviz; Burgu, Berk; Gogus, Cagatay

    2015-01-01

    Congenital bladder diverticulum (CBD) is a very uncommon entity in adults. CBD could be unilateral or bilateral and is caused by a congenital weakness in the bladder musculature. CBD is differentiated from the paraureteral or Hutch type of diverticula. A 42-year-old male presented with bilateral Hutch diverticulum and multiple diverticulum calculus on intravenous pyelography. Cystoscopy revealed bladder diverticulum just medial to the left ureteral orifice with multiple calculi; the patient successfully underwent endoscopic laser cystolithotripsy with resolution of his urinary tract infection. To the best of our knowledge, this is the first case report presenting stone formation of CBD in an adult. PMID:26029313

  19. Zenker's Diverticulum: Carbon Dioxide Laser Endoscopic Surgery

    Directory of Open Access Journals (Sweden)

    Jan Plzák

    2014-01-01

    Full Text Available Nowadays endoscopic diverticulotomy is the surgical approach of the first choice in treatment of Zenker's diverticulum. We report our experience with this procedure and try to sum up recent recommendations for management of surgery and postoperative care. Data of 34 patients with Zenker's diverticulum, treated by endoscopic carbon dioxide laser diverticulotomy at the Department of Otorhinolaryngology and Head and Neck Surgery, 1st Faculty of Medicine, Charles University, University Hospital Motol, Prague, Czech Republic, were prospectively stored and followed in relatively short period from May 2009 to December 2013. The average length of diverticulum was 32 mm. The average duration of surgery was 32 min. The patients were fed via feeding tube for 6.1 days and antibiotics were administered for 7 days. Mean hospitalization time was 7.4 days. We observed one transient recurrent laryngeal nerve paralysis and no other serious complications. Recurrence rate was 3%. We recommend complete transection of the diverticular septum in one procedure, systemic antibiotic treatment and exclusion of transoral intake for minimally 5 days, and contrast oesophagogram before resumption of oral intake to exclude fistula. Open diverticulectomy should be reserved for cases with inadequate endoscopic exposure and for revision surgery for multiple recurrences from endoscopic diverticulotomies.

  20. Small Bowel Obstruction due to Mesodiverticular Band of Meckel's Diverticulum: A Case Report

    Directory of Open Access Journals (Sweden)

    Aziz Sumer

    2010-01-01

    Full Text Available Meckel's diverticulum is the most common congenital anomaly of the small intestine. Common complications related to a Meckel's diverticulum include haemorrhage, intestinal obstruction, and inflammation. Small bowel obstruction due to mesodiverticular band of Meckel's diverticulum is a rare complication. Herein, we report the diagnosis and management of a small bowel obstruction occurring due to mesodiverticular band of a Meckel's diverticulum.

  1. 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.

  2. [Oral cholangiography and duodenal atresia].

    Science.gov (United States)

    Baeza-Herrera, Carlos; León-Cruz, Alberto; Sanjuán-Fabián, Héctor; García-Cabello, Luís Manuel

    2006-01-01

    A newborn male patient with trisomy-21 presented with bilious hemesis. The patient was icteric with slight hepatomegaly. Simple abdominal X-ray and upper gastrointestinal series with barium showed a dilated duodenal loop and inflammatory changes involving the duodenal mucosa. This image known as "double bubble" is characteristic of congenital duodenal obstruction. Simultaneously the gallbladder and choledochus were visualized. The former X-ray finding is very unusual. An uneventful Kimura procedure was performed. PMID:16711553

  3. 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.

  4. 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.

  5. 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.

  6. 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.

  7. 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.

  8. Duodenal obstruction after successful embolization for duodenal diverticular hemorrhage: A case report

    Institute of Scientific and Technical Information of China (English)

    Yu Jin Kwon; Ji Hun Kim; Seung Hyoung Kim; Bong Soo Kim; Heung Up Kim; Eun Kwang Choi; In Ho Jeong

    2009-01-01

    We present a 69-year-old woman with a duodenal obstruction after successful selective transcatheter arterial embolization (TAE) for a duodenal diverticular hemorrhage. Two weeks after TAE, the patient showed abrupt symptoms of duodenal obstruction. Resolving hematomas after successful selective transcatheter arterial embolization should be thoroughly observed because they might result in duodenal fibrotic encasement featuring inflammatory duodenal wall thickening, duodenal deformity, dysmotility, and finally obstruction.

  9. Deformity of duodenal bulb, gastric metaplasia of duodenal regenerating mucosa and recurrence of duodenal ulcer: A correlated study

    Institute of Scientific and Technical Information of China (English)

    Chun-Chao Chang; Shiann Pan; Gi-Shih Lien; Cheng-Hsiung Liao; Sheng-Hsuan Chen; Yeong-Shan Cheng

    2005-01-01

    AIM: To investigate the correlation among the presence and degree of gastric metaplasia of duodenal regenerating mucosa, the deformity of bulb and the recurrence of duodenal ulcer.METHODS: A total of 99 patients with duodenal ulcer were treated with H2-antagonist with or without antimicrobial therapy. All patients received follow-up endoscopic examinations 6 wk after treatment. When the ulcer(s) were noted to be healed, two biopsies were taken from the ulcer scar for histological study of gastric metaplasia, and 4 biopsies were taken from antrum for Helicobacter pylori(H pylori) study. Out of these cases,44 received further follow-up endoscopic examinations after 3, 6 and 12 mo respectively for studying the recurrence rate of duodenal ulcers. The correlation among ulcer recurrence, degree of gastric metaplasia of regenerating mucosa, bulbar deformity, and colonization of Hpylori in the stomach was then studied.RESULTS: The results showed that there was a strong correlation between the deformity of duodenal bulb and the degree of gastric metaplasia of regenerating duodenal mucosa. The recurrence rate of duodenal ulcer had a significant difference between patients with and without Hpyloricolonization in the stomach (P<0.001). The greater the degree of gastric metaplasia of duodenal regenerating mucosa, the higher the recurrence rate of duodenal ulcer (P= 0.021). The more deformed the duodenal bulb, the higher the incidence of recurrence of duodenal ulcer (P = 0.03).CONCLUSION: There is a correlation among deformity of duodenal bulb, gastric metaplasia of duodenal regenerating mucosa and recurrence of duodenal ulcer.A more severely deformed duodenal bulb is closely related to a greater extent of gastric metaplasia. Both factors contribute to the recurrence of duodenal ulcer.

  10. 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.

  11. Mucosal cell proliferation in duodenal ulcer and duodenitis.

    OpenAIRE

    Bransom, C J; Boxer, M E; Palmer, K R; Clark, J. C.; Underwood, J C; Duthie, H. L.

    1981-01-01

    Mucosal cell proliferation in the first part of the duodenum was studied in 24 patients using a tissue culture technique in which endoscopic biopsies were subjected to autoradiography after exposure to tritiated thymidine. Eight patients had a normal duodenum, eight had duodenal ulcer, and eight had symptomatic chronic non-specific duodenitis. The mean crypt labelling index (LI) in normal duodenum was 8.8 0.4% (SEM). Increased labelling indices of 15.6 +/- 1.7% were found near the edge of du...

  12. 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.

  13. 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.)

  14. 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...

  15. Inverted Meckel's diverticulum preoperatively diagnosed using double-balloon enteroscopy.

    Science.gov (United States)

    Takagaki, Kosuke; Osawa, Satoshi; Ito, Tatsuhiro; Iwaizumi, Moriya; Hamaya, Yasushi; Tsukui, Hiroe; Furuta, Takahisa; Wada, Hidetoshi; Baba, Satoshi; Sugimoto, Ken

    2016-05-01

    An inverted Meckel's diverticulum is a rare gastrointestinal congenital anomaly that is difficult to diagnose prior to surgery and presents with anemia, abdominal pain, or intussusception. Here, we report the case of 57-year-old men with an inverted Meckel's diverticulum, who was preoperatively diagnosed using double-balloon enteroscopy. He had repeatedly experienced epigastric pain for 2 mo. Ultrasonography and computed tomography showed intestinal wall thickening in the pelvis. Double-balloon enteroscopy via the anal route was performed for further examination, which demonstrated an approximately 8-cm, sausage-shaped, submucosal tumor located approximately 80 cm proximal to the ileocecal valve. A small depressed erosion was observed at the tip of this lesion. Forceps biopsy revealed heterotopic gastric mucosa. Thus, the patient was diagnosed with an inverted Meckel's diverticulum, and single-incision laparoscopic surgery was performed. This case suggests that an inverted Meckel's diverticulum should be considered as a differential diagnosis for a submucosal tumor in the ileum. Balloon-assisted enteroscopy with forceps biopsy facilitate a precise diagnosis of this condition. PMID:27158212

  16. Paracoccidioidomicose duodenal com sangramento digestivo

    OpenAIRE

    Roberto Martinez; Rossi, Marcos A.

    1984-01-01

    Apresenta-se um caso de hematêmese fatal por úlcera duodenal paracoccidioidomicótica. Tanto esta localização da paracoccidioidomicose, como sua manifestação clínica são incomuns, resultando provavelmente do grande comprometimento da cavidade abdominal.

  17. Extrinsic duodenal obstruction and halitosis.

    OpenAIRE

    Stephenson, B M; Rees, B. I.

    1990-01-01

    Two siblings with extrinsic duodenal obstruction caused by congenital peritoneal bands are reported. Attention is drawn to the unusual physical sign of halitosis as a presenting feature. It is suggested that this physical sign may be an indication for barium studies.

  18. 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

  19. 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.

  20. 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.

  1. Duodenoscopic appraisal of duodenal ulcer in dogs

    Directory of Open Access Journals (Sweden)

    S Kavitha

    Full Text Available Aim: To assess the usefulness of duodenoscopy in the diagnosis of duodenal ulcers in dogs. Materials and Methods: Sick dogs with chronic gastrointestinal problems were physically examined and samples were collected for haematology, biochemistry and faecal examination. Duodenal biopsies, duodenal contents and brush cytology were obtained via duodenoscopy. Results: Seven duodenal ulcers cases were recorded, higher incidences was recorded in Labrador retriever, 2-4 years of aged male dogs. Significantly decreased Hb (9.10 ± 0.25 g/dl, RBCs (4.39 ± 0.19 mill/cu.mm and albumin (2.343b ± 0.13 g/dl level were noticed. Hyperaemia with ulceration of duodenal mucosa was observed. Conclusion: Duodenoscopy is very much useful for detection of duodenal ulceration and provided a sensitive technique for early diagnosis of mucosal lesions and ulceration. [Vet. World 2012; 5(7.000: 420-423

  2. Duodenal gastric metaplasia and Helicobacter pylori infection in patients with diffuse nodular duodenitis

    OpenAIRE

    Li, X. B.; Z.Z. Ge; Chen, X. Y.; Liu, W Z

    2007-01-01

    Whether the regression of gastric metaplasia in the duodenum can be achieved after eradication of Helicobacter pylori is not clear. The aim of the present study was to investigate the relationship between H. pylori infection and gastric metaplasia in patients with endoscopic diffuse nodular duodenitis. Eighty-six patients with endoscopically confirmed nodular duodenitis and 40 control patients with normal duodenal appearance were investigated. The H. pylori-positive patients with duodenitis r...

  3. 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...

  4. Nestin predicts a favorable prognosis in early ampullary adenocarcinoma and functions as a promoter of metastasis in advanced cancer.

    Science.gov (United States)

    Shan, Yan-Shen; Chen, Yi-Ling; Lai, Ming-Derg; Hsu, Hui-Ping

    2015-01-01

    Nestin exhibits stemness characteristics and is overexpressed in several types of cancers. Downstream signaling of nestin [cyclin-dependent kinase 5 (CDK5) and Ras-related C3 botulinum toxin substrate 1 (Rac1)] functions in cancer to modulate cellular behaviors. We studied the function of nestin in ampullary adenocarcinoma. Immunohistochemistry (IHC), reverse transcription-polymerase chain reaction, and cDNA microarray of nestin in ampullary adenocarcinoma was compared with normal duodenum. CDK5 and Rac1 were assessed by western blotting. We hypothesized that nestin/CDK5/Rac1 signaling behaves different in early and advanced cancer. We found that the presence of nestin mRNA was increased in the early stages of cancer (T2N0 or T3N0) and advanced cancer with lymph node metastasis (T4N1). A total of 102 patients were enrolled in the IHC staining. Weak nestin expression was correlated with favorable characteristics of cancer, decreased incidence of local recurrence and lower risk of recurrence within 12 months after surgery. Patients with weak nestin expression had the most favorable recurrence‑free survival rates. Patients with mild to strong nestin expression exhibited an advanced behavior of cancer and increased possibility of cancer recurrence. The reciprocal expression of nestin and RAC1 were explored using a cDNA microarray analysis in the early stages of ampullary adenocarcinoma. Increased level of CDK5 with simultaneously decreased expression of Rac1 was detected by western blotting of ampullary adenocarcinoma in patients without cancer recurrence. The activation of multiple oncogenic pathways, combined with the stemness characteristics of nestin, formed a complex network in advanced ampullary adenocarcinoma. Our study demonstrated that nestin performs a dual role in ampullary adenocarcinoma. Appropriate amount of nestin enhances CDK5 function to suppress Rac1 and excessive nestin/CDK5 participates in multiple oncogenic pathways to promote cancer invasiveness

  5. The Incidence of Gastric Metaplasia in Patients with Duodenal Ulcer *

    OpenAIRE

    Min, Young II; LEE, BYOUNG WOOK; Chang, Young Woon; Chi, Hyun Sook; Lee, Jung Kook

    1987-01-01

    To investigate the incidence of duodenal gastric metaplasia and its underlying gastric or duodenal diseases, the authors obtained endoscopic biopsy specimens from the duodenal bulb at random sites during endoscopy from 19 normal subjects, 11 patients with gastric ulcer, 18 with duodenal and/or prepyloric ulcer (s), 7 with duodenitis and 8 with gastric erosions. The biopsy specimens were assessed with PAS staining to confirm gastric metaplasia. The incidence of duodenal gastric metaplasia was ...

  6. 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.

  7. Diverticulum of the midthoracic oesophagus and left diaphragmatic relaxation

    OpenAIRE

    Antonacci, Nicola; Sciannamea, Gianluca; Antonacci, Filippo; Casadei, Riccardo; Ricci, Claudio; Di Saverio, Salomone; Minni, Francesco

    2010-01-01

    The case of a 58-year-old man with a large midthoracic oesophageal diverticulum and a left diaphragmatic relaxation who presented with night regurgitations, abdominal bloating, epigastric burning and a sensation of fullness after meals is reported. The patient underwent a successful thoracotomic diverticulectomy with left diaphragmatic plicature. The postoperative course was uneventful. To our knowledge this is the first reported case of an association between midthoracic oesophageal divertic...

  8. Pseudolipoma of inverted Meckel's diverticulum: clinical, radiological and pathological correlation

    International Nuclear Information System (INIS)

    Three cases of isolated inverted Meckel's diverticulum are described. In two cases an initial pathological diagnosis of small bowel lipoma was suggested. In a third case central fat was demonstrated on CT and peristalsis of the intraluminal polypoid mass was observed during US examination. In all three cases small bowel enema examination demonstrated the lesion. Correlation of the clinical, radiological and pathological features is emphasised, as this will allow the correct diagnosis. (orig.). With 4 figs

  9. Urethral obstruction from dislodged bladder Diverticulum stones: a case report

    Directory of Open Access Journals (Sweden)

    Okeke Linus I

    2012-11-01

    Full Text Available Abstract Background Secondary urethral stone although rare, commonly arises from the kidneys, bladder or are seen in patients with urethral stricture. These stones are either found in the posterior or anterior urethra and do result in acute urinary retention. We report urethral obstruction from dislodged bladder diverticulum stones. This to our knowledge is the first report from Nigeria and in English literature. Case presentation A 69 year old, male, Nigerian with clinical and radiological features of acute urinary retention, benign prostate enlargement and bladder diverticulum. He had a transurethral resection of the prostate (TURP and was lost to follow up. He re-presented with retained urethral catheter of 4months duration. The catheter was removed but attempt at re-passing the catheter failed and a suprapubic cystostomy was performed. Clinical examination and plain radiograph of the penis confirmed anterior and posterior urethral stones. He had meatotomy and antegrade manual stone extraction with no urethra injury. Conclusions Urethral obstruction can result from inadequate treatment of patient with benign prostate enlargement and bladder diverticulum stones. Surgeons in resource limited environment should be conversant with transurethral resection of the prostate and cystolithotripsy or open prostatectomy and diverticulectomy.

  10. 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.

  11. Evaluation of adjuvant chemoradiation therapy for ampullary adenocarcinoma: the Johns Hopkins Hospital - Mayo Clinic collaborative study

    International Nuclear Information System (INIS)

    The role of adjuvant chemoradiation therapy for ampullary carcinoma is unknown. Previous literature suggests that certain populations with high risk factors for recurrence may benefit from adjuvant chemoradiation. We combined the experience of two institutions to better delineate which patients may benefit from adjuvant chemoradiation. Patients who underwent curative surgery for ampullary carcinoma at the Johns Hopkins Hospital (n = 290; 1992-2007) and at the Mayo Clinic (n = 130; 1977-2005) were reviewed. Patients with <60 days of follow-up, metastatic disease at surgery, or insufficient pathologic data were excluded. The final combined study consisted of 186 patients (n = 104 Johns Hopkins, n = 82 Mayo). Most patients received 5-FU based chemoradiation with conformal radiation. Cox proportional hazards models were used for survival analysis. Median overall-survival was 39.9 months with 2- and 5-year survival rates of 62.4% and 39.1%. On univariate analysis, adverse prognostic factors for overall survival included T3/T4 stage disease (RR = 1.86, p = 0.002), node positive status (RR = 3.18, p < 0.001), and poor histological grade (RR = 1.69, p = 0.011). Patients who received adjuvant chemoradiation (n = 66) vs. surgery alone (n = 120) showed a higher rate of T3/T4 stage disease (57.6% vs. 30.8%, P < 0.001), lymph node involvement (72.7% vs. 30.0%, P < 0.001), and close or positive margins (4.6% vs. 0.0%, P = 0.019). Five year survival rates among node negative and node positive patients were 58.7% and 18.4% respectively. When compared with surgery alone, use of adjuvant chemoradiation improved survival among node positive patients (mOS 32.1 vs. 15.7 mos, 5 yr OS: 27.5% vs. 5.9%; RR = 0.47, P = 0.004). After adjusting for adverse prognostic factors on multivariate analysis, patients treated with adjuvant chemoradiation demonstrated a significant survival benefit (RR = 0.40, P < 0.001). Disease relapse occurred in 37.1% of all patients, most commonly metastatic

  12. New technique using LigaSure for endoscopic mucomyotomy of Zenker's diverticulum

    DEFF Research Database (Denmark)

    Nielsen, Hans Ulrik Kjaerem; Trolle, Waldemar; Rubek, Niclas;

    2014-01-01

    OBJECTIVES/HYPOTHESIS: The purpose of this study is to present a new approach for treatment of Zenker's diverticulum using the LigaSure (Covidien, Mansfield, MA) technique. STUDY DESIGN: A consecutive study with follow-up of 15 patients with Zenker's diverticulum endoscopically treated using the ...

  13. 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.

  14. Duodenal epithelial transport in functional dyspepsia

    DEFF Research Database (Denmark)

    Witte, Anne-Barbara; D'Amato, Mauro; Poulsen, Steen Seier;

    2013-01-01

    To investigate functional duodenal abnormalities in functional dyspepsia (FD) and the role of serotonin (5-hydroxytryptamine, 5-HT) in mucosal ion transport and signalling.......To investigate functional duodenal abnormalities in functional dyspepsia (FD) and the role of serotonin (5-hydroxytryptamine, 5-HT) in mucosal ion transport and signalling....

  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. 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.

  17. 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.

  18. 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.

  19. 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.

  20. 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.

  1. Scintigraphic evaluation of Zenker's diverticulum

    Energy Technology Data Exchange (ETDEWEB)

    Valenza, Venanzio; Perotti, Germano; Di Giuda, Daniela [Institute of Nuclear Medicine, Policlinico A. Gemelli, Catholic University of Sacred Heart, Largo Gemelli 8, 00168, Rome (Italy); Castrucci, Gioacchino [Department of Surgery, Bel Colle Hospital, Viterbo (Italy); Celi, Giuseppe; Restaino, Gennaro [Institute of Radiology, Catholic University of Sacred Heart, Rome (Italy)

    2003-12-01

    Zenker's diverticulum (ZD) is a rare pathology, with a prevalence of between 0.01% and 0.11%. Definitive diagnosis of ZD can be accomplished by contrast radiographic examination (barium oesophagogram, BE); oesophageal manometry (ME) is recommended mainly for those patients suffering from dysphagia and/or gastro-oesophageal reflux. The aims of the present study were to assess whether oropharyngo-oesophageal scintigraphy (OPES) is able (a) to visualise ZD and (2) to demonstrate the corresponding alteration in the swallowing phases. We studied 16 patients (nine male, seven female, mean age 67.4 years), and 17 healthy volunteers (ten male, seven female, mean age 53 years) as a control group. All the patients underwent ME, BE and OPES. Nine patients underwent surgery and six of them were re-evaluated after 6 months. We administered 10 ml of water with 37 MBq of technetium-99m colloid through a straw, acquiring 480 sequential images (0.125 s/frame for a total of 60 s) with the patient standing in front of the gamma camera in the 80 right anterior oblique position. Two static images were performed at the end of the dynamic phase, before and after ingestion of 100 ml of unlabelled water to evaluate the presence of inflammation (persistence of radioactivity in the diverticulum or oesophagus). Study of the sequential scintigraphic images and time-activity curves permitted both qualitative (diverticulum visualisation, multiple deglutitions, reflux, presence of inflammation) and quantitative analyses [oral, pharyngeal and oesophageal transit times and retention indexes, tracheal aspiration percentage] of swallowing disorders. OPES showed a good correlation with the results of other diagnostic techniques usually performed in patients with this pathology, and especially with ME in the evaluation of oropharyngeal phase disorders. Furthermore, OPES is a sensitive and simple technique that is well tolerated and entails a low irradiation dose for patients. (orig.)

  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. RE: Simple vs Complex Urethral Diverticulum: Presentation and Outcomes

    OpenAIRE

    Samuel Walker Nickles; Gini Ikwuezunma; Lara MacLachlan

    2015-01-01

    Urethral diverticulum (UD) was first described by Hey in 1805. Albeit it has mostly an acquired origin, it might also be congenital. According to the literature, the prevalance ranges between 1 and 6% in female population and it is mostly located at the mid-urethra. Size also reveals a variability from a few mm to more bigger forms. In 10% of cases, multiple numbers of UD can be observed at the same patient. Romanzi in 2000 reported that the diagnosis is often overlooked and after an...

  4. 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)

  5. Abnormal small bowel permeability and duodenitis in recurrent abdominal pain.

    OpenAIRE

    Meer, S.B.; Forget, P P; Arends, J.W.

    1990-01-01

    Thirty nine children with recurrent abdominal pain aged between 5.5 and 12 years, underwent endoscopic duodenal biopsy to find out if there were any duodenal inflammatory changes, and if there was a relationship between duodenal inflammation and intestinal permeability to 51Cr-EDTA. Duodenal inflammation was graded by the duodenitis scale of Whitehead et al (grade 0, 1, 2, and 3). In 13 out of 39 patients (33%) definite signs of inflammation were found (grade 2 and 3). Intestinal permeability...

  6. Congenital duodenal obstruction associated with Down's syndrome presenting with hematemesis

    OpenAIRE

    Al Shahwani, Noora; Mandhan, Parkash; Elkadhi, Abdelrahman; Ali, Mansour J.; Latif, Abdel

    2013-01-01

    Congenital duodenal obstruction is usually characterized by onset of early vomiting due to high bowel obstruction. Presentation of congenital duodenal obstruction with acute gastrointestinal bleeding is very uncommon. We present an unusual case of congenital intrinsic duodenal obstruction associated with the Down's syndrome presenting with hematemesis secondary to duodenitis. This is a rare presentation of congenital duodenal obstruction associated with Down's syndrome in addition to seven ca...

  7. Duodenal X-ray diagnostics

    International Nuclear Information System (INIS)

    The publication provides an overview of duodenal X-ray diagnostics with the aid of barium meals in 1362 patients. The introducing paragraphs deal with the topographic anatomy of the region and the methodics of X-ray investigation. The chapter entitled ''processes at the duodenum itself'' describes mainly ulcers, diverticula, congenital anomalies, tumors and inflammations. The neighbourhood processes comprise in the first place diseases having their origin at the pancreas and bile ducts. As a conclusion, endoscopic rectograde cholangio-pancreaticography and percutaneous transhepatic cholangiography are pointed out as advanced X-ray investigation methods. In the annex of X-ray images some of the described phenomena are shown in exemplary manner. (orig./MG)

  8. Denticle-embedded ampullary organs in a Cretaceous shark provide unique insight into the evolution of elasmobranch electroreceptors

    Science.gov (United States)

    Vullo, Romain; Guinot, Guillaume

    2015-10-01

    Here, we report a novel type of dermal denticle (or placoid scale), unknown among both living and fossil chondrichthyan fishes, in a Cretaceous lamniform shark. By their morphology and location, these dermal denticles, grouped into clusters in the cephalic region, appear to have been directly associated with the electrosensory ampullary system. These denticles have a relatively enlarged (˜350 μm in diameter), ornamented crown with a small (˜100 μm) asterisk- or cross-shaped central perforation connected to a multi-alveolate internal cavity. The formation of such a complex structure can be explained by the annular coalescence and fusion, around an ampullary vesicle, of several developmental units still at papillary stage (i.e. before mineralization), leading to a single denticle embedding an alveolar ampulla devoid of canal. This differs from larger typical ampullae of Lorenzini with a well-developed canal opening in a pore of the skin and may represent another adaptive response to low skin resistance. Since it has been recently demonstrated that ampullary organs arise from lateral line placodes in chondrichthyans, this highly specialized type of dermal denticle (most likely non-deciduous) may be derived from the modified placoid scales covering the superficial neuromasts (pit organs) of the mechanosensory lateral line system of many modern sharks.

  9. Endoscopic duodenal biopsy in children

    Directory of Open Access Journals (Sweden)

    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.

  10. Duodenal surveillance improves the prognosis after duodenal cancer in familial adenomatous polyposis

    DEFF Research Database (Denmark)

    Bülow, Steffen; Christensen, Ib Jarle; Højen, Helle;

    2012-01-01

    Background and aim: Duodenal adenomatosis in FAP results in a cancer risk that increases with age. Endoscopic surveillance has been recommended, but the effect has not yet been documented. The aim of this study is to present results of long-term duodenal surveillance and to evaluate the risk of...... (interquartile range 9-17). The cumulative lifetime risk of duodenal adenomatosis was 88% (95% CI 84-93), and of Spigelman stage IV 35% (95% CI 25-45). The Spigelman stage improved in 32 (12%), remained unchanged in 88 (34%) and worsened in 116 (44%). Twenty patients (7%) had duodenal cancer at a median age of...

  11. Duodenal surveillance improves the prognosis after duodenal cancer in familial adenomatous polyposis

    DEFF Research Database (Denmark)

    Bülow, Steffen; Christensen, Ib Jarle; Højen, Helle;

    2012-01-01

    Background and aim:  Duodenal adenomatosis in FAP results in a cancer risk that increases with age. Endoscopic surveillance has been recommended, but the effect has not yet been documented. The aim of this study is to present results of long-term duodenal surveillance and to evaluate the risk of...... (interquartile range 9-17). The cumulative lifetime risk of duodenal adenomatosis was 88% (95% CI 84-93), and of Spigelman stage IV 35% (95% CI 25-45). The Spigelman stage improved in 32 (12%), remained unchanged in 88 (34%) and worsened in 116 (44%). Twenty patients (7%) had duodenal cancer at a median age of...

  12. 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.

  13. A Rare Case of Vesicourachal Diverticulum with Calculus in a 24-Year-Old Man

    Science.gov (United States)

    Atalar, Mehmet Haydar; Salk, Ismail; Cetin, Ali; Bozbiyik, Nisa

    2016-01-01

    Summary Background During embryonal period, complete obliteration of the urachus at the umbilicus and incomplete closure at the bladder level are the cause of vesicourachal diverticulum. This abnormality is a rare finding that is usually discovered incidentally during radiological evaluation. Occasionally, stones have been detected within the diverticulum. Case Report We present a case of a vesicourachal diverticulum with calculus diagnosed by multidetector computed tomography and confirmed surgically and histopathologically in a 24-year-old man. Conclusions During the radiological differential diagnosis of abnormalities of abdominal wall and urinary system, consideration of urachal abnormalities is important especially in symptomatic patients. PMID:27429672

  14. Annular pancreas associated with duodenal carcinoma

    Institute of Scientific and Technical Information of China (English)

    Enrico; Bronnimann; Silke; Potthast; Tatjana; Vlajnic; Daniel; Oertli; Oleg; Heizmann

    2010-01-01

    Annular pancreas (AP) is a rare congenital anomaly. Coexisting malignancy has been reported only in a few cases. We report what is, to the best of our knowledge, the first case in the English literature of duodenal adenocarcinoma in a patient with AP. In a 55-year old woman with duodenal outlet stenosis magnetic resonance cholangiopancreatography showed an aberrant pancreatic duct encircling the duodenum. Duodenojejunostomy was performed. Eight weeks later she presented with painless jaundice. Duodenopancre...

  15. Cytomegalovirus as an Insidious Pathogen Causing Duodenitis

    OpenAIRE

    Hagiya, Hideharu; Iwamuro, Masaya; Tanaka, Takehiro; Hanayama, Yoshihisa; Otsuka, Fumio

    2015-01-01

    A 60-year-old woman with rheumatoid arthritis treated with methotrexate for a decade complained of slight epigastric discomfort. A positive cytomegalovirus (CMV) antigenemia test indicated the probability of CMV-related gastrointestinal infection, for which esophagogastroduodenoscopy was performed. Endoscopic findings showed a non-specific duodenal mucosal lesion;however, pathological investigation revealed evidence of CMV duodenitis. There is scarce information on the clinical and pathologic...

  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. 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.

  18. [LAPAROSCOPIC APPROACH AND SURGICAL CONSIDERATIONS IN RESECTION OF A LARGE EPIPHRENIC ESOPHAGEAL DIVERTICULUM].

    Science.gov (United States)

    Rudnicki, Yaron; Inbar, Roy; Barkay, Olga; Shpitz, Baruch; Ghinea, Ronen; Avital, Shmuel

    2015-08-01

    Epiphrenic diverticulum of the esophagus is an uncommon finding. Small diverticula are usually asymptomatic in nature. Large diverticula may present with dysphagia, chest or upper abdominal discomfort, vomiting, irritating cough or halitosis. There are a few different surgical approaches to epiphrenic diverticulum resection. It can be performed with an abdominal or a thoracic approach and in an open or a laparoscopic manner. In this case report we present a 70 years old male patient with a giant epiphrenic diverticulum and dysphagia. The patient was operated upon via a laparoscopic abdominal approach with intra-operative endoscopic assistance and underwent a diverticulum resection. We present a review of the different kinds of esophageal diverticula, the mechanism of their formation, and the surgical considerations associated with choosing the appropriate surgical approach. PMID:26480613

  19. 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

  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. Detection of Meckel's diverticulum in an infant by Tc-99m-sulfur colloid scintigraphy

    International Nuclear Information System (INIS)

    Active lower intestinal bleeding from a Meckel's diverticulum in an infant was detected with Tc-99m-sulfur colloid scintigraphy. This technique expands the scintigraphic armamentarium for evaluation of lower intestinal bleeding in infants and children

  2. Inverted meckel's diverticulum as a cause of obscure lower gastrointestinal bleeding

    International Nuclear Information System (INIS)

    Inverted Meckel's diverticulum is an infrequent cause of gastrointestinal blood loss, especially in adults. A high index of suspicion is needed for this rare entity when entertaining the possible differentials of gastrointestinal bleeding.(author)

  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. 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.

  5. NSAID-Associated Perforation of a Meckel’s Diverticulum: A Case Report

    OpenAIRE

    Brar, Avneet S.; Gill, Richdeep S; Gill, Sumeet S.; Wang, Haili

    2011-01-01

    Meckel’s diverticulum is the most frequent congenital malformation of the gastrointestinal tract. The most common ectopic tissue within a Meckel’s is heterotopic gastric mucosa, with bleeding being the most common presentation. However, perforation of a Meckel’s diverticulum is a rare presentation. NSAID-associated Meckel’s perforation has been suggested, however has not been documented in the literature. We present a case of a 17-year-old female with acute abdominal pain and tenderness follo...

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

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    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.

  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. 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.

  9. Ileal obstruction from Meckel's diverticulum in a neonate: A case report and review of literature

    OpenAIRE

    Akputa Aja Obasi; Ekenze, Sebastian O.; Uchechukwu Ogbobe

    2015-01-01

    Meckel's diverticulum is the most common of the omphalomesenteric duct anomalies encountered in clinical practice. It may present with a wide variety of symptoms. Presentation in the neonatal period is very rare. We present a case of ileal obstruction from Meckel's diverticulum in a neonate with resultant stenosis of the proximal and distal bowel adjoining the Meckel's diverticulum and a short review of literature. Intrinsic intestinal stenosis should be borne in mind as one of the mechanisms...

  10. Spontaneous perforation of Meckel's diverticulum: a case report and review of literature.

    Science.gov (United States)

    Farah, Robleh Hassan; Avala, Prude; Khaiz, Driss; Bensardi, Fatmazahra; Elhattabi, Khalid; Lefriyekh, Rachid; Berrada, Saad; Fadil, Abdelaziz; Zerouali, Najib Ouariti

    2015-01-01

    Meckel's diverticulum is the commonest congenital abnormality of the gastrointestinal tract. Hemorrhage, obstruction and inflammation are the three main categories of complications resulting from Meckel's diverticulum. Spontaneously perforation of Meckel's diverticulum is very rare and mimics acute appendicitis. We report a case of 26 year-old male, who presented since 5 days worsening abdominal pain predominantly in the right iliac fossa associated with high grade fever. On physical examination his abdomen was distended with guarding and rigidity. A provisional diagnosis of appendiculaire peritonitis was made. Our patient had an emergency laparotomy, where a perforated Meckel's diverticulum and advanced peritonitis were discovered. A diverticulectomy with ileostomy were performed. Heterotopic mucosa of diverticulitis was confirmed on histopathology. The patient made an uneventful recovery postoperatively and ileostomy reconstruction was done two months later. This case report is an interesting and unusual case of Meckel's diverticulum complications and highlights the importance of considering Meckel's diverticulum as a differential diagnosis in every patient presenting with acute abdomen. PMID:26175810

  11. Ileal obstruction from Meckel's diverticulum in a neonate: A case report and review of literature

    Directory of Open Access Journals (Sweden)

    Akputa Aja Obasi

    2015-10-01

    Full Text Available Meckel's diverticulum is the most common of the omphalomesenteric duct anomalies encountered in clinical practice. It may present with a wide variety of symptoms. Presentation in the neonatal period is very rare. We present a case of ileal obstruction from Meckel's diverticulum in a neonate with resultant stenosis of the proximal and distal bowel adjoining the Meckel's diverticulum and a short review of literature. Intrinsic intestinal stenosis should be borne in mind as one of the mechanisms by which Meckel's diverticulum causes bowel obstruction.

  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. Prostatic hyperplasia and congenital bladder diverticulum. A case report

    Directory of Open Access Journals (Sweden)

    Ciro Esteban Delgado Cantero

    2011-04-01

    Full Text Available Congenital diverticula in adults are typically associated with bladder outlet obstruction and their manifestation is most commonly by urinary sepsis. The case of a 69 years old male patient who attended consultation because of nocturia, thin urine stream, pushing, urgent urination and sense of incomplete emptying is presented. Through rectal examination grade I prostate with discrete grade I asymmetry consistent with right nodular lobe that did not rise to the surface was detected. During the physical examination tumor mass was palpated in the lower abdomen region. It was painless. Ultrasound and cystography showed giant bladder diverticulum with a narrow neck into the right lateral wall of the bladder. Cystoscopy confirmed the diagnosis and the patient was treated trough surgery. Histology revealed mucosal layers and muscle and adventitia in the wall, thus confirming congenital origin. Recovering after surgery was satisfactor.

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

    Directory of Open Access Journals (Sweden)

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

    Directory of Open Access Journals (Sweden)

    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.

  16. Mucosal reactive oxygen metabolite production in duodenal ulcer disease.

    OpenAIRE

    Davies, G. R.; Simmonds, N J; Stevens, T R; Grandison, A; D. R. Blake; Rampton, D S

    1992-01-01

    To investigate the hypothesis that reactive oxygen metabolites are important in the pathophysiology of duodenal ulcer disease, their production by duodenal mucosal biopsy specimens was measured using luminol and lucigenin amplified chemiluminescence. Luminol chemiluminescence, expressed as background corrected median photon emission/mg/min x 10(3) (95% confidence intervals), was increased in duodenal inflammation as assessed macroscopically: ulcers 20.3 (4.8 to 51.3), n = 29; severe duodeniti...

  17. Cytomegalovirus as an Insidious Pathogen Causing Duodenitis.

    Science.gov (United States)

    Hagiya, Hideharu; Iwamuro, Masaya; Tanaka, Takehiro; Hanayama, Yoshihisa; Otsuka, Fumio

    2015-01-01

    A 60-year-old woman with rheumatoid arthritis treated with methotrexate for a decade complained of slight epigastric discomfort. A positive cytomegalovirus (CMV) antigenemia test indicated the probability of CMV-related gastrointestinal infection, for which esophagogastroduodenoscopy was performed. Endoscopic findings showed a non-specific duodenal mucosal lesion;however, pathological investigation revealed evidence of CMV duodenitis. There is scarce information on the clinical and pathological features of CMV-related duodenitis, likely due to its low prevalence. CMV infection in the upper gastrointestinal tract should be considered as a differential diagnosis in high-risk individuals, particularly those with symptoms relating to the digestive system. Biopsy examinations are preferable for the definitive diagnosis of CMV gastrointestinal infection, even without specific endoscopic features. PMID:26490030

  18. 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.

  19. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  1. 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.

  2. Torsion of Meckel’s diverticulum as a cause of small bowel obstruction: A case report

    Institute of Scientific and Technical Information of China (English)

    Marko; Murruste; Geidi; Rajaste; Karri; Kase

    2014-01-01

    Axial torsion and necrosis of Meckel’s diverticulum causing simultaneous mechanical small bowel obstruc-tion are the rarest complications of this congenital anomaly. This kind of pathology has been reported only eleven times. Our case report presents this very unusual case of Meckel’s diverticulum. A 41-year-old man presented at the emergency department with complaints of crampy abdominal pain, nausea and re-tention of stool and gases. Clinical diagnosis was small bowel obstruction. Because the origin of obstruction was unknown, computer tomography was indicated. Computed tomography(CT)-scan revealed dilated small bowel loops with multiple air-fluid levels; the oral con-trast medium had reached the jejunum and proximal parts of the ileum but not the distal small bowel loops or the large bowel; in the right mid-abdomen there was a 11 cm × 6.4 cm × 7.8 cm fluid containing cavity with thickened wall, which was considered a dilated bowel-loop or cyst or diverticulum. Initially the patient was treated conservatively. Because of persistent abdominal pain emergency laparotomy was indicated. Abdominal exploration revealed distended small bowel loops proxi-mal to the obstruction, and a large(12 cm × 14 cm) Meckel’s diverticulum at the site of obstruction. Meckel’s diverticulum was axially rotated by 720°, which caused small bowel obstruction and diverticular necrosis. About 20 cm of the small bowel with Meckel’s diverticulum was resected. The postoperative course was uneventful and the patient was discharged on the fifth postopera-tive day. We recommend CT-scan as the most useful diagnostic tool in bowel obstruction of unknown origin. In cases of Meckel’s diverticulum causing small bowel obstruction, prompt surgical treatment is indicated; de-lay in diagnosis and in adequate treatment may lead to bowel necrosis and peritonitis.

  3. Duodenal gastric metaplasia and Helicobacter pylori infection in patients with diffuse nodular duodenitis

    Directory of Open Access Journals (Sweden)

    X.B. Li

    2007-07-01

    Full Text Available Whether the regression of gastric metaplasia in the duodenum can be achieved after eradication of Helicobacter pylori is not clear. The aim of the present study was to investigate the relationship between H. pylori infection and gastric metaplasia in patients with endoscopic diffuse nodular duodenitis. Eighty-six patients with endoscopically confirmed nodular duodenitis and 40 control patients with normal duodenal appearance were investigated. The H. pylori-positive patients with duodenitis received anti-H. pylori triple therapy (20 mg omeprazole plus 250 mg clarithromycin and 400 mg metronidazole, all twice daily for one week. A control endoscopy was performed 6 months after H. pylori treatment. The H. pylori-negative patients with duodenitis received 20 mg omeprazole once daily for 6 months and a control endoscopy was performed 2 weeks after treatment. The prevalence of H. pylori infection was 58.1%, and the prevalence of gastric metaplasia was 57.0%. Seventy-six patients underwent endoscopy again. No influence on the endoscopic appearance of nodular duodenitis was found after eradication of H. pylori or acid suppression therapy. However, gastric metaplasia significantly decreased and complete regression was achieved in 15/28 patients (53.6% 6 months after eradication of H. pylori, accompanied by significant improvement of other histological alterations. Only mild chronic inflammation, but not gastric metaplasia, was found in the control group, none with H. pylori infection in the duodenal bulb. Therefore, H. pylori infection is related to the extent of gastric metaplasia in the duodenum, but not to the presence of diffuse nodular duodenitis.

  4. Duodenal mucosal architecture in non-specific and ulcer-associated duodenitis.

    OpenAIRE

    M. Hasan; Sircus, W; Ferguson, A.

    1981-01-01

    This study was done to determine the severity and extent of abnormalities of duodenal mucosal architecture in non-specific (non-ulcerative) and ulcer-associated duodenitis. The effect of successful treatment with cimetidine on these changes has also been assessed. A method of microdissection and measurement of villus height, crypt depth, and mitotic figure count per crypt was applied to endoscopic biopsies from the duodenum. Five groups of patients were studied: untreated ulcer-associated duo...

  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. Duodenal Intracellular Bicarbonate and the 'CF Paradox'

    Directory of Open Access Journals (Sweden)

    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.

  7. 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.

  8. Future directions of duodenal endoscopic submucosaldissection

    Institute of Scientific and Technical Information of China (English)

    Satohiro Matsumoto; Hiroyuki Miyatani; Yukio Yoshida

    2015-01-01

    Endoscopic therapies for lesions of the duodenumare technically more difficult than those for lesionsof the other parts of the gastrointestinal tract due tothe anatomical features of the duodenum, and theincidence rate of complications such as perforation andbleeding is also higher. These aforementioned trendswere especially noticeable for the case of duodenalendoscopic submucosal dissection (ESD). The indicationfor ESD of duodenal tumors should be determinedby assessment of the histopathology, macroscopicmorphology, and diameter of the tumors. The threetypes of candidate lesions for endoscopic therapy areadenoma, carcinoma, and neuroendocrine tumors. Forapplying endoscopic therapies to duodenal lesions,accurate preoperative histopathological diagnosisis necessary. The most important technical issue induodenal ESD is the submucosal dissection process.In duodenal ESD, a short needle-type knife is suitablefor the mucosal incision and submucosal dissectionprocesses, and the Small-caliber-tip Transparent hoodis an important tool. After endoscopic therapies, thewound should be closed by clipping in order to preventcomplications such as secondary hemorrhage anddelayed perforation. At present, the criteria for selectionbetween ESD and EMR vary among institutions. Theindications for ESD should be carefully considered.Duodenal ESD should have limitations, such as theneed for its being performed by experts with abundantexperience in performing the procedure.

  9. 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

  10. RE: Simple vs Complex Urethral Diverticulum: Presentation and Outcomes

    Directory of Open Access Journals (Sweden)

    Samuel Walker Nickles

    2015-03-01

    Full Text Available Urethral diverticulum (UD was first described by Hey in 1805. Albeit it has mostly an acquired origin, it might also be congenital. According to the literature, the prevalance ranges between 1 and 6% in female population and it is mostly located at the mid-urethra. Size also reveals a variability from a few mm to more bigger forms. In 10% of cases, multiple numbers of UD can be observed at the same patient. Romanzi in 2000 reported that the diagnosis is often overlooked and after an average of 9 doctors a proper diagnosis could be established. This paper is an excellent presentation of UD which were further sub-categorized as simple and complex. Literature is limited on the presenting symptoms and results after repair of complex UD compared with simple UD. In this series, 11 over 43 UD cases were classified as complex when an axial MRI imaging revealed more than 75% circumferential involvement of the urethra. Complete urethral division and an end to end anastomosis was done in complex UD to access the dorsally or circumferentially located diverticulum. In simple UD, transvaginal excision technique was used. When the patients complained urinary incontinance concomitantly, videourodynamics was done to differentiate postvoid dribbling from the true SUI. An autologous fascial pubovaginal sling was done in those cases with SUI besides the repair of UD. When the tissue was poor they utilized Martius flap. Mean age of both complex and simple UD did not reveal a significant difference (52.7 vs. 50.9. The striking difference when evaluating patient demographics was the high concomitant occurence of SUI in complex UD (90.9 vs. 56.3%. Postoperative symptoms were also similar except a more tendency to urinary tract infection after repairs of complex UD (27.3 vs. 3.2%. In three patients urinary retention was observed and in one of them sling was incised vaginally. Urethral stricture developed in one case belonging to complex group that was managed with

  11. DUODENAL WEBS: AN EXPERIENCE WITH 18 PATIENTS

    Directory of Open Access Journals (Sweden)

    Yogesh Kumar Sarin

    2012-04-01

    Full Text Available Aim: To describe the management and outcome of patients with duodenal webs, managed over a period of 12 ½ years in our unit.Methods: It is a retrospective case series of 18 patients with congenital duodenal webs, managed in our unit, between 1999 and 2011. The medical record of these patients was retrieved and analyzed for demographic details, clinical presentation, associated anomalies, and outcome. Results: The median age of presentation was 8 days (range 1 day to 1.5 years. Antenatal diagnosis was made in only 2 (11.1% patients. The commonest presentation was bilious vomiting. Associated anomalies were present in 8/18 patients, common being malrotation of gut. Down’s syndrome was seen in 2 patients and congenital heart disease in 1 patient. One patient had double duodenal webs. There was a delay in presentation of more than 5 days of life in 11/18 (61% patients. Three patients who presented beyond neonatal age group had fenestrated duodenal membranes causing partial obstruction. In addition, the diagnosis was missed in patients operated for malrotation elsewhere (n=2, imperforate anus (n=2 and esophageal atresia with tracheo-esophageal fistula (n=1. A lateral duodenotomy with excision of the obstructive membrane was done in all patients. A trans-anastomotic tube (TAT for enteral feeding was used in 8 patients The mortality rate was 4/18 (22%; the main causes being sepsis, prematurity, very low birth weight and associated congenital anomalies. The mean hospital stay for the 14 survivors was 18 days. Total parental nutrition (TPN was not given to any patient.Conclusions: Congenital duodenal webs are different as the diagnosis is often missed especially in case of perforated webs. Outcome depends upon the time of presentation and associated anomalies. The use of TAT feeding for nutritional support is an easy alternative to TPN.

  12. 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

    Directory of Open Access Journals (Sweden)

    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.

  13. 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”.

  14. Calyceal Diverticulum of the Kidney – Diagnostic Imaging Dilemma in Pediatric Patients – Case Report

    International Nuclear Information System (INIS)

    Calyceal diverticula are rarely diagnosed in children. They can mimic other renal cystic lesions and correct diagnosis can be difficult to establish. Connection between fluid collection and collecting system confirmed by imaging studies is the key diagnostic finding. In this report we present a case of pediatric patient with calyceal diverticulum, with initial ultrasonographic diagnosis of simple renal cyst. Final diagnosis was established after extended diagnostics following infection of a fluid collection. 1. Differential diagnosis of well-circumscribed solitary renal fluid collections in children should include particularly: simple cyst, calyceal diverticulum and the first demonstration of ADPKD. 2. Diagnosis of calyceal diverticulum should be confirmed by contrast studies. 3. Standard management of calyceal diverticula in children includes ultrasonographic follow-up and conservative treatment and rarely requires surgical intervention

  15. 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.

  16. Laparoscopic Management of Perforated Meckel's Diverticulum in Adults

    Directory of Open Access Journals (Sweden)

    Yinlu Ding, Yong Zhou, Zhipeng Ji, Jianliang Zhang, Qisan Wang

    2012-01-01

    Full Text Available Objective: To determine the role of laparoscopy in diagnosis and surgical treatment of perforated Meckel's diverticulum (MD in adults.Methods: Between July 2003 and July 2011, fifteen patients were seen with perforated MD. Eleven were male and four were female. The median age was 38 years (range, 21-68. All patients presented with a sudden onset of pain. Among them 9 had a past medical history of bloody stools and /or chronic recurrent abdominal pain. 2 were preoperatively diagnosed with perforated MD confirmly and 4 suspiciously, 9 with perforated acute appendicitis. All 15 patients underwent exploratory laparoscopy.Results: 4 patients with broad-base(≧ 2 cm and 2 patients with narrow-base(<2 cm whose perforative site was near the base underwent laparoscopically assisted extracorporal bowel segment resection, the other 9 patients with narrow-base(<2 cm underwent laparoscopically intraabdominal wedge resection of the MD. No intraoperative or postoperative complications occurred. The median hospital stay was 4 days (range, 2-7days. The histopathologic studies showed heterotopic gastric mucosa (HGM in 10 cases (66.7%. All patients recovered uneventfully.Conclusion: To patients with sudden abdomen pain mimic acute appendicitis accompanied by a past medical history of bloody stools and/or chronic recurrent abdominal pain, proferated MD should be kept in mind as a differential diagnosis. Laparoscopy is a safe and effective surgical modality for diagnosis of proferated MD and has a therapeutic role that results in an excellent cosmetic result.

  17. Clinicopathological features of early gastric cancer with duodenal invasion

    Institute of Scientific and Technical Information of China (English)

    Tsutomu Namikawa; Kazuhiro Hanazaki

    2009-01-01

    The incidence of early gastric cancer (EGC) with duodenal invasion is ext remely low, al though advanced gastric cancer that arises in the antrum occasionally invades the duodenum. We investigated the clinicopathological features of EGC with duodenal invasion and provided strategies for clinical management. A Medline search was performed using the keyword "early gastric cancer" and "duodenal invasion". Additional articles were obtained from references within the papers identified by the Medline search. We revealed that EGC with duodenal invasion was of the superficial spreading type of tumor. Tumors > 60 mm in size invaded the duodenum more extensively, and the distance of duodenal invasion from the pyloric ring was further in the elevated type than in the depressed type of tumor. There was no significant difference between the length of duodenal invasion and the histological type of the tumor. Gastric cancer located adjacent to the pyloric ring, even if cancer invasion was confined to the mucosa or submucosa, was more likely to invade the duodenum. The present study reveals that the elevated type of EGC is associated with more extensive duodenal invasion when the tumor size is > 60 mm, thus highlighting the importance of identification of duodenal invasion in these cases. We also reveal that sufficient duodenal resection with a cancer-free distal surgical margin should be performed in cases of duodenal invasion.

  18. Invaginated meckel's diverticulum: A rare cause of small intestine intussusception in adults

    International Nuclear Information System (INIS)

    Intussusception is commonly seen in infants. It is occasionally found in adults usually due to carcinomas, colonic diverticuli, polyps and rarely Meckel's diverticulum. An adult male presented with upper abdominal pain, nausea, anorexia and loose stools. The initial investigative workup was unremarkable and patient responded to treatment given for acute gastroenteritis. After 3 days, the pain recurred in right iliac fossa with rebound tenderness and leukocytosis. Surgery was performed with provisional diagnoses of acute appendicitis and/or acute Meckel's diverticulitis. Per-operative findings revealed invaginated Meckel's diverticulum causing non-obstructing intussusception. (author)

  19. 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...

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

    Directory of Open Access Journals (Sweden)

    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.

  1. 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.

  2. 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...

  3. 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.

  4. Nature of the inflammatory cell infiltrate in duodenitis.

    OpenAIRE

    M. Hasan; Hay, F; Sircus, W; Ferguson, A.

    1983-01-01

    Counts of lamina propria and intraepithelial cells, lymphoid and polymorphonuclear, have been performed on semithin sections of endoscopic biopsies from the duodenum of patients with ulcer-associated duodenitis, with non-specific duodenitis, and from controls. In both types of duodenitis there were significant increases in lamina propria counts of plasma cells, lymphocytes and eosinophils, and in intraepithelial lymphocyte counts, when compared with controls. In control specimens, neutrophil ...

  5. Two Cases of Diffuse Duodenitis Associated with Ulcerative Colitis

    OpenAIRE

    Katsuya Endo; Masatake Kuroha; Hisashi Shiga; Yoichi Kakuta; Seiichi Takahashi; Yoshitaka Kinouchi; Tooru Shimosegawa

    2012-01-01

    The upper gastrointestinal tract is not generally considered a target organ in ulcerative colitis (UC). However, several cases showing upper gastrointestinal involvement in UC have been reported. In this report, we present 2 rare cases of diffuse duodenitis accompanying pancolonic UC. Case patient 1 was a 44-year-old man who developed diffuse duodenitis shortly after colectomy and was successfully treated with mesalazine. Case patient 2 was a 25-year-old woman who developed diffuse duodenitis...

  6. 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.

  7. [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.

  8. 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.

  9. Russell body duodenitis with immunoglobulin kappa light chain restriction.

    Science.gov (United States)

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

    2015-01-16

    Russell bodies are eosinophilic intracytoplasmic globules which are likely the result of disturbed secretion of immunoglobulins that accumulate within the plasma cell. Russell body collections have been identified within the stomach, known as Russell body gastritis. Similar lesions within the duodenum are referred to as Russell body duodenitis, which is rare. Several Russell body gastritis case reports are associated with Helicobacter pylori. However, the etiology of Russell body duodenitis remains unclear. Here we report the first case of Russell body duodenitis with immunoglobulin light chain restriction in a background of peptic duodenitis. PMID:25610537

  10. RESECTION FOR RUPTURED DUODENAL VARICES SECONDARY TO PORTAL HYPERTENSION

    Institute of Scientific and Technical Information of China (English)

    Hai-quan Qiao; Bing Liu; Wen-jie Dai; Hong-chi Jiang

    2004-01-01

    @@ Apatient complicated by gastrointestinal bleeding was treated successfully using resection of ruptured duodenal varies. The paper reviewed the literatures and introduced surgical procedures and its indications.

  11. 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.

  12. Massive upper GI bleeding: A rare complication of Zenker′s diverticulum

    Directory of Open Access Journals (Sweden)

    Haas I

    2008-01-01

    Full Text Available Bleeding from a Zenker′s diverticulum is rare. A 71-year-old man was urgently admitted with massive hematemesis. It was known that he had a Zenker′s diverticulum, but on emergency endoscopy, the source of bleeding was not detected due to large blood clots in the esophagus, hypo-pharynx and also into the tracheal-bronchial tree. Computerized tomography angiography demonstrated a blush of intravenous contrast arising from the diverticulum. The patient was operated upon urgently; the diverticle had a deep ulceration which was the source of the bleeding. The cause of the ulceration is unknown but it is possible that it was caused by the direct effect of an aspirin pill within the diverticle. A similar case with the same conclusion has been published in the past and since the use of aspirin has become common, especially in the elder population, we present this case report to highlight this possible life-threatening complication of Zenker′s diverticulum in patients receiving aspirin.

  13. Giant epiphrenic diverticulum in a boy with Ehlers-Danlos syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Toyohara, T.; Kaneko, T.; Araki, H.; Takahashi, K.; Nakamura, T.

    1989-07-01

    We treated a 12 year old boy with Ehlers-Danlos syndrome. There were multiple diverticula in the oesophagus, stomach, colon and urinary bladder. Most prominent was the giant epiphrenic diverticulum of the oesophagus, a rare finding as a complication of Ehlers-Danlos syndrome. (orig.).

  14. A PELVIC MASS - BLADDER DIVERTICULUM WITH HEMORRHAGE IN EHLERS-DANLOS PATIENT

    NARCIS (Netherlands)

    BADE, JJ; YPMA, AFGVM; VANELK, P; MENSINK, HJA

    1994-01-01

    We report on a case of haemorrhage in a large bladder diverticulum, impressing as a pelvic mass, in a patient with the Ehlers-Danlos syndrome. A review of the literature revealed 14 other cases of bladder diverticula and the Ehlers-Danlos Syndrome. Conservative treatment is first choice, unless comp

  15. Inverted Meckel’s diverticulum preoperatively diagnosed using double-balloon enteroscopy

    Science.gov (United States)

    Takagaki, Kosuke; Osawa, Satoshi; Ito, Tatsuhiro; Iwaizumi, Moriya; Hamaya, Yasushi; Tsukui, Hiroe; Furuta, Takahisa; Wada, Hidetoshi; Baba, Satoshi; Sugimoto, Ken

    2016-01-01

    An inverted Meckel’s diverticulum is a rare gastrointestinal congenital anomaly that is difficult to diagnose prior to surgery and presents with anemia, abdominal pain, or intussusception. Here, we report the case of 57-year-old men with an inverted Meckel’s diverticulum, who was preoperatively diagnosed using double-balloon enteroscopy. He had repeatedly experienced epigastric pain for 2 mo. Ultrasonography and computed tomography showed intestinal wall thickening in the pelvis. Double-balloon enteroscopy via the anal route was performed for further examination, which demonstrated an approximately 8-cm, sausage-shaped, submucosal tumor located approximately 80 cm proximal to the ileocecal valve. A small depressed erosion was observed at the tip of this lesion. Forceps biopsy revealed heterotopic gastric mucosa. Thus, the patient was diagnosed with an inverted Meckel’s diverticulum, and single-incision laparoscopic surgery was performed. This case suggests that an inverted Meckel’s diverticulum should be considered as a differential diagnosis for a submucosal tumor in the ileum. Balloon-assisted enteroscopy with forceps biopsy facilitate a precise diagnosis of this condition. PMID:27158212

  16. 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...

  17. Meckel's diverticulum: a case report from the University Hospital Center Yaoundé, Cameroon

    Directory of Open Access Journals (Sweden)

    Arthur Essomba

    2009-10-01

    Full Text Available To the best of our knowledge there is no reported case of Meckel's diverticulum (MD in Cameroon. The prevalence of MD in the general population is 2-3 %. The aim of this paper is to recapitulate the role of this pathology in acute abdomens and abdominal pain of uncertain aetiology in young patients and to review the medical literature.

  18. Meckel's diverticulum--a rare cause of intestinal obstruction in adults.

    Science.gov (United States)

    Bălălău, C; Bacalbaşa, N; Motofei, I; Popa, Fl; Voiculescu, S; Scăunaşu, R V

    2015-01-01

    Although many people have Meckel's diverticulum, only some experience any symptoms, most under the age of 10. In adults it is usually asymptomatic but approximately 4% develop complications. Meckel's diverticulum is usually diagnosed in the first years of life and after that the risk of the complications decreases with increasing age, with no predictive factors for the development of complications. We describe the case of a 34-year-old man admitted in the emergency department with diffuse abdominal pain, nausea, flatulence and lack of transit for feces and gas. The patient had been previously operated for peritonitis due to a perforated ulcer. Clinical examination and paraclinical investigations (abdominal radiography and ultrasound) suggested the diagnosis of intestinal obstruction, probably produced by adhesions due to previous abdominal intervention. The diverticulum was resected using a linear stapler and the patient recovered without any complications. Small bowel obstruction due to Meckel's diverticulitis may be caused by entangled loop of small bowel around a fibrous cord, intussusception, volvulus, or incarceration within a hernia sac. The discovery of a Meckel's diverticulum complication in a mid thirties patient represented an intra-operatory surprise and is the peculiarity of the case. PMID:25970960

  19. Relationship of Gastric Metaplasia and Age, Sex, Smoking and Helicobacter pylori Infection in Patients with Duodenal Ulcer and Duodenitis

    OpenAIRE

    Bago, J; Kranjčec, D.; Strinić, D.; Petrović, Z.; Kučišec, N.; Bevanda, M.; Bilić, A.; Eljuga, D.

    2000-01-01

    Gastric metaplasia is one of the factors in duodenal ulcer appearance. The aim of this study was to investigate the frequency of gastric metaplasia and its connection with age, sex, cigarette smoking and H. pylori infection. In the study 216 patients were included. There were 98 patients with duodenal ulcer, 60 with duodenitis, and 58 healthy control subjects. There was no statistically significant difference in gastric metaplasia frequency according to age and sex. Gastric metaplasia was sta...

  20. 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.

  1. Imaging findings of midgut volvuIus associated with a large small-bowel diverticulum in an aduIt patient: case report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jee Young; Rha, Sung Eun; Oh, Soon Nam; Bo, Seal Hwang; Byun, Jae Young [College of Medicine, The Catholic Univ. of Korea, Seoul (Korea, Republic of)

    2004-05-01

    Although most patients with jejunoileal diverticulum are asymptomatic, a large, small-bowel diverticulum can be associated with midgut volvulus in an adult. We present a rare case of midgut volvulus that was associated with a large, small-bowel diverticulum in a 77-year-old woman presenting with chronic recurrent abdominal pain. The CT showed the characteristic whirl sign of twisted mesentery, the small bowel loops along the superior mesenteric artery and a large sac-like small-bowel diverticulum. A small bowel series also demonstrated a corkscrew appearance of proximal jejunum, a finding suggestive of midgut volvulus, and a large jejunal diverticulum. During the laparotomy, the small bowel was seen twisted counterclockwise 270 .deg.. The mesenteric root was very shortened. A 4 cm sized diverticulum was seen on the mesenteric border of jejunum, on the portion about 40 cm distal from the Treitz ligament.

  2. 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...

  3. 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.

  4. 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. PMID:24647303

  5. 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.

  6. Duodenal perforation associated with norovirus and rotavirus gastroenteritis

    OpenAIRE

    Ueda, Norishi; Shimotake, Takashi; Ohama, Kazunori

    2013-01-01

    Key Clinical Message Norovirus (NoV) and rotavirus (RV) gastroenteritis are usually self-limiting. However, few pediatric cases of bowel perforation and no duodenal perforation with NoV gastroenteritis were reported. We describe two children with duodenal perforation due to NoV or RV gastroenteritis. Suspicion for this association enables prompt intervention, preventing lethal outcomes of these common infections.

  7. Metabolic Alkalosis resulting from a Congenital Duodenal Diaphragm

    Directory of Open Access Journals (Sweden)

    Annalisa Passariello

    2014-10-01

    Full Text Available Duodenal diaphragm is an unusual cause of upper intestinal obstruction. We present here a neonate with duodenal diaphragm who presented with features of metabolic alkalosis. Further, an algorithm of management of metabolic alkalosis in a newborn is suggested.

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

    Institute of Scientific and Technical Information of China (English)

    Yong—HengHuang; Tian—ZhuLong; Zhi_YuXiao; HuaYe; Yun-LeWan; JieWang

    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 patho- logically diagnosed as duodenal pseudolymphoma.

  9. [Ulcerated duodenitis revealing Henoch-Schönlein purpura].

    Science.gov (United States)

    Marting, A; Defrance, P; Wain, E; Van Severen, M; Deflandre, J

    2015-01-01

    Inflammation and duodenal ulcers can meet many etiologies. We report the case of a young adult with an ulcerated duodenitis revealing Henoch-Schönlein purpura. The abdominal symptoms preceded the emergence of the classical cutaneous signs of the disease. PMID:26376566

  10. Presentation and Surgical Management of Duodenal Duplication in Adults

    Directory of Open Access Journals (Sweden)

    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.

  11. Temporary duodenal stenting as a bridge to ERCP for inaccessible papilla due to duodenal obstruction: a retrospective study

    Science.gov (United States)

    Donatelli, Gianfranco; Cereatti, Fabrizio; Dumont, Jean-Loup; Dhumane, Parag; Tuszynski, Thierry; Derhy, Serge; Meduri, Alexandre; Vergeau, Bertrand Marie; Meduri, Bruno

    2016-01-01

    Background and study aims: Duodenal obstruction may prevent performance of endoscopic retrograde cholangiopancreatography (ERCP). Percutaneous transhepatic biliary drainage (PTBD) or Endoscopic ultrasonograhy-guided biliary access (EUS-BD) are alternative treatments but are associated with a higher morbidity and mortality rate. The aim of the study is to report overall technical success rate and clinical outcome with deployment of temporary fully or partially covered self-expanding duodenal stent (pc/fcSEMS) as a bridge to ERCP in case of inaccessible papilla due to duodenal strictures. Patients and methods: This retrospective study included 66 consecutive patients presenting with a duodenal stricture impeding the ability to perform an ERCP. Provisional duodenal stenting was performed as a bridge to ERCP. A second endoscopic session was performed to remove the provisional stent and to perform an ERCP. Afterward, a permanent duodenal stent was delivered if necessary. Results: Sixty-six duodenal stents (17 pcSEMS and 49 fcSEMS) were delivered with a median indwelling time of 3.15 (1 – 7) days. Two migrations occurred in the pcSEMS group, 1 of which required lower endoscopy for retrieval. No other procedure-related complications were observed. At second endoscopy a successful ERCP was performed in 56 patients (85 %); 10 patients (15 %) with endoscopic failure underwent PTBD or EUS-BD. Forty patients needed permanent duodenal stenting. Conclusions: Provisional removable covered duodenal stenting as a bridge to ERCP for duodenal obstruction is safe procedure and in most cases allows successful performance of therapeutic ERCP. This technique could be a sound option as a step up approach before referring such cases for more complex techniques such as EUS-BD or PTBD. PMID:27652301

  12. Acute Duodenal Obstruction After Percutaneous Placement of Metallic Biliary Stents: Peroral Treatment with Enteral Stents

    International Nuclear Information System (INIS)

    Three patients with malignant biliary obstruction were treated with placement of metallic biliary stents. Two patients had known partial duodenal stenosis but had no symptoms of gastrointestinal obstruction. The patients developed symptomatic duodenal obstruction early after biliary metallic stent placement. The symptomatic duodenal obstructions were successfully treated with peroral placement of duodenal stents, which obviated the need for surgical intervention

  13. Duodenal mucosal hemodynamics in patients with liver cirrhosis.

    Directory of Open Access Journals (Sweden)

    Tanaka,Michio

    1990-10-01

    Full Text Available Clinical studies show that patients with liver cirrhosis associated with portal hypertension have a high incidence of duodenal ulcer and duodenitis. However, little information is available concerning pathophysiological process of such duodenal diseases in liver cirrhosis. Hemodynamics of the duodenal mucosa was studied in cirrhotics with esophageal varices (68 cases and in noncirrhotics with non-ulcer dyspepsia (37 cases as well. In each group, hemoglobin concentration in the peripheral venous blood was measured, and mucosal hemodynamics was examined in 4 regions of the duodenum by endoscopic reflectance spectrophotometer. No significant intergroup difference was noted in the mean age or sex ratio. Hemoglobin concentration in the peripheral venous blood was significantly lower (p less than 0.01 in the cirrhotics. There were no significant intergroup differences in duodenal mucosal blood volume. However, the cirrhotics showed significantly lower oxygen saturation of hemoglobin in all regions of the duodenum (p less than 0.01. These results show that the cirrhotics with esophageal varices had relative increase in blood volume and decrease in oxygen saturation of hemoglobin in the duodenal mucosa. Such microcirculatory disturbances seem to predispose liver cirrhosis patients to duodenal injury.

  14. Infected tracheal diverticulum: a rare association with alpha-1 antitrypsin deficiency

    Directory of Open Access Journals (Sweden)

    Cecília Beatriz Alves Amaral

    2014-12-01

    Full Text Available Tracheal diverticulum, defined as a benign outpouching of the tracheal wall, is rarely diagnosed in clinical practice. It can be congenital or acquired in origin, and most cases are asymptomatic, typically being diagnosed postmortem. We report a case of a 69-year-old woman who was hospitalized after presenting with fever, fatigue, pleuritic chest pain, and a right neck mass complicated by dysphagia. Her medical history was significant: pulmonary emphysema (alpha-1 antitrypsin deficiency; bronchiectasis; and thyroidectomy. On physical examination, she presented diminished breath sounds and muffled heart sounds, with a systolic murmur. Laboratory tests revealed elevated inflammatory markers, a CT scan showed an air-filled, multilocular mass in the right tracheal wall, and magnetic resonance imaging confirmed the CT findings. Fiberoptic bronchoscopy failed to reveal any abnormalities. Nevertheless, the patient was diagnosed with tracheal diverticulum. The treatment approach was conservative, consisting mainly of antibiotics. After showing clinical improvement, the patient was discharged.

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

    Directory of Open Access Journals (Sweden)

    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.

  16. 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.

  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. 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.

  19. 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.

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

    OpenAIRE

    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 Neurofi...

  1. 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.

  2. Healing of cysteamine-induced duodenal ulcers in the rat

    DEFF Research Database (Denmark)

    Poulsen, Steen Seier

    1985-01-01

    The mechanism and time for healing of cysteamine-induced duodenal ulcers in rats were investigated. Cysteamine induces a mixture of erosions, ulcers, and penetrating ulcers. These three stages of ulcerations healed in different ways and in different times. Erosions healed within three days...... layer of Brunner's glands in the submucosa. Healing was complete within 15 days. Penetrated ulcers healed very slowly by formation of new epithelium and Brunner's glands from the ulcer edges. The newly formed epithelium was desquamated unless protected by underlying Brunner's glands and the regeneration...... a model for a chronic duodenal ulcer which may be of value as a model for testing treatments of duodenal ulcers....

  3. Pathologic observations of the duodenum in 615 consecutive duodenal specimens: I. benign lesions

    OpenAIRE

    Terada, Tadashi

    2012-01-01

    The author investigated histopathology of 615 consecutive duodenal specimens in our pathology laboratory. Computer search of the duodenal lesions was performed. Review of histological slides was done, when appropriate. The duodenal specimens were composed of 567 benign lesions and 48 malignant lesions. The 567 benign lesions were composed of chronic non-specific duodenitis in 334 cases (60.0%), duodenal ulcer in 101 cases (17,8%), heterotopic gastric mucosa in 81 cases (14.3%), hyperplastic p...

  4. Campylobacter pyloridis and acid induced gastric metaplasia in the pathogenesis of duodenitis.

    OpenAIRE

    Wyatt, J I; Rathbone, B J; Dixon, M F; Heatley, R. V.

    1987-01-01

    Biopsy specimens of gastric and duodenal mucosa from 290 patients were examined histologically for metaplasia and Campylobacter pyloridis. Estimates of pH on samples of fasting gastric juice from 55 of the patients were performed, and mucosal biopsy specimens from 33 patients were also cultured for C pyloridis. Active duodenitis was seen in 34 duodenal biopsy specimens. Thirty (88%) of the patients with active duodenitis had both greater than 5% gastric metaplasia in the duodenal specimen and...

  5. 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.

  6. Gut wall replacing type of gastrointestinal stromal tumor presenting as a perforation of the ileal diverticulum.

    Science.gov (United States)

    Ikemura, Masako; Kunita, Akiko; Miwa, Yoshiyuki; Jimbo, Keiichi; Mori, Kazuhiko; Seto, Yasuyuki; Fukayama, Masashi

    2015-11-01

    Gastrointestinal stromal tumors (GISTs) usually form a well-circumscribed mass. Very rarely, however, sporadic GISTs show gut-wall replacing growth, similar to the diffuse hyperplasia of interstitial cells of Cajal (ICC) observed in patients with neurofibromatosis type 1 (NF1) and hereditary GIST. Here we describe a patient with ileal perforation caused by this unusual type of GIST. An 82-year-old man was admitted to the emergency department with sudden abdominal pain. Following a provisional diagnosis of perforation of Meckel's diverticulum, he underwent segmental resection of the small intestine. Macroscopic examination revealed a diverticulum-like structure 2.5cm in size near the site of mesenteric attachment of the ileum. Histological examination showed diffuse and nodular proliferation of spindle cells positive for c-KIT and CD34 that had replaced the muscularis propria of the small intestine. Mutational analyses of the lesions revealed monoclonality of proliferating cells with a somatic mutation in c-kit exon 11 (p.Leu576Pro). Gut-wall replacing type of GIST should be recognized as a specific type of GIST causing diverticulum-like structures of the gastrointestinal tract. PMID:26298631

  7. 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. PMID:24294389

  8. Phytobezoar in a jejunal diverticulum as a cause of small bowel obstruction: a case report

    Directory of Open Access Journals (Sweden)

    Rauf Fozia

    2011-09-01

    Full Text Available Abstract Introduction Phytobezoars are concretions of poorly digested fruit and vegetable fibers found in the alimentary tract. Previous gastric resection, gastrojejunostomy, or pyloroplasty predispose people to bezoar formation. Small-bowel bezoars normally come from the stomach, and primary small-bowel bezoars are very rare. They are seen only in patients with underlying small-bowel diseases such as diverticula, strictures, or tumors. Primary small-bowel bezoars almost always present as intestinal obstructions, although it is a very rare cause, being responsible for less than 3% of all small-bowel obstructions in one series. Jejunal diverticula are rare, with an incidence of less than 0.5%. They are usually asymptomatic pseudodiverticula of pulsion type, and complications are reported in 10% to 30% of patients. A phytobezoar in a jejunal diverticulum is an extremely rare presentation. Case presentation A 78-year-old Pakistani man presented to our clinic with small-bowel obstruction. Upon exploration, we found a primary small-bowel bezoar originating in a jejunal diverticulum and causing jejunal obstruction. Resection and anastomosis of the jejunal segment harboring the diverticulum was performed, and our patient had an uneventful recovery. Conclusion Primary small-bowel bezoars are very rare but must be kept in mind as a possible cause of small-bowel obstruction.

  9. 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

  10. 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.

  11. 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.

  12. 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.

  13. 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.

  14. 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.

  15. 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...... was studied. Luminal epidermal growth factor significantly inhibited the formation of cysteamine-induced duodenal ulcer, compared with controls receiving saline. The effect was not due to inhibition of gastric acid secretion or stimulation of duodenal bicarbonate secretion since the dose of epidermal...... growth 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...

  16. Malrotation causing duodenal chronic obstruction in an adult

    Institute of Scientific and Technical Information of China (English)

    Jun Gong; Zhen-Jiang Zheng; Gang Mai; Xu-Bao Liu

    2009-01-01

    Congenital duodenal obstruction is rare in adulthood. An unusual presentation of this condition has led to difficult preoperative diagnosis. We present a case of proximal jejunal obstruction by a congenital band in an adult and review the literature.

  17. 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...

  18. 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 ...

  19. Management of Simultaneous Biliary and Duodenal Obstruction: The Endoscopic Perspective

    OpenAIRE

    Baron, Todd H

    2010-01-01

    Obstructive jaundice often develops in patients with unresectable malignancy in and around the head of the pancreas. Duodenal obstruction can also occur in these patients, and usually develops late in the disease course. Palliation of both malignant biliary and duodenal obstruction is traditionally performed with surgical diversion of the bile duct and stomach, respectively. With the advent of nonsurgical palliation of biliary obstruction using endoscopic transpapillary expandable metal stent...

  20. Isolated duodenal rupture due to blunt abdominal trauma

    Directory of Open Access Journals (Sweden)

    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.

  1. Clinical and morphological characteristics of chronic duodenitis in children

    OpenAIRE

    Tishchenko D.V.; Matveeva O.V.; Chernenkov Yu.V.; Maslyakova G.N.; Bucharskaya A.B.

    2012-01-01

     

    The research goal is to determine clinical, endoscopic and morphological signs of chronic duodenitis in children. Materials and methods: The diagnostic value of molecular markers has been revealed by immunohistochemical research of biopsy. It has been received from endoscopic examination of 32 children aged from 3 to 17 years old with chronic duodenitis. Morphometric investigation of markers expression has been ca...

  2. Russell body duodenitis with immunoglobulin kappa light chain restriction

    OpenAIRE

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

    2015-01-01

    Russell bodies are eosinophilic intracytoplasmic globules which are likely the result of disturbed secretion of immunoglobulins that accumulate within the plasma cell. Russell body collections have been identified within the stomach, known as Russell body gastritis. Similar lesions within the duodenum are referred to as Russell body duodenitis, which is rare. Several Russell body gastritis case reports are associated with Helicobacter pylori. However, the etiology of Russell body duodenitis r...

  3. The water jet deformation sign: a novel provocative colonoscopic maneuver to help diagnose an inverted colonic diverticulum.

    Science.gov (United States)

    Cappell, Mitchell S

    2009-03-01

    Colonoscopic differentiation of an inverted colonic diverticulum from a true colonic polyp is important because a true colonic polyp usually requires colonoscopic snare polypectomy or at least biopsy, whereas these maneuvers are contraindicated for an inverted diverticulum due to the risk of colonic perforation. Previously described diagnostic maneuvers to evert an inverted diverticulum include probing it with a closed biopsy forceps or intraluminal air insufflation during colonoscopy. On colonoscopy, a 59-year-old female had two intraluminal colonic projections. Probing these projections and using air insufflation failed to indent or evert them. Spraying these lesions with a water jet, however, flattened or partly everted them. This novel maneuver provided conclusive evidence that these intraluminal projections represented inverted diverticula. The proposed pathophysiology is that water pressure causes an inverted diverticulum to indent or evert due to its thin wall. The currently reported maneuver may be easier and safer than probing an inverted diverticulum with biopsy forceps and may prove a more reliable diagnostic maneuver than air insufflation. PMID:19204608

  4. 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

  5. DUODENAL – ILEAL FISTULA, RARE VARIANT OF PENETRATING OF DUODENAL ULCER, ASSOCIATED WITH SIGMOID CANCER

    Directory of Open Access Journals (Sweden)

    A. Andercou

    2013-09-01

    Full Text Available Duodeno-ileal fistula has benign (penetration of the duodenal ulcer or malignant etiology. We present the case of a 73 years old woman, with history of right colectomy; she was admitted in our surgical unit for abdominal pain, fecaloid vomiting, fetid halitosis, bloody diarrhea, weight loss and impaired general condition. A moderate anemia and several electrolytic disorders have been revealed by the laboratory exams. The upper digestive endoscopy revealed a penetrating duodenal ulcer with duodeno-ileal fistula and colonoscopy a stenosant tumor at 25 cm of the anal edge. After the correction of anemia and electrolytic disorders an exploratory laparotomy was performed The exploration noted a tumor mass which included duodenum and gastric antrum, gallbladder, ileum, sigmoid loop and the great omentum. The careful dissection confirmed the sigmoid cancer invading the antropyloric region and the double duodenal ulcer with pancreatic penetration and duodeno-ileal fistula. Multiple organs resection were performed: anterograde cholecystectomy; segmental enterectomy; ¾ distal gastric resection with precolic gastro-jejunal anastomosis (Leger type; sigmoid resection with end-to-end colo-colic anastomosis. The postoperative course was uneventful. Several data from the literature were discussed. CONCLUSIONS: Duodeno-ileal fistula is an accidental variety of ulcer penetration caused by particular morphopathological conditions. Surgical treatment of gastro-digestive fistulas should be applied early with a correct balancing of the patient. Operation is complex and often atypical and implies multiple organs resections. In this particular case, the sigmoid cancer which invaded the distal part of the stomach complicated much more the surgical procedure.

  6. Laparoscopy in the treatment of a giant true epiphrenic diverticulum with migration of the gastrointestinal anastomosis staples

    International Nuclear Information System (INIS)

    Our case is a 62-year-old diabetic man with a long-standing history of regurgitation, halitosis, recurrent chest infection, and most recently upper gastro-intestinal bleeding. He was diagnosed 10 years earlier with an epiphrenic esophageal diverticulum, and also has a family history of this condition. Barium study revealed a 10x10 cm epiphrenic diverticula with a 4 cm neck, the lower margin of the opening lying 6 cm from the gastro-esophageal junction. Endoscopy confirmed the x-ray findings, and motility studies were within normal limits. The patient underwent laparoscopic excision of the diverticulum via the trans-abdominal approach. Histopathological examination revealed this diverticulum to be of the true type. (author)

  7. Perforated duodenal ulcer in Asir central hospital

    Directory of Open Access Journals (Sweden)

    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.

  8. Meckels diverticulum in children: A 12 years experience in Amir-Kabir children's hospital

    OpenAIRE

    Pediatric; Acute abdomen; Meckel's diverticulum

    1999-01-01

    Meckels Diverticulum is the most common congenital anomaly of GI tract. Complications develop in about 4% of cases as an acute abdomen. During the last 12 years, 58 patients with Meckel's diverticulum were treated in Amir-Kabir children's hospital. The majority of our cases (84%, 49 from 58) were under 6 years of age, with boys outnumbering girls (4:1). Intestinal obstruction was the most common form of presentation, included 60% of symptomatic patients and lower GI bleeding was the...

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

    Directory of Open Access Journals (Sweden)

    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.

  10. 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.

  11. Total endovascular repair of aberrant left subclavian artery with Kommerell's diverticulum using a customized branched device.

    Science.gov (United States)

    Silveira, Pierre Galvagni; Franklin, Rafael Narciso; Cunha, Josué Rafael Ferreira; Neves, Thais Torres; Nascimento, Gilberto Galego; Bortoluzzi, Cristiano Torres

    2013-04-01

    We describe a case of Kommerell's diverticulum involving the distal portion of a right-sided aortic arch and the origin of an aberrant left subclavian artery (LSA). The patient underwent a total endovascular repair with the use of a modified Valiant endograft (Medtronic, Minneapolis, Minn) to which a branch was attached to keep LSA patency. Postoperative computed tomography showed complete exclusion of the lesion, without endoleaks. The use of "customized off-label" devices to treat special conditions was feasible in this case, keeping patency of the LSA without risk of arm claudication or the requirement for a complementary surgical bypass. PMID:23312832

  12. 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.

  13. [Acute complications after endoscopic resection of duodenal adenomas].

    Science.gov (United States)

    König, J; Kaiser, A; Opfermann, P; Manner, H; Pohl, J; Ell, C; May, A D

    2014-02-01

    With the increasing technological development of endoscopy in recent years the diagnosis of and endoscopic therapy for duodenal adenomas has gained in importance. Due to its potentially malignant transformation an effective and safe therapy is necessary. The endoscopic resection has been shown to be safe and effective, even in cases of resection of large duodenal adenomas. Several studies have supported this thesis but are based on relatively small numbers of patients. In our clinic we have performed endoscopic resections of 178 duodenal adenomas over a period of 14 years, including sporadic duodenal adenomas as well as adenomas in familial polyposis syndromes. The aim of this retrospective analysis was to determine the acute complications associated with this technique. The rate of severe complications such as major bleeding or perforations was 9%. Further complications were minor bleeding (15.7%), pain needing treatment with analgesia (6.7%), fever (2.8%) and pancreatitis (0.6%). Summing up our experience with the endoscopic resection of adenomas of the small bowel we also consider the endoscopic resection of duodenal adenomas in most cases as a safe and effective alternative to surgical therapy. Because of the potential complications and their management especially in the resection of large adenomas with a size more than 2 cm, the endoscopic resection should be performed on an inpatient basis in experienced centres. PMID:24526403

  14. Two Cases of Diffuse Duodenitis Associated with Ulcerative Colitis

    Directory of Open Access Journals (Sweden)

    Katsuya Endo

    2012-01-01

    Full Text Available The upper gastrointestinal tract is not generally considered a target organ in ulcerative colitis (UC. However, several cases showing upper gastrointestinal involvement in UC have been reported. In this report, we present 2 rare cases of diffuse duodenitis accompanying pancolonic UC. Case patient 1 was a 44-year-old man who developed diffuse duodenitis shortly after colectomy and was successfully treated with mesalazine. Case patient 2 was a 25-year-old woman who developed diffuse duodenitis under a steroid-free condition and was successfully treated with prednisolone. The 2 patients had Helicobacter pylori-negative duodenitis that resembled colonic lesions of UC in both the endoscopic and histological findings. No evidence of Crohn’s disease was found in these cases. We diagnosed both cases as typical UC-associated diffuse duodenitis. The occurrence of gastrointestinal involvement in UC has been attracting attention because such lesions could potentially open a new window for studying the etiology and pathogenesis of UC. Further studies involving a large number of patients are needed to clarify whether the upper gastrointestinal tract is a target organ in UC.

  15. Management of gastric and duodenal neuroendocrine tumors

    Science.gov (United States)

    Sato, Yuichi; Hashimoto, Satoru; Mizuno, Ken-ichi; Takeuchi, Manabu; Terai, Shuji

    2016-01-01

    Gastrointestinal neuroendocrine tumors (GI-NETs) are rare neoplasms, like all NETs. However, the incidence of GI-NETS has been increasing in recent years. Gastric NETs (G-NETs) and duodenal NETs (D-NETs) are the common types of upper GI-NETs based on tumor location. G-NETs are classified into three distinct subgroups: type I, II, and III. Type I G-NETs, which are the most common subtype (70%-80% of all G-NETs), are associated with chronic atrophic gastritis, including autoimmune gastritis and Helicobacter pylori associated atrophic gastritis. Type II G-NETs (5%-6%) are associated with multiple endocrine neoplasia type 1 and Zollinger-Ellison syndrome (MEN1-ZES). Both type I and II G-NETs are related to hypergastrinemia, are small in size, occur in multiple numbers, and are generally benign. In contrast, type III G-NETs (10%-15%) are not associated with hypergastrinemia, are large-sized single tumors, and are usually malignant. Therefore, surgical resection and chemotherapy are generally necessary for type III G-NETs, while endoscopic resection and follow-up, which are acceptable for the treatment of most type I and II G-NETs, are only acceptable for small and well differentiated type III G-NETs. D-NETs include gastrinomas (50%-60%), somatostatin-producing tumors (15%), nonfunctional serotonin-containing tumors (20%), poorly differentiated neuroendocrine carcinomas (< 3%), and gangliocytic paragangliomas (< 2%). Most D-NETs are located in the first or second part of the duodenum, with 20% occurring in the periampullary region. Therapy for D-NETs is based on tumor size, location, histological grade, stage, and tumor type. While endoscopic resection may be considered for small nonfunctional D-NETs (G1) located in the higher papilla region, surgical resection is necessary for most other D-NETs. However, there is no consensus regarding the ideal treatment of D-NETs. PMID:27570419

  16. 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.

  17. Treating bilio-duodenal obstruction: Combining new endoscopic technique with 6 Fr stent introducer

    OpenAIRE

    Maetani, Iruru; Nambu, Tomoko; Omuta, Shigefumi; Ukita, Takeo; Shigoka, Hiroaki

    2010-01-01

    Periampullary cancer may cause not only biliary but also duodenal obstructions. In patients with concomitant duodenal obstructions, endoscopic biliary stenting remains technically difficult and may often require percutaneous transhepatic biliary drainage. We describe a method of metal stent placement via a thin forward-viewing endoscope in patients with simultaneous biliary and duodenal obstruction. In two consecutive patients with biliary and duodenal obstruction due to pancreatic cancer, a ...

  18. Treating bilio-duodenal obstruction: Combining new endoscopic technique with 6 Fr stent introducer

    Institute of Scientific and Technical Information of China (English)

    Iruru; Maetani; Tomoko; Nambu; Shigefumi; Omuta; Takeo; Ukita; Hiroaki; Shigoka

    2010-01-01

    Periampullary cancer may cause not only biliary but also duodenal obstructions. In patients with concomitant duodenal obstructions, endoscopic biliary stenting remains technically difficult and may often require percutaneous transhepatic biliary drainage. We describe a method of metal stent placement via a thin forwardviewing endoscope in patients with simultaneous biliary and duodenal obstruction. In two consecutive patients with biliary and duodenal obstruction due to pancreatic cancer, a new biliary meta...

  19. 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.

  20. Duodenal adenoma surveillance in patients with familialadenomatous polyposis

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    Familial adenomatous polyposis (FAP) is a hereditarydisorder caused by Adenomatous Polyposis Genemutations that lead to the development of colorectalpolyps with great malignant risk throughout life. Moreover,numerous extracolonic manifestations incorporatedifferent clinical features to produce varied individualphenotypes. Among them, the occurrence of duodenaladenomatous polyps is considered an almost inevitableevent, and their incidence rates increase as a patient'sage advances. Although the majority of patients exhibitdifferent grades of duodenal adenomatosis as theyage, only a small proportion (1%-5%) of patients willultimately develop duodenal carcinoma. Within thiscontext, the aim of the present study was to reviewthe data regarding the epidemiology, classification,genetic features, endoscopic features, carcinogenesis,surveillance and management of duodenal polyps inpatients with FAP.

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

    Directory of Open Access Journals (Sweden)

    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.

  2. Radiation-induced hemorrhagic duodenitis associated with sorafenib treatment.

    Science.gov (United States)

    Yanai, Shunichi; Nakamura, Shotaro; Ooho, Aritsune; Nakamura, Shigeo; Esaki, Motohiro; Azuma, Koichi; Kitazono, Takanari; Matsumoto, Takayuki

    2015-06-01

    Sorafenib, an oral inhibitor of multiple tyrosine kinase receptors, has been widely used as a standard medical treatment for advanced hepatocellular carcinoma (HCC). Here, we report a 66-year-old male patient who developed gastrointestinal bleeding due to radiation-induced hemorrhagic duodenitis associated with sorafenib treatment. We started oral administration of sorafenib because of the recurrence of HCC with lung metastases. The patient had been treated by radiotherapy for para-aortic lymph node metastases from HCC 4 months before the bleeding. Esophagogastroduodenoscopy (EGD) revealed edematous reddish mucosa with friability and telangiectasia in the second portion of the duodenum. Computed tomography and capsule endoscopy revealed that the hemorrhagic lesions were located in the distal duodenum. After discontinuation of sorafenib, the bleeding disappeared and a follow-up EGD confirmed improvement of duodenitis. Based on these findings, the diagnosis of radiation-induced hemorrhagic duodenitis associated with sorafenib was made. PMID:25832768

  3. Duodenal duplication cyst that manifested as duodeno-jejunal intussusception in an adult: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Kwon, Hee Jin [College of Medicine, Dong-A University, Busan (Korea, Republic of)

    2007-08-15

    Duodenal duplication cyst account for 4% or 5% of all gastrointestinal duplications. Duodenal duplication acting as a lead point for an intussusception is an extremely rare event as it is largely a fixed retroperitoneal structure. We report here on the radiologic findings of a case of duodenal duplication cyst that manifested as duodeno-jejunal intussusception in an adult.

  4. 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.)

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

    International Nuclear Information System (INIS)

    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.)

  6. A RETROSPECTIVE STUDY ON DUODENAL ULCER PERFORATION AND OUTCOME

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    Parameshwara Chaldiganahalli

    2016-02-01

    Full Text Available INTRODUCTION Duodenal ulcer disease which was once so common 3-4 decades ago has drastically decreased in its incidence due to invent of PPIs and anti H. Pylori therapy. But percentage of patients with complications of duodenal ulcer has not shown a similar decline. In spite of understanding the disease effective resuscitation and prompt surgery there is still High incidence of morbidity and mortality. Hence in this study an attempt is made to analyse the various factors which effect the morbidity, mortality of patients with duodenal ulcer perforation and management of the same. AIMS The objective is to study, 1. The factors responsible for duodenal ulcer perforation. 2. The factors that affect the post-operative outcome. 3. Morbidity, mortality after surgery. MATERIALS AND METHODS Fifty patient’s case sheets were selected retrospectively who were diagnosed as duodenal ulcer perforation, admitted in MIMS Hospital, Mandya. Between 2012 to 2014 patients underwent Graham's omentoplasty. All the data related to the objectives of the study were collected. RESULTS Majority of patients belong to the. Age group of 30-50 years and commonly males Most of the perforations occur in first part of duodenum low socio-economic group, O+ve blood group with maximum seasonal incidence in October-January All cases were managed by Graham's omentoplasty. Four per cent of mortality noted. CONCLUSION Duodenal ulcer perforation is one of the common acute abdominal emergencies. The peak incidence between 30 and 50 years, majority cases males, common in lower socio–economic group, unskilled workers, maximum incidence period October-January, increased morbidity and mortality when perforation time period >24 hours, maximum in patient with blood group o+, early diagnosis and septicaemia management necessary for patients better prognosis, emergency procedure is Graham’s omentoplasty (perforations<2cm with H. pylori eradication treatment. Mortality noticed in longer

  7. Bleeding duodenal hemangioma: Morphological changes and endoscopic mucosal resection

    Institute of Scientific and Technical Information of China (English)

    Noriko Nishiyama; Hirohito Mori; Hideki Kobara; Shintarou Fujihara; Takako Nomura; Mitsuyoshi Kobayashi; Tsutomu Masaki

    2012-01-01

    Recently,the development of endoscopic procedures has increased the availability of minimally invasive treatments; however,there have been few case reports of duodenal hemangioma treated by endoscopic mucosal resection.The present report describes a case of duodenal hemangioma that showed various endoscopic changes over time and was treated by endoscopic mucosal resection.An 80-year-old woman presented with tarry stools and a loss of appetite.An examination of her blood revealed severe anemia,and her hemoglobin level was 4.2 g/dL.An emergency upper gastrointestinal endoscopy was performed.A red,protrusive,semipedunculated tumor (approximately 20 mm in diameter) with spontaneous bleeding on its surface was found in the superior duodenal angle.Given the semipedunculated appearance of the tumor,it was suspected to be an epithelial tumor with a differential diagnosis of hyperplastic polyp.The biopsy results suggested a telangiectatic hemangioma.Because this lesion was considered to be responsible for her anemia,endoscopic mucosal resection was performed for diagnostic and treatment purposes after informed consent was obtained.A histopathological examination of the resected specimen revealed dilated and proliferated capillary lumens of various sizes,which confirmed the final diagnosis of duodenal hemangioma.Neither anemia nor tumor recurrence has been observed since the endoscopic mucosal resection (approximately 1 year).Duodenal hemangiomas can be treated endoscopically provided that sufficient consideration is given to all of the possible treatment strategies.Interestingly,duodenal hemangiomas show morphological changes that are influenced by various factors,such as mechanical stimuli.

  8. Meckels diverticulum in children: A 12 years experience in Amir-Kabir children's hospital

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    Pediatric

    1999-08-01

    Full Text Available Meckels Diverticulum is the most common congenital anomaly of GI tract. Complications develop in about 4% of cases as an acute abdomen. During the last 12 years, 58 patients with Meckel's diverticulum were treated in Amir-Kabir children's hospital. The majority of our cases (84%, 49 from 58 were under 6 years of age, with boys outnumbering girls (4:1. Intestinal obstruction was the most common form of presentation, included 60% of symptomatic patients and lower GI bleeding was the second one and included 25% of symptomatic cases. 31% (18 cases were found in laparotomy for other reasons (Asymptomatic. There were heterotopic gastric mucosa in all of 10 patients with lower GI bleeding out in 4 of 18 incidentally discovered cases. In conclusion the Meckel's diverticulum must be one of the primary concern, in the differential diagnosis of the pediatric patients with painless, moderate to massive rectal bleeding with or without clots, intestinal obstruction or abdominal pain of uncertain cause. Heterotopic tissue in Meckel's diverticulum has important role in occurrence of complications.

  9. MEDITATION ON THE PATHOGENESIS OF HYPOPHARYNGEAL (ZENKERS) DIVERTICULUM AND A REPORT OF ENDOSCOPIC TREATMENT IN 545 PATIENTS

    NARCIS (Netherlands)

    VANOVERBEEK, JJM

    1994-01-01

    Much discussion in the literature concerning Zenker's diverticulum is related to etiology. Various theories have been propounded, but no single conclusion is generally accepted. We believe that an anatomic predisposition plays a prominent role. Considerations for this conclusion will be discussed. I

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

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    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.

  11. Gastric Diverticulum: “A Wayside House of Ill Fame” with a Laparoscopic Solution

    Science.gov (United States)

    DuBois, Ben; Powell, Ben

    2012-01-01

    Background: Gastric diverticulum (GD) is an extremely rare disorder that can easily be overlooked when investigating the cause of abdominal pain. Its diagnosis is founded on a history of gastrointestinal symptoms and a typically unrevealing physical examination, and diagnosis requires confirmation from UGI contrast studies, EGD, and CT scan. Symptomatic GD should be kept in consideration as a cause of abdominal issues, because not only is it treatable, but also complications of GD can be life threatening. The surgical treatment of GDs has evolved from thoraco-abdominal incisions in the early twentieth century to the laparoscopic approach used today. Case Report: The patient is a 45-y-old male presenting with a 4-mo case of dysphagia, small amounts of regurgitation, and abdominal pain but no other symptoms. Results: The patient was diagnosed with a gastric diverticulum, which was subsequently successfully treated with a laparoscopic gastric diverticulectomy. Conclusion: Laparoscopic gastric diverticulectomy is a safe procedure and should be considered as an option to treat symptomatic GD. PMID:23318077

  12. 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.

  13. Tracheal diverticulum: an unusual cause of chronic cough and recurrent respiratory infections.

    Science.gov (United States)

    Takhar, Rajendra Prasad; Bunkar, Motilal; Jain, Shubhra; Ghabale, Sanjay

    2016-03-01

    Tracheal diverticulum (TD) defined as a typical benign out-pouching of the tracheal wall due to structural weakness, congenital or acquired in origin, resulting in paratracheal air cysts. It is rarely diagnosed in clinical practice with only limited reports in the literature. Most cases found incidentally in the postmortem examination and located on the right side. Uncomplicated TDs are usually asymptomatic and when symptoms have occurred, they usually present with non-specific symptoms like pharyngeal discomfort, cough, dyspnea, and recurrent respiratory infection due to either the compression of adjacent organs or secondary bacterial infection. Imaging techniques like thoraco-cervical multi-slice spiral computed tomography (CT) and fiber-optic bronchoscopy are important diagnostic tools for this entity. Asymptomatic TDs usually require no treatment and managed conservatively while surgical excision is indicated in cases of compression of adjacent organs and recurrent infections. Here we report a case of tracheal diverticulum on the left side, which was diagnosed as part of a work-up for chronic cough and recurrent chest infection in a 40 year old female who was already on bronchodilator without any relief. Diagnosis of TD was based on findings of computed tomography, revealing small bud like projection on left para tracheal region and further confirmed by fiber-optic bronchoscopy while the barium contrast study showed no esophageal communication. She was managed conservatively and referred for surgical excision. PMID:27266290

  14. 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.

  15. 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.

  16. 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.

  17. Cystic dystrophy of heterotopic pancreas in duodenal wall

    Directory of Open Access Journals (Sweden)

    Gandhi Minesh B

    2014-05-01

    Full Text Available Cystic dystrophy in heterotopic pancreas is a rare, poorly understood benign disease of gastric and duodenal wall, which was described for the first time by the French authors in 1970, who reported the presence of focal pancreatic disease localized in an area comprising the C-loop of duodenum & the head of pancreas. We report a case of 33 years old male patient with complaint of recurrent abdominal pain with the probable diagnosis of groove pancreatitis on the clinoradiological findings. Whipple surgery was done. Diagnosis of cystic dystrophy in heterotopic pancreas in duodenal wall with chronic pancreatitis was given histopathologically

  18. 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...

  19. DISINSERTION OF DUODENAL PAPILLA DURING DUODENAL SURGERY – 20 YEARS AFTER SURGICAL REPAIR

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    V. Șurlin

    2010-11-01

    Full Text Available The authors present the case of a 68 years old patient admitted for chronic calculous cholecistitis and symptomatic choledocolithiasis with obstructive jaundice and moderate biochemical cholestasis. The patient had a Reichel-Polya gastric resection for ulcer 20 years ago with disinsertion of duodenal papilla repaired with jejunal loop patch in “Roux en Y”. Intraoperatively we noticed chronic sclerous acalculous cholecistitis, equivalence of cholecisto-choledocal fistula, choledocolithiasis. Exploration of the duodenal papilla identified a relative oddian stenosis. The first and second parts of duodenum were absent and replaced by a jejunal loop in “Roux en Y” patching the papilla on the side, with a free blind end and anastomosed laterally to the gastric stump. The second, subvaterian part of duodenum have been closed and left blind. The treatment of the common bile duct lithiasis consisted in cholecistectomy with primary closure of the large communication between the gallbladder and common bile duct, coledocolithotomy, common bile duct (CBD lavage. To ensure an adequate biliary flow we decided for a side-to-side anastomosis between the CBD and the blind part of the jejunal Roux-en-Y loop. The blind end of the second subvaterian part of the duodenum was anastomosed in an end-to-end fashion also to the blind end of the jejunal Roux-en-Y- loop to ensure some biliary flow through remaining part of the duodenum. The postoperative course was simple. At 2 years of follow-up the patient is free of symptoms.

  20. 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.

  1. 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.

  2. Perforated Meckel's diverticulum presenting with combined bowel and urinary obstruction and mimicking Crohn's disease: a case report

    Directory of Open Access Journals (Sweden)

    Wong Banny S

    2010-08-01

    Full Text Available Abstract Introduction Meckel's diverticulum is a common congenital anomaly of the gastrointestinal tract, but is an uncommon cause of serious complications in adults. Although cases of patients with hemorrhage, bowel obstruction or perforation associated with Meckel's diverticulum have been reported, there have been no prior reports of patients with combined urinary and bowel obstruction due to abscess formation. Case presentation We describe the case of a 21-year-old man with a history of recurrent papillary thyroid cancer, but no prior abdominal surgeries, who presented with a one-month history of rectal pain and new-onset obstipation with urinary retention. He reported night sweats and weight loss, and had a second-degree relative with known Crohn's disease. A digital rectal examination was notable and revealed marked tenderness with proximal induration. A computed tomography scan of the patient's abdomen revealed a large, complex, circumferential perirectal abscess compressing the rectal lumen and base of the urinary bladder, associated with terminal ileal thickening and an ileocecal fistula. A flexible sigmoidoscopy with an endorectal ultrasound scan displayed a complex abscess with extensive mucosal and surrounding inflammation. An exploratory laparotomy revealed a Meckel's diverticulum with a large perforation at its base, positioned near the ileocecal fistula and immediately superior to the perirectal abscess. The section of small bowel containing the Meckel's diverticulum, the terminal ileum, and the cecum, were all resected, and the abscess was debrided. Conclusions Pre-operative diagnosis of Meckel's diverticulum can be difficult. If the nature of the complication makes ultimate surgical management likely, an early laparoscopic or open exploration should be performed to prevent the morbidity and mortality associated with late complications.

  3. Perforated duodenal ulcer: an unusual complication of gastroenteritis.

    OpenAIRE

    Wilson, J. M.; Darby, C. R.

    1990-01-01

    A 7 year old boy was admitted to hospital with gastroenteritis, which was complicated by an acute perforated duodenal ulcer. After oversewing of the perforation he made an uncomplicated recovery. Peptic ulceration is under-diagnosed in childhood and this leads to delay in diagnosis and appropriate management. Ulceration is associated with severe illness and viral infections, but perforation is rare.

  4. Duodenal atresia in association with situs inversus abdominus

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    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.

  5. 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.)

  6. Omeprazole promotes proximal duodenal mucosal bicarbonate secretion in humans

    DEFF Research Database (Denmark)

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

    1996-01-01

    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...

  7. Management of a large mucosal defect after duodenal endoscopic resection

    Science.gov (United States)

    Fujihara, Shintaro; Mori, Hirohito; Kobara, Hideki; Nishiyama, Noriko; Matsunaga, Tae; Ayaki, Maki; Yachida, Tatsuo; Masaki, Tsutomu

    2016-01-01

    Duodenal endoscopic resection is the most difficult type of endoscopic treatment in the gastrointestinal tract (GI) and is technically challenging because of anatomical specificities. In addition to these technical difficulties, this procedure is associated with a significantly higher rate of complication than endoscopic treatment in other parts of the GI tract. Postoperative delayed perforation and bleeding are hazardous complications, and emergency surgical intervention is sometimes required. Therefore, it is urgently necessary to establish a management protocol for preventing serious complications. For instance, the prophylactic closure of large mucosal defects after endoscopic resection may reduce the risk of hazardous complications. However, the size of mucosal defects after endoscopic submucosal dissection (ESD) is relatively large compared with the size after endoscopic mucosal resection, making it impossible to achieve complete closure using only conventional clips. The over-the-scope clip and polyglycolic acid sheets with fibrin gel make it possible to close large mucosal defects after duodenal ESD. In addition to the combination of laparoscopic surgery and endoscopic resection, endoscopic full-thickness resection holds therapeutic potential for difficult duodenal lesions and may overcome the disadvantages of endoscopic resection in the near future. This review aims to summarize the complications and closure techniques of large mucosal defects and to highlight some directions for management after duodenal endoscopic treatment. PMID:27547003

  8. A Rare Cause of Persistent Nausea and Vomiting: Candida Duodenitis

    Directory of Open Access Journals (Sweden)

    Mustafa Yildirim

    2014-03-01

    Full Text Available Ižntestinal bowel lesions caused by Candida species are uncommon. These lesions may be  plaques or ulcers form. In this article, We presented endoscopic images  Candida duodenitis as a cause of persistent nausea, vomiting in a lung cancer patient treated with chemotherapy.  

  9. A Rare Cause of Persistent Nausea and Vomiting: Candida Duodenitis

    OpenAIRE

    Mustafa Yildirim

    2014-01-01

    Intestinal bowel lesions caused by Candida species are uncommon. These lesions may be  plaques or ulcers form. In this article, We presented endoscopic images  Candida duodenitis as a cause of persistent nausea, vomiting in a lung cancer patient treated with chemotherapy.  

  10. Duodenal invagination som årsag til ventrikelretention

    DEFF Research Database (Denmark)

    Alamili, Mahdi; Berg, Jais Oliver; Lindström, Christine;

    2008-01-01

    A case of gastroduodenal intussusception caused by a duodenal lipoma is presented. The condition was characterized by severe upper gastrointestinal retention, epigastric pain and weight loss. The mass was diagnosed by CT scan. The diagnosis was confirmed by operation. The patient was treated...

  11. Abnormal duodenal loop demonstrated by X-ray. Correlation to symptoms and prognosis of dyspepsia

    Energy Technology Data Exchange (ETDEWEB)

    Thommesen, P.; Funch-Jensen, P.

    1986-01-01

    The occurrence of dyspeptic symptoms has previously been correlated with the shape of the duodenal loop in patients with X-ray-negative dyspepsia. An abnormal duodenal loop was associated with a significantly higher incidence of symtoms provoked by meals, vomiting, regurgitations, heartburn, and the irritable bowel syndrome. 89% of these patients (26 patients with a normal duodenal loop and 39 patients with abnormal duodenal loop) were available for a 5-year follow-up study of symptomatic outcome. The incidence of symptoms provoked by meals was still significantly higher in patients with an abnormal duodenal loop, and there was also a significant difference concerning symptomatic outcome. Approximately 75% of the patients with a normal duodenal loop had improved, and 25% had unchanged clinical conditions. Approximately 50% of the patients with an abnormal duodenal loop had improved, and 50% had an unchanged or even deteriorated clinical condition.

  12. 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

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

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    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

  14. Duodenal histology, ulceration, and Helicobacter pylori in the presence or absence of non-steroidal anti-inflammatory drugs.

    OpenAIRE

    Taha, A S; Dahill, S; Nakshabendi, I.; Lee, F D; Sturrock, R D; Russell, R I

    1993-01-01

    Duodenitis and gastric metaplasia, which is often colonised by Helicobacter pylori (H pylori), are increasingly recognised for their importance in the pathogenesis of duodenal ulcers. The situation is not clear in patients receiving non-steroidal anti-inflammatory drugs (NSAIDs), who have a higher risk of peptic ulceration. The aim of this study was to identify the duodenal histological abnormalities in the presence or absence of NSAIDs, H pylori, and duodenal ulceration. Endoscopic duodenal ...

  15. Acute pancreatitis secondary to duodeno-duodenal intussusception caused by a duodenal membrane, in a patient with intestinal malrotation

    DEFF Research Database (Denmark)

    Larsen, Pernille Oehlenschläger; Pedersen, Mark Ellebæk; Kjærulf Pless, Torsten;

    2015-01-01

    Duodeno-duodenal intussusception is often caused by an intraluminal tumour. The condition is rare owing to the retroperitoneal fixation of the duodenum, which is sometime absent in cases of intestinal malrotation. We describe the case of a 19-year old man admitted to hospital with abdominal pain ...

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

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    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.

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

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    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.

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

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    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.

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

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    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.

  20. Flexible endoscopic cricopharyngeal myotomy - The gold standard for the management of Zenker's diverticulum.

    Science.gov (United States)

    Juzgado Lucas, Diego

    2016-06-01

    The prevalence of Zenker's diverticulum (ZD) is difficult to estimate. If we focus on some published data, it may be as low as 2 new cases per 100,000 inhabitants per year in the United Kingdom, which is in contrast the with feeling in some endoscopy units, that this condition's prevalence is increasing year after year. Prevalence likely remains the same as ever, but the addition of factors such as population ageing, optimal diagnostic care, availability of effective endoscopic management, increased awareness, and cumulative experience in some endoscopy teams, may well have increasingly brought this condition to our attention in our daily practice. This is reflected by an unbelievable 18 ZDs over the last 18 months, as discussed in the manuscript by Dr. de la Morena, reported in this issue of The Spanish Journal of Digestive Diseases (Revista Española de Enfermedades Digestivas. PMID:27282273

  1. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  3. 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...

  4. Heterotopic Pancreas Presented as Duodenal Tumor with Obstruction.

    Science.gov (United States)

    Kim, Sung Heun; Nam, So Hyun

    2015-12-01

    Heterotopic pancreas (HP) is defined as pancreatic tissue lacking anatomic and vascular continuity with the main body of the pancreas. Most are asymptomatic, but can cause ulcer, bleeding, intussusception, and mechanical obstruction. Herein, we presented one case of HP presented as duodenal tumor causing duodenal obstruction. A 7-year-old girl visited the emergency room for abdominal pain with vomiting for 24 hours. Computed tomography and upper gastrointestinal series revealed a polypoid mass with short stalk in the 2nd portion of duodenum. We attempted an endoscopic removal. However, the lumen was nearly obstructed by the mass and the stalk was too broad and hard to excise. The mass was surgically removed via duodenotomy. It was confirmed as a HP with ductal and acini components (type 2 by Heinrich classification). Postoperatively, the patient has been well without any complication and recurrence. PMID:26770904

  5. A rare case of duodenal duplication treated surgically

    Institute of Scientific and Technical Information of China (English)

    Mehmet Ali Uzun; Neset Koksal; Munire Kayahan; Atilla Celik; Gamze Klcoglu; Selvinaz Ozkara

    2009-01-01

    Duodenal duplication, a rare congenital malformation,can also be observed in adulthood. Although it can be cystic or tubular, communicating or noncommunicating, cystic and non-communicating forms are the most common. Several complications, such as obstruction, bleeding, perforation and pancreatitis, may result. Optimal treatment is total excision,although endoscopic procedures have also been described in appropriate cases. If total excision is not possible, subtotal excision and internal derivation can be performed. The 38-year-old woman presented here had occasional attacks of abdominal pain and obstruction, and we considered the diagnosis of duodenal duplication by abdominal computerized tomography. As we confirmed the diagnosis with operative findings and histopathological signs, we treated her with subtotal excision and intraduodenal cystoduodenostomy.

  6. 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.

  7. Meckel's diverticulum

    Science.gov (United States)

    Kahn E, Daum F. Anatomy, histology, embryology, and developmental anomalies of the small and large intestine. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran's Gastrointestinal and Liver ...

  8. 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.

  9. Delayed Duodenal Hematoma and Pancreatitis from a Seatbelt Injury

    OpenAIRE

    DeAmbrosis, Katherine; Subramanya, Manjunath S.; Memon, Breda; Memon, Muhammed A.

    2011-01-01

    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 duodena...

  10. [Duodenal varices. Review of the literature apropos of a case].

    Science.gov (United States)

    Boutboul, R; Le Treut, Y P; Maurin, B; Ezraty, A; Castro, R; Bricot, R

    1984-01-01

    The authors report a case of digestive hemorrhage secondary to isolated duodenal varicosities, in a patient with ethylic cirrhosis. The diagnosis done through optical fibroscope was confirmed by arteriography. The evolution was unfavorable. Lesions were corroborated by autopsy. A review of the literature is done, about the 22 cases already published. With the help of these cases to authors stress the points that can lead to the good diagnosis and what therapeutical management should be done. PMID:6335644

  11. Duodenal pseudomelanosis (pseudomelanosis duodeni): a rare endoscopic finding

    OpenAIRE

    Aloísio Felipe-Silva; Fernando Peixoto Ferraz de Campos; José Guilherme Nogueira da Silva

    2011-01-01

    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...

  12. Cystic dystrophy of heterotopic pancreas in duodenal wall

    OpenAIRE

    Gandhi Minesh B; Panjvani Sahil I; Shah Cherry K; Shah Nailesh R

    2014-01-01

    Cystic dystrophy in heterotopic pancreas is a rare, poorly understood benign disease of gastric and duodenal wall, which was described for the first time by the French authors in 1970, who reported the presence of focal pancreatic disease localized in an area comprising the C-loop of duodenum & the head of pancreas. We report a case of 33 years old male patient with complaint of recurrent abdominal pain with the probable diagnosis of groove pancreatitis on the clinoradiological fi...

  13. An Unusual Cause of Gastrointestinal Bleeding: Duodenal Lipoma

    Directory of Open Access Journals (Sweden)

    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.

  14. Malignant duodenal obstructions: palliative treatment with covered expandable nitinol stent

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Hyun Chul; Jung, Gyoo Sik; Lee, Sang Hee; Kim, Sung Min; Oh, Kyung Seung; Huh, Jin Do; Cho, Young Duk [College of Medicine, Kosin Univ, Pusan (Korea, Republic of); Song, Ho Young [College of Medicine, Ulsan Univ., Seoul (Korea, Republic of)

    2002-04-01

    To evaluate the feasibility and clinical effectiveness of using a polyurethane-covered expandable nitinol stent in the palliative treatment of malignant duodenal obstruction. Under fluoroscopic guidance, a polyurethane-covered expandable nitinol stent was placed in 12 consecutive patients with malignant duodenal obstructions. All presented with severe nausea and recurrent vomiting. The underlying causes of obstruction were duodenal carcinoma (n=4), pancreatic carcinoma (n=4), gall bladder carcinoma (n=2), distal CBD carcinoma (n=1), and uterine cervical carcinoma (n=1). The sites of obstruction were part I (n=1), part II (n=8), and III (n=3). Due to pre-existing jaundice, eight patients with part II obstructions underwent biliary decompression prior to stent placement. An introducer sheath with a 6-mm outer diameter and stents 16 mm in diameter were employed, and to place the stent, and after-loading technique was used. Stent placement was technically successful in ten patients, and no procedural complications occuured. In one of two patients in whom there was technical failure, and in whom the obstructions were located in part III, the stent was placed transgastrically. Stent migration occurred in one patient four days after the procedure, and treatment involved the palcement of a second, uncovered, nitinol stent. After stent placement, symptoms improved in all patients. During follow-up, obstructive symptoms due to stent stenosis (n=1), colonic obstruction (n=1), and multiple small bowel obstruction (n=1) recurred in three patients. Two of these were treated by placing additional stents in the duodenum and colon, respectively. One of the eight patients in whom a stent was placed in the second portion of the duodenum developed jaundice. The patients died a mean 14 (median, 9) weeks after stent placement. The placement of a polyurethane-covered expandable nitinol stent seems to be technically feasible, safe and effective for the palliative treatment of malignant

  15. An unusual cause of upper gastrointestinal system bleeding: Duodenal varices

    OpenAIRE

    Yılmaz, Ömer; Ataseven, Hilmi

    2012-01-01

    Abstract Duodenal varices are an uncommon site of hemorrhage in patients with portal hypertension, but their rupture is a serious and often fatal event. We report the case of a 27- year- old man with liver cirrhosis who presented with upper gastrointestinal bleeding. Upper gastrointestinal endoscopy revealed nodular varices in the second portion of the duodenum which were considered to be the source of bleeding. We decided to inject N-butyl-2-cyanoacrylate (Histoacryl), an adhesive agent, and...

  16. SPONTANEOUS DUODENO-BILIARY FISTULA CAUSED BY DUODENAL PEPTIC ULCER

    Directory of Open Access Journals (Sweden)

    N. Danila

    2005-07-01

    Full Text Available Spontaneous duodeno-biliary fistula represents a rare complication of chronic duodenal peptic ulcer. The authors present two cases with this pathology and also the particularities of surgical approach. Spontaneous duodeno-biliary fistula caused by chronic peptic ulcer is often a surprising diagnostic in the era of H2 blockers. The difficulties and the complexity of the diagnosis associated with the particularities of surgical technique represent the key of this rare disease.

  17. Left ventricular diverticulum with marked hypertrophy of the left ventricular apex revealed by thallium-201 myocardial emission CT

    International Nuclear Information System (INIS)

    A case of left ventricular apical diverticulum with marked hypertrophy of the left ventricular apical wall revealed by thallium-201 myocardial emission CT is reported. A 23-year-old woman was admitted to our hospital for evaluation of chest oppression. She was known to have had a heart murmur soon after birth, but she grew uneventfully, partaking in normal exercise. At the age of 21, she began to feel chest oppression during exercise. As the attacks became frequent, she was admitted to our hospital. Physical examination revealed an ejection systolic murmur in the second left intercostal space. Electrocardiography showed ST depression and T inversion in leads III, a VF and V4-6. M-mode echocardiography was normal. Two-dimensional echocardiography showed a small diverticulum at the apex of the left ventricle, which was also recognized by left ventriculography. It was about 8 x 12 mm in size. Thallium-201 myocardial emission CT disclosed marked uptake in the apex of the left ventricle, suggesting apical hypertrophy. Stress thallium-201 myocardial emission CT was negative. Coronary angiography was normal. The cause of chest oppression in this patient is uncertain, but the small diverticulum and hypertrophy of the cardiac apex may play a role in its pathogenesis. (author)

  18. [Chronic Duodenitis and Celiac Disease: a path between the nonspecific and the early stages of Marsh].

    Science.gov (United States)

    Passera, Andrea Helena; Passera, Mario Luis; Higa, Antonio Luis; Nuñez, Maria; Armando, Lucas; Barzón, Silvia

    2015-01-01

    Given the advances in diagnosis for CD, some patients are detected with symptoms and signs of food intolerance, which have positive antibodies and autoantibodies for coeliac disease, whom present proximal bowel biopsies with chronic nonspecific duodenitis and are not associated with stages 0 and 1 Marsh. On the other hand, patients with bloating, abdominal pain, pondostatural delay, negative antibodies for CD, and chronic nonspecific duodenitis in whom removing cow's milk or gluten, the symptoms remit. There are also celiac patients with biopsies before diagnosis, with chronic nonspecific duodenitis. In this paper, we summarize three brothers with different degrees of chronic duodenitis, one with chronic nonspecific duodenitis, and two with histopathological sings of coeliac disease. It is an invitation to think that chronic nonspecific duodenitis in some patients may be an earlier manifestation of celiac disease. PMID:26544059

  19. [New approaches in treatment of patients with perforated duodenal ulcer].

    Science.gov (United States)

    Romashchenko, P N; Maĭstrenko, N A; Korovin, A E; Sibirev, S A; Sidorchuk, P A

    2013-01-01

    The results of examination and treatment of 152 patients with perforated duodenal ulcer were analyzed with the aim to make the ground of systemic approach to their surgical treatment in consideration of contemporary achievements of laboratorial and instrumental diagnostics and the opportunities of minimally invasive surgery. The results of conducted clinical study showed that in order to establish the correct preoperative diagnosis and the choice of rational treatment of patients with perforated duodenal ulcer it is necessary to conduct a purposeful complex investigation, including an assessment of general somatic state and the operative-anaesthetic risk of patients and changes of pyloroduodenal zone and the severity of peritonitis and prediction of lethality. The diagnostic algorithm let the authors make a diagnosis of perforated duodenal ulcer before the operation and decide on an adequate volume of surgical intervention. It is established, that the integral assessment of the examination results and surgery, the evaluation of the titres of antibody to ulcerogenic strains Helicobacter pylori, studying of psychophysiological profile of patient can justify the complex program of medicamentous therapy in postoperative period, providing the remission of peptic ulcer. PMID:24340972

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  2. Semiological characters and morphopathological-radiological correlations in duodenal malignancy.

    Science.gov (United States)

    Bratu, Ana Magdalena; Cristian, Daniel Alin; Sălcianu, Iulia Alecsandra; Zaharia, Constantin; Iana, Gheorghe; Popa, Bogdan Valeriu; Ştefănescu, VictoriŢa

    2015-01-01

    Localized duodenal neoplasms are relatively rare entities, most often representing invasions of the duodenum by malignant masses developed in the duodeno-pancreatic region. The paper makes a more exact analysis of radiological semiology of duodenal localized tumors and seeks to determine through this analysis the role of radiological examinations in the support for the anatomopathologist. The study group included 17 cases of duodenal localized tumors, nine cases of which have been shown to be vaterian ampulloma and eight malignant tumors of the duodenum. All cases were CT (computed tomography) examined and two-thirds were performed conventional radiological examinations, prior to CT examination. Pre-operatively, all cases were evaluated endoscopically, and in three of them bile prostheses were made. CT examination protocol included a native acquisition and post-administration of intravenous contrast agent in both the arterial phase and in parenchymal and venous phase. The acquisition was made with 3 mm thin sections, subsequently coronal and sagittal plane reconstructions being made. The paper tries to establish possible correlations between the morphopathological aspect and the radio-imaging semiological characteristics of lesions. PMID:26662134

  3. 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.

  4. 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

  5. Clinical and morphological characteristics of chronic duodenitis in children

    Directory of Open Access Journals (Sweden)

    Tishchenko D.V.

    2012-09-01

    Full Text Available

     

    The research goal is to determine clinical, endoscopic and morphological signs of chronic duodenitis in children. Materials and methods: The diagnostic value of molecular markers has been revealed by immunohistochemical research of biopsy. It has been received from endoscopic examination of 32 children aged from 3 to 17 years old with chronic duodenitis. Morphometric investigation of markers expression has been carried out by means of analyzing system of digital images of Mikrovizor medical uVizo-103. Results: The index of proliferation has been higher in cells of cover epithelium than in glands. The inductor expression of apoptosis Bax has been poorly expressed in both groups of patients. It has been proved that proliferative processes are predominant in this pathology. Conclusion: It has been found out that proliferation of significant activity in the cover epithelium accompanies the development of preatrophic processes in children with chronic duodenitis. The greater degree of regeneration has been marked in crypts.

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

    Directory of Open Access Journals (Sweden)

    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.

  7. Successful Endoscopic Ultrasound-Guided Transduodenal Biliary Drainage Through a Pre-Existing Duodenal Stent

    OpenAIRE

    Paul J Belletrutti; Hans Gerdes; Schattner, Mark A

    2010-01-01

    Context When ERCP fails in the setting of combined biliary and duodenal obstruction, EUS-guided biliary drainage has emerged as an alternate method of biliary decompression. Case report We present a case of a 40-year-old man with advanced pancreatic cancer and a pre-existing duodenal wall stent who subsequently develops jaundice due to biliary obstruction. An ERCP was technically unsuccessful as the papilla was inaccessible despite probing within the duodenal stent. Transduodenal biliary drai...

  8. Simultaneous Duodenal Metal Stent Placement and EUS-Guided Choledochoduodenostomy for Unresectable Pancreatic Cancer

    OpenAIRE

    Kawakubo, Kazumichi; Isayama, Hiroyuki; Nakai, Yousuke; Sasahira, Naoki; Kogure, Hirofumi; Sasaki, Takashi; Hirano, Kenji; Tada, Minoru; Koike, Kazuhiko

    2012-01-01

    Patients with pancreatic cancer frequently suffer from both biliary and duodenal obstruction. For such patients, both biliary and duodenal self-expandable metal stent placement is necessary to palliate their symptoms, but it was difficult to cross two metal stents. Recently, endoscopic ultrasonography-guided choledochoduodenostomy (EUS-CDS) was reported to be effective for patients with an inaccessible papilla. We report two cases of pancreatic cancer with both biliary and duodenal obstructio...

  9. Perforated Duodenal Ulcer –A Rare Cause of Acute Abdomen in Pregnancy

    OpenAIRE

    Goel, Bharti; Rani, Jyotsna; Huria, Anju; Gupta, Pratiksha; Dalal, Usha

    2014-01-01

    Acute abdomen during pregnancy is a medico-surgical emergency demanding concerted, synchronized specialties approach of obstetrician, surgeon and gastroenterologist. Duodenal perforation is one of the rarer causes of acute abdomen in pregnancy. Here, we report a case of duodenal perforation with peritonitis in third trimester of pregnancy requiring surgical management. Our aim of reporting this case is to stress the physicians to keep the differential of duodenal perforation also in mind whil...

  10. Effect of Helicobacter pylori eradication on the natural history of duodenal ulcer disease

    OpenAIRE

    Goggin, N; Rowland, M; Imrie, C; Walsh, D.; Clyne, M.; Drumm, B

    1998-01-01

    BACKGROUND—Duodenal ulcer disease is strongly associated with Helicobacter pylori infection of the gastric mucosa. Eradication of H pylori from the gastric mucosa in adults is associated with long term healing of ulcers.
AIMS—To follow a cohort of children with duodenal ulcer disease for a minimum of two years after the eradication of H pylori.
PATIENTS AND METHODS—Over a three year period, all children diagnosed with duodenal ulcer disease had their symptoms documented a...

  11. Features of morphological changes of duodenal mucosa in patients with biliary calculosis

    OpenAIRE

    Shcherbinina M.B.; Gladun V.M.; Korolenko A.S.

    2009-01-01

    Today there are up to the end not established mechanisms of pathological changes of a duodenal mucosa at biliary calculosis. Investigation of morphological condition of duodenal mucosa at patients with biliary calculosis was the aim of this work. Histological examination of duodenal mucosa bioptats taken during esophagogastroduodenoscopy of two groups of supervision was carried out. 1-st group included patients with presence in a gallbladder biliary sludge and stones ≤5 mm (n=13). 2-nd group ...

  12. Defining duodenitis: quantitative histological study of mucosal responses and their correlations.

    OpenAIRE

    D. Jenkins(University of York, UK); Goodall, A; Gillet, F R; Scott, B B

    1985-01-01

    Biopsies from 56 patients with endoscopically normal duodenal bulbs, duodenitis, or duodenal ulceration were studied for counts of plasma cells, polymorphs, and eosinophils and extent of gastric metaplasia, villous atrophy, and mucosal oedema. A correlation matrix showed that the counts of different types of plasma cells were closely correlated with each other and that there was also a close correlation between the presence of intraepithelial polymorphs, villous atrophy, and gastric metaplasi...

  13. Peptic duodenitis--does it exist in the second part of the duodenum?

    OpenAIRE

    Leonard, N; Feighery, C F; Hourihane, D O

    1997-01-01

    AIM: To re-evaluate all patients diagnosed histologically as having peptic duodenitis who had known endomysial antibody (EMA) test results to find out whether they would still be classified as peptic duodenitis on histological analysis and to review their subsequent clinical course. METHODS: All mucosal biopsy specimens of the second part of the duodenum which were reported as showing features of peptic duodenitis and on which a serum EMA test had been done between January 1990 and January 19...

  14. Magnified Endoscopic Features of Duodenal Follicular Lymphoma and Other Whitish Lesions

    OpenAIRE

    Iwamuro, Masaya; Okada, Hiroyuki; Takata, Katsuyoshi; Kawai, Yoshinari; Kawano, Seiji; Nasu,Junichiro; Kawahara, Yoshiro; Tanaka, Takehiro; Yoshino, Tadashi; Yamamoto, Kazuhide

    2015-01-01

    The sensitivity and specificity of magnified endoscopic features for differentiating follicular lymphoma from other diseases with duodenal whitish lesions have never been investigated. Here we compared the magnified endoscopic features of duodenal follicular lymphoma with those of other whitish lesions. We retrospectively reviewed the cases of patients with follicular lymphoma (n=9), lymphangiectasia (n=7), adenoma (n=10), duodenitis (n=4), erosion (n=1), lymphangioma (n=1), and hyperplastic ...

  15. 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.

  16. Duodenal Hemorrhage from Pancreatic Cancer Infiltration Controlled through Combination Therapy with Gemcitabine and S-1

    Directory of Open Access Journals (Sweden)

    Ryoji Takada

    2014-06-01

    Full Text Available 2.6% of pancreatic cancer patients have the primary manifestation of gastrointestinal bleeding. It is not feasible to stop the duodenal hemorrhage caused by the pancreatic cancer infiltration. A 43-year-old woman who was diagnosed as having pancreatic cancer with multiple hepatic metastases and duodenal infiltration was administered gemcitabine and S-1 combination therapy. During the chemotherapy, initially, bleeding occurred due to duodenal infiltration. However, we continued the chemotherapy and duodenal infiltration was markedly reduced in size and did not rebleed. Aggressive chemotherapy contributed to maintenance of performance status as well as improvement of quality of life for the patient.

  17. Is epidermal growth factor involved in development of duodenal polyps in familial polyposis coli?

    DEFF Research Database (Denmark)

    Poulsen, Steen Seier

    1988-01-01

    Duodenal adenomas are a frequent extracolonic manifestation in patients with familial polyposis coli (FPC). Epidermal growth factor (EGF), a polypeptide that stimulates cellular growth and differentiation, is localized in Paneth cells in the small intestine. In two patients with FPC, we found EGF...... immunoreactivity in duodenal adenomas. Numerous EGF immunoreactive Paneth cells were localized, not as usually, in the bottom of the crypts, but scattered along the crypts alone or in clusters. We do not know whether EGF is involved in the development of duodenal polyps in FPC patients, or whether the present...... findings represent secondary changes in duodenal polyps....

  18. A CLINICAL STUDY ON PATIENTS WITH DUODENAL ULCER PERFORATION

    Directory of Open Access Journals (Sweden)

    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. 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.

  20. 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

  1. Techniques and efficacy of flexible endoscopic therapy ofZenker's diverticulum

    Institute of Scientific and Technical Information of China (English)

    Yaseen Perbtani; Alejandro Suarez; Mihir S Wagh

    2015-01-01

    Zenker's diverticulum (ZD) is an abnormal hypopharyngealpouch often presenting with dysphagia. Treatment isoften sought with invasive surgical management of thediverticulum being the only mode of definitive therapy.Primarily done by an open transcervical approachin the past, nowadays treatment is usually providedby otolaryngologists using a less invasive trans-oraltechnique with a rigid endoscope. When first described,this method grew into acceptance quickly due to itssimilar efficacy and vastly improved safety profilecompared to the open transcervical approach. However,the main limitation with this approach is that it may notbe suitable for all patients. Nonetheless, progress inthe field of natural orifice endoscopic surgery over thelast 10-20 years has led to the increase in utilization ofthe flexible endoscope in the treatment of ZD. Primarilyperformed by interventional gastroenterologists, thisapproach overcomes the prior limitation of its surgicalcounterpart and allows adequate visualization of thediverticulum independent of the patient's body habitus.Additionally, it may be performed without the useof general anesthesia and in an outpatient setting,thus further increasing the utility of this modality,especially in elderly patients with other comorbidities.Today, results in more than 600 patients have beendescribed in various published case series usingdifferent techniques and devices demonstrating a highpercentage of clinical symptom resolution with lowrates of adverse events. In this article, we present ourexperience with flexible endoscopic therapy of Zenker'sdiverticulum and highlight the endoscopic technique,outcomes and adverse events related to this minimallyinvasive modality.

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

    Directory of Open Access Journals (Sweden)

    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.

  3. Evaluation of endoscopically obtained duodenal biopsy samples from cats and dogs in an adapter-modified Ussing chamber

    OpenAIRE

    Ruhnke, Isabelle; DeBiasio, John V.; Suchodolski, Jan S.; Newman, Shelley; Musch, Mark W.; Steiner, Jörg M.

    2014-01-01

    This study was conducted to evaluate an adapter-modified Ussing chamber for assessment of transport physiology in endoscopically obtained duodenal biopsies from healthy cats and dogs, as well as dogs with chronic enteropathies. 17 duodenal biopsies from five cats and 51 duodenal biopsies from 13 dogs were obtained. Samples were transferred into an adapter-modified Ussing chamber and sequentially exposed to various absorbagogues and secretagogues. Overall, 78.6% of duodenal samples obtained fr...

  4. Histological appearances of oesophagus, antrum and duodenum and their correlation with symptoms in patients with a duodenal ulcer.

    OpenAIRE

    Earlam, R. J.; Amerigo, J; Kakavoulis, T; Pollock, D J

    1985-01-01

    Clinical data and histology from the oesophagus, gastric antrum, and duodenum were collected from 36 patients undergoing surgery for duodenal ulcer. Gastritis was present in 94% of the patients (25% of atrophic type), oesophagitis in 72% and duodenitis in 39%. Abnormal biopsies were present from all three sites in 33% of the patients. Only one patient showed three normal biopsies. The low incidence of duodenitis does not support the theory that duodenitis is part of the same spectrum as duode...

  5. 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.

  6. CT scan and US evaluation of the traumatic duodenal intramural hematoma in childhood

    International Nuclear Information System (INIS)

    CT scan and ultrasonography were very effective in evaluating and following-up the traumatic duodenal intramural hematoma in a child (5-year-old boy). These two methods were demonstrated very useful not only for ditection of associated trauma but also for diagnosis and follow-up of the duodenal intramural hematoma. (author)

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

    Directory of Open Access Journals (Sweden)

    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.

  8. Features of morphological changes of duodenal mucosa in patients with biliary calculosis

    Directory of Open Access Journals (Sweden)

    Shcherbinina M.B.

    2009-01-01

    Full Text Available Today there are up to the end not established mechanisms of pathological changes of a duodenal mucosa at biliary calculosis. Investigation of morphological condition of duodenal mucosa at patients with biliary calculosis was the aim of this work. Histological examination of duodenal mucosa bioptats taken during esophagogastroduodenoscopy of two groups of supervision was carried out. 1-st group included patients with presence in a gallbladder biliary sludge and stones ≤5 mm (n=13. 2-nd group was presented by patients with stones in a gallbladder of ≥5 mm (n=13. The morphological evaluation of chronic duodenitis, degree of activity of inflammation and atrophy of duodenal mucosa were performed. A volume fraction of villi, intestinal glands, lymphocytes, and plasmocytes, with definition of lympho-plasmocytes index were studied in percentage. The results were evaluated by t-criterion of Student, changes were statistically evident if р<0,05. Also we used the correlative analysis for estimation of correlation coefficient, r. There was established, that exchange-inflammatory changes of gallbladder and morphological signs of chronic duodenitis were more significant in 2-nd group of patients. Char-acteristically for patients of this group was moderated chronic duodenitis (80 %, р <0,05. Morphological changes in duode-nal mucosa were connected with inflammatory processes in walls of a gallbladder (correlation communications were estab-lished.

  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. Is there a role for pyloric exclusion after severe duodenal trauma?

    Directory of Open Access Journals (Sweden)

    José Cruvinel Neto

    2014-06-01

    Full Text Available Duodenal trauma is an infrequent injury, but linked to high morbidity and mortality. Surgical management of duodenal injuries is dictated by: patient's hemodynamic status, injury severity, time of diagnosis, and presence of concomitant injuries. Even though most cases can be treated with primary repair, some experts advocate adjuvant procedures. Pyloric exclusion (PE has emerged as an ancillary method to protect suture repair in more complex injuries. However, the effectiveness of this procedure is debatable. The "Evidence Based Telemedicine - Trauma & Acute Care Surgery" (EBT-TACS Journal Club performed a critical appraisal of the literature and selected three relevant publications on the indications for PE in duodenal trauma. The first study retrospectively compared 14 cases of duodenal injuries greater than grade II treated by PE, with 15 cases repaired primarily, all of which penetrating. Results showed that PE did not improve outcome. The second study, also retrospective, compared primary repair (34 cases with PE (16 cases in blunt and penetrating grade > II duodenal injuries. The authors concluded that PE was not necessary in all cases. The third was a literature review on the management of challenging duodenal traumas. The author of that study concluded that PE is indicated for anastomotic leak management after gastrojejunostomies. In conclusion, the choice of the surgical procedure to treat duodenal injuries should be individualized. Moreover, there is insufficient high quality scientific evidence to support the abandonment of PE in severe duodenal injuries with extensive tissue loss.

  11. 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.)

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

    Directory of Open Access Journals (Sweden)

    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.

  13. 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.

  14. Radiological aspects of the mucosal surface of the duodenal bulbe

    International Nuclear Information System (INIS)

    Double contrast barium meal, endoscopy and hystology of the doudenal bulb were blindly compared in 47 consecutive patients. The agreement in the judgement of normality of the mucosal surface between radiology and endoscopy was 78%. The agreement in the diagnosis of presence or absence of nodularity and thickened folds was respectively 91% and 87%. The findings of nodularity correspond to doudenitis with pyloric metaplasia or to heterotopic gastric mucosa, while the thickened folds correspond to duodenitis with pyloric metaplasia, Brunner's hyperplasia, lymphathic nodular dilatation. The diagnostic errors in the radiological examination in respect to endoscopy is quite important in the case of erosions

  15. Endoscopic resection of carcinoid of the minor duodenal papilla

    Institute of Scientific and Technical Information of China (English)

    Takao Itoi; Atsushi Sofuni; Fumihide Itokawa; Takayoshi Tsuchiya; Toshio Kurihara; Fuminori Moriyasu

    2007-01-01

    We encountered a 6S-year-old man with a carcinoid tumor of the minor duodenal papilla. Since he had liver cirrhosis and completely refused surgery, we performed an endoscopic snare papillectomy. The papillectomy was performed successfully without procedure-related complication. The specimens revealed a carcinoid tumor showing that the margin of the tumor was positive. One week later, upper GI endoscopy was performed and the biopsy specimens obtained from base of ulcer showed no neoplastic cells. We performed a duodenoscopy and CT 3, 6 and 18 mo later, and there was no macroscopic or microscopic evidence of tumor recurrence after more than 4 years.

  16. Obstructive Jaundice Secondary to Primary Duodenal Lymphoma with CMV Duodenitis Causing Upper GI Bleed in Retro-Positive Patient: A Case Report

    OpenAIRE

    Patil, Basavaraj B.; Kumar P, Sampath; Suresh, B. P.; Dinesh, B. V.; Geetha, V.; Sabasis, B.

    2012-01-01

    Gastrointestinal (GI) tract is the most common site of extranodal lymphoma. Primary GI lymphoma constitutes a small amount of all lymphomas. Primary duodenal lymphoma presenting initially with obstructive jaundice is very rare. Primary B-cell lymphoma of the duodenum was shown to be the cause of biliary obstruction in a retropositive male, which was proved by endoscopic biopsy. Histopathology also showed cytomegalovirus inclusion bodies with duodenitis.

  17. Massive Lower Gastrointestinal Bleeding from Meckel’s Diverticulum with Heterotopic Pancreas: Case Report and a Brief Review of the Literature

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    Xing Yang

    2013-05-01

    Full Text Available Context Heterotopic pancreas is defined as pancreatic tissue found out of the pancreas proper with no vascular or anatomical connection. It is a rare clinical entity and can be found at any portion of the alimentary system. Case report We describe a case of Meckel’s diverticulum with heterotopic pancreas who presented massive lower gastrointestinal bleeding. Conclusion Lower gastrointestinal bleeding due to Meckel’s diverticulum with heterotopic pancreas is extremely difficult to make a definitive diagnosis preoperatively especially when it onsets rapidly.

  18. Palliation of Malignant Biliary and Duodenal Obstruction with Combined Metallic Stenting

    International Nuclear Information System (INIS)

    Purpose. The purpose of this study is to evaluate the efficacy of palliation of malignant biliary and duodenal obstruction with combined metallic stenting under fluoroscopy guidance. Materials and Methods. A retrospective analysis of 9 patients (6 men and 3 women) who underwent biliary and duodenal stenting was performed. The mean age of patients was 61 years (range: 42-80 years). The causes of obstruction were pancreatic carcinoma in 7 patients, cholangiocellular carcinoma in one, and duodenal carcinoma in the other. Biliary and duodenal stents were placed simultaneously in 4 patients. In other 5 patients dudodenal stents were placed after biliary stenting when the duodenal obstruction symptoms have developed. In two patients duodenal stents were advanced via transgastric approach. Results. Technical success rate was 100 %. After percutaneous biliary drainage and stenting bilirubin levels decreased to normal levels in 6 patients and in remaining 3 patients mean reduction of 71% in bilirubin levels was achieved. Tumoral ingrowth occurred in one patient and percutaneous biliary restenting was performed 90 days after the initial procedure. Of the 9 patients, 6 patients were able to tolerate solid diet, whereas 2 patients could tolerate liquid diet and one patient did not show any improvement. Mean survival periods were 111 and 73 days after biliary and duodenal stenting, respectively. Conclusion. Combined biliary and duodenal stent placement which can be performed under fluoroscopic guidance without assistance of endoscopy is feasible and an effective method of palliation of malignant biliary and duodenal obstructions. If transoral and endoscopic approaches fail, percutaneous gastrostomy route allows duodenal stenting

  19. [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.

  20. 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.

  1. Gastric and Duodenal Stents: Follow-Up and Complications

    International Nuclear Information System (INIS)

    Purpose: To assess the efficacy of self-expanding metallic stents in treating inoperable gastric and duodenal stenoses during follow-up and to evaluate the complications encountered.Methods: A total of 31 patients suffering from gastroduodenal obstruction (29 malignant, 2 benign) were treated with a self-expanding metallic stent (Wallstent). In 24 cases insertion was by the peroral route, in seven cases via gastrostomy.Results: All the strictures were successfully negotiated under fluoroscopic guidance without having to resort to endoscopy. A total of 27 patients (87%) were able to resume a regular diet, a soft diet, or a liquid diet orally. Complications included one case of stent malpositioning, one case of leakage of ascitic fluid through the gastrostomy orifice, one case of perforation and fistula to the biliary tree, and two cases of hematemesis. In two patients (6%) additional stents were implanted to improve patency. In all patients follow-up was maintained until death. Recurrence of symptoms immediately before death occurred in seven cases (23%). Mean survival time of patients was 13.3 weeks (SE ± 4.6).Conclusions: The deployment of gastroduodenal stents resulted in good palliation of inoperable gastric and duodenal stenoses. Certain technical aspects, e.g., adaptation of stents to bowel morphology, is critical to proper stent function and avoidance of complications

  2. Study of Duodenal Rupture Followed by Abdominal Blunt Trauma

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    Mohammad Reza Abdoulhosseini

    2014-01-01

    Full Text Available Duodenal rupture followed by blunt trauma is usually very rare and happens by hit to epigastrium region caused by trauma, accident or sport injuries. Because of unclear signs or no specific signs of rupture, usually diagnosis of rupture is delayed and associated with dangerous or occasionally deathful complications. The patient was a 29-year-old male who three days after accident referred to emergency unit of Shahroud Imam Hossein hospital with severe pain of abdomen, nausea, decrease in level of consciousness and unstable vital signs. After resuscitation, the patient with diagnosis of peritonitis underwent laparotomy. He had transverse and severs rupture that after duodenal reconstruction, a jejunostomy was performed, then a drain was placed at the site of duodenum and pancreas and the patient was sent to ICU. After two days followed by leakage from abdominal drain, the patient underwent laparotomy again. Then after one week, followed by leakage from abdominal drain, the patient underwent laparotomy. One week after last operation, due to general condition improvement, the patient was transferred to surgical ward and jejunostomy feeding was started for him and duodenostomy and jejunostomy were excluded. Then with enough speed, and paying attention to clinical signs & symptoms and with patient's exact examination, it is possible to prevent the waste of time and expense and gain desired results of treatment.

  3. 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.

  4. 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

  5. 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.

  6. Prognostic significance of standardized uptake value on preoperative {sup 18}F-FDG PET/CT in patients with ampullary adenocarcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Hye Jin [Yonsei University College of Medicine, Division of Oncology, Department of Internal Medicine, Seoul (Korea, Republic of); Kang, Chang Moo; Lee, Woo Jung [Yonsei University College of Medicine, Division of Hepatobiliary and Pancreas, Department of Surgery, Seoul (Korea, Republic of); Jo, Kwanhyeong; Lee, Jong Doo [Yonsei University College of Medicine, Department of Nuclear Medicine, Seoul (Korea, Republic of); Lee, Jae-Hoon [Yonsei University College of Medicine, Department of Nuclear Medicine, Seoul (Korea, Republic of); Yonsei University College of Medicine, Department of Nuclear Medicine, Gangnam Severance Hospital, Seoul (Korea, Republic of); Ryu, Young Hoon [Yonsei University College of Medicine, Department of Nuclear Medicine, Gangnam Severance Hospital, Seoul (Korea, Republic of)

    2015-05-01

    The purpose of this study was to investigate the prognostic value of {sup 18}F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in patients with ampullary adenocarcinoma (AAC) after curative surgical resection. Fifty-two patients with AAC who had undergone {sup 18}F-FDG PET/CT and subsequent curative resections were retrospectively enrolled. The maximum standardized uptake value (SUV{sub max}) and tumor to background ratio (TBR) were measured on {sup 18}F-FDG PET/CT in all patients. The prognostic significances of PET/CT parameters and clinicopathologic factors for recurrence-free survival (RFS) and overall survival (OS) were evaluated by univariate and multivariate analyses. Of the 52 patients, 19 (36.5 %) experienced tumor recurrence during the follow-up period and 18 (35.8 %) died. The 3-year RFS and OS were 62.3 and 61.5 %, respectively. Preoperative CA19-9 level, tumor differentiation, presence of lymph node metastasis, SUV{sub max}, and TBR were significant prognostic factors for both RFS and OS (p < 0.05) on univariate analyses, and patient age showed significance only for predicting RFS (p < 0.05). On multivariate analyses, SUV{sub max} and TBR were independent prognostic factors for RFS, and tumor differentiation, SUV{sub max}, and TBR were independent prognostic factors for OS. SUV{sub max} and TBR on preoperative {sup 18}F-FDG PET/CT are independent prognostic factors for predicting RFS and OS in patients with AAC; patients with high SUV{sub max} (>4.80) or TBR (>1.75) had poor survival outcomes. The role of and indications for adjuvant therapy after curative resection of AAC are still unclear. {sup 18}F-FDG uptake in the primary tumor could provide additive prognostic information for the decision-making process regarding adjuvant therapy. (orig.)

  7. 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.

  8. Isolated Blunt Duodenal Trauma: Delayed Diagnosis and Favorable Outcome with "Quadruple Tube" Decompression

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    Stefano Crippa

    2007-09-01

    Full Text Available Context Isolated blunt duodenal injury is a rare finding associated with high morbidity and significant mortality. The early identification of a duodenal injury is usually difficult, considering the anatomical location of the duodenum and lack of peritoneal signs and diagnostic delay is part of the clinical picture in most cases. Case report A 43-year-old man was admitted to our hospital after a motor vehicle collision. At admission he underwent emergency surgery because of lower extremities fractures. Twelve hours later he started to complain an increasing abdominal pain; blood tests showed serum amylase up to 180 U/L and a CT scan demonstrated a perforation of the third duodenal portion. At laparotomy a Grade III injury of the duodenum was evident. The laceration was sutured and a “quadruple-tube” decompression was performed. The postoperative course was uneventful. One year after surgery he is well without any long-term complication. Conclusion A high degree of suspicion is necessary for early diagnosis of blunt duodenal trauma and CT scan should be performed in case of all significant epigastric trauma. In most cases primary direct repair of duodenal wounds can be safely achieved and duodenal decompression via triple or quadriple tube technique is required to decrease the risk of duodenal fistula.

  9. 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.

  10. Congenital duplication of the urethra with urethral diverticulum: a case report [v1; ref status: indexed, http://f1000r.es/36h

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    Darshan H Shah

    2014-05-01

    Full Text Available Duplication of the urethra is a rare congenital anomaly. Urethral duplication with the presence of diverticulum is a rare combination and to the best of our knowledge has  not been previously reported. We report a case of a 16 month old male child with duplication of the urethra and diverticulum arising from the ventral urethra. We also cover the intricacies and challenges in the management of such a case. The opening of the narrowed accessory dorsal urethra at the verumontanum was cauterized and gradually the dorsal urethra became atrophied. The ventral urethral diverticulum was excised. This case is unique due to: The unusual presentation of swelling over the dorsum of the penis, together with duplication of the urethra with diverticulum. The use of cauterization as a treatment modality. Cauterization of the ventral urethra with a Bugbee electrode and diverticulectomy was performed. A glidewire helped in identifying the small opening of the dorsal urethra at the level of the verumontanum. The case also highlights the importance of endoscopic management of this clinical entity.

  11. Killian-Jamieson diverticulum mimicking a calcified thyroid nodule on ultrasonography: A case report and literature review

    Science.gov (United States)

    Cao, Li; Ge, Junna; Zhao, Donghui; Lei, Shangtong

    2016-01-01

    As a rare hypopharyngeal diverticulum, Killian-Jamieson diverticulum (KJD) is usually incidentally detected, small, asymptomatic and likely to be misdiagnosed as a thyroid nodule. In order to avoid unnecessary treatments resulting from misdiagnosis, principles to distinguish between esophageal diverticula and thyroid nodules should be noted clearly. The current study presents a case of an asymptomatic unilateral KJD that mimicked a calcified thyroid nodule. In the current case, a 40-year-old man presented with a ‘suspected malignant thyroid nodule’ in the left thyroid gland, and underwent left thyroid lobectomy and a neck exploration. However, no visible ‘suspected tumor’, but a sac protruding from the left anterolateral wall of the cervical esophagus, was observed during the surgery. A swallow test on ultrasonography (US) in combination with pharyngoesophagography was then performed, which confirmed the diagnosis. The patient recovered well during the 3-month follow-up after the operation. The present study indicates that real-time US and pharyngoesophagography are important techniques to distinguish a KJD from a thyroid nodule so that unnecessary surgical intervention can be avoided.

  12. 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.

  13. An Option of Conservative Management of a Duodenal Injury Following Laparoscopic Cholecystectomy

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    MA Modi

    2014-01-01

    Full Text Available Duodenal injury following laparoscopic cholecystectomy is rare complications with catastrophic sequelae. Most injuries are attributed to thermal burns with electrocautery following adhesiolysis and have a delayed presentation requiring surgical intervention. We present a case of a 47-year-old gentleman operated on for laparoscopic cholecystectomy with a bilious drain postoperatively; for which an ERC was done showing choledocholithiasis with cystic duct stump blow-out and a drain in the duodenum suggestive of an iatrogenic duodenal injury. He was managed conservatively like a duodenal fistula and recovered without undergoing any intervention.

  14. Measurements of intestinal villi non-specific and ulcer-associated duodenitis-correlation between area of microdissected villus and villus epithelial cell count.

    OpenAIRE

    M. Hasan; Ferguson, A.

    1981-01-01

    Measurements of villus height, villus area, together with counts of epithelial cells in individual villi, were performed on endoscopic duodenal biopsies from five groups of patients: controls, ulcer-associated duodenitis, mild and severe non-specific (non-ulcerative) duodenitis, cimetidine healed ulcer-associated duodenitis and cimetidine healed non-specific duodenitis. The objectives of the study were two-fold: to establish if epithelial cell count correlated with simpler measurements of vil...

  15. Sonographic features of duodenal lipomas in eight clinicopathologically diagnosed patients

    Institute of Scientific and Technical Information of China (English)

    Hong-Tan Chen; Guo-Qiang Xu; Li-Jun Wang; Yi-Peng Chen; You-Ming Li

    2011-01-01

    AIM: To investigate the sonographic features and diagnostic value of endoscopic ultrasonography (EUS) for duodenal lipomas (DLs).METHODS: A total of eight consecutive patients with DL diagnosed pathologically were included in the study.One EUS expert reviewed the ultrasonic images for all lesions, including the original layer of the duodenal wall, the echo intensity and the echo homogeneity. The size of the lesions and the perifocal structures were also investigated. The diagnosis by EUS was compared with the histological results.RESULTS: Using routine endoscopy, only one case was correctly diagnosed as DL. Four cases were classified as submucosal tumors, and three cases were mistaken for stromal tumors. All tumors appeared as round or oval intensive hyperechoic lesions with distinct anterior borders that originated from the submucosal layer on EUS. Tumors ranged from 8 to 36 mm in size, with an average size of 16 mm. Homogeneous echogenicity was seen in all cases except one that had a tubular structure inside the tumor. Echo attenuation was observed only in the area behind the tumors in five cases, and it was observed both inside and behind the tumors in three cases in which the posterior border was obscure or invisible.Seven (87.5%) cases were correctly diagnosed as DL, and one (12.5%) was mistaken as Brunner's gland adenoma by EUS. Pathologically, all tumors originated from the submucosal layer and consisted of mature fat cells without heteromorphism. Among the fat cells, there was a small amount of thick-wall vessels infiltrating the lymphocytes, and abundant fibrous connective tissues.CONCLUSION: On EUS, DL is featured as an intensive homogeneous hyperechoic submucosal lesion with marked echo attenuation and without involvement of the mucosa.

  16. [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.

  17. 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

  18. 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.

  19. 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.

  20. Successful Endoscopic Ultrasound-Guided Transduodenal Biliary Drainage Through a Pre-Existing Duodenal Stent

    Directory of Open Access Journals (Sweden)

    Paul J Belletrutti

    2010-05-01

    Full Text Available Context When ERCP fails in the setting of combined biliary and duodenal obstruction, EUS-guided biliary drainage has emerged as an alternate method of biliary decompression. Case report We present a case of a 40-year-old man with advanced pancreatic cancer and a pre-existing duodenal wall stent who subsequently develops jaundice due to biliary obstruction. An ERCP was technically unsuccessful as the papilla was inaccessible despite probing within the duodenal stent. Transduodenal biliary drainage was achieved using EUS guidance to create a choledochoduodenostomy tract. A fully covered metal biliary stent was then deployed through the mesh of the duodenal wall stent. The patient’s jaundice and pruritus subsequently resolved. Conclusion This is the first report of successful transduodenal EUS-guided biliary drainage performed through an existing enteral wall stent and can still be considered as an alternate mode of biliary drainage in this setting.

  1. Rare presentation of pancreatitis secondary to intussusception of duodenal duplication cyst, a pediatric case report

    Directory of Open Access Journals (Sweden)

    Valentina Shakhnovich

    2014-12-01

    Full Text Available Duodenal duplication cysts are rare congenital malformations of which there is limited literature in the pediatric population. The most common presentation in symptomatic patients is abdominal pain and pancreatitis. We present a case of a 14 year old female that presented with emesis, abdominal pain, weight loss, and admission biochemical profile concerning for acute pancreatitis in conjunction with severe hypochloremic, hypokalemic metabolic alkalosis. Further imaging was highly suggestive of duodeno-duodenal intussusception causing obstruction of the pancreatic duct. Patient was taken emergently to the operating room for exploration. Patient underwent laparoscopic assisted reduction of intussusception and resection of duodenal duplication cyst. Patient tolerated the surgery well, and was able to be discharged home in stable condition soon after. There have been no cases reported in the literature that describe pancreatitis secondary to intussusception of duodenal duplication cyst. When diagnosed early, these patients can be safely managed laparoscopically even in emergent settings.

  2. 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.

  3. The Assessment Criteria of Morphological Changes of Duodenal Mucosa in Gastroduodenitis in Follow-up

    Directory of Open Access Journals (Sweden)

    Pletnyova N.B.

    2011-12-01

    Full Text Available The aim of the investigation is to determine prognostic criteria of the course of chronic gastroduodenitis in young patients based on the analysis of dysregenerative process in duodenal mucosa in the same patients at school age. Materials and Methods. There were examined 24 patients with chronic gastroduodenitis (CGD in exacerbation, aged 7–14 years. And 18–20 years later 20 patients of the same group were examined outpatiently. Results. The revealed parallels of morphological changes in duodenal mucosa in the same patients in childhood and in adults suggest that the presence of recurrent diffuse inflammatory process characterizing severe duodenitis at school age causes persistent structural changes. The shortening of villi contours, the decrease of crypts volume, and morphometrical confirmation of the monomorphic character of epithelial layer and cellular spectrum of lamina propria taking into account leiomyocyti in the gradient ”villus-crypt” are informative criteria complex that allows suggesting duodenal mucosa atrophy.

  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. PMID:25362226

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

    International Nuclear Information System (INIS)

    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

  6. Application of purse-string suture for management of duodenal stump in radical gastrectomy

    Institute of Scientific and Technical Information of China (English)

    SHAO Qin-shu; WANG Yong-xiang; YE Zai-yuan; ZHAO Zhong-kuo; XU Ji

    2011-01-01

    Background Gastric cancer (GC) is the second leading cause of cancer mortality worldwide,and surgical resection is currently the only possible curative approach. Duodenal stump leakage is the most serious complication after radical gastrectomy,and optimal treatment is still lacking.Methods We retrospectively reviewed 2034 cases of total or subtotal gastrectomy for GC from January 1995 to December 2009,including 465 cases of duodenal stump closure using purse-string suture (group A),835 cases of duodenal stump treated with linear cutting stapler and seromuscular layer suture (group B),and 734 cases of duodenal stump closure using full-thickness and seromuscular layer suture (group C). We evaluated the surgical cost,operative time for duodenal stump closure,short-term postoperative complications,perioperative blood loss,and postoperative recovery.Results There was no perioperative mortality in any group. Ninety-four postoperative (within 1 month) complications occurred:18 abdominal bleeding,14 anastomotic leakage,15 abdominal infection,36 wound infection,and 11 duodenal stump leakage. There was no significant difference among the groups in intra-abdominal hemorrhage,anastomotic leakage,abdominal infection and wound infection. No postoperative duodenal stump leakage occurred in group A,which had a significant difference compared with groups B and C (6 cases in group B and 5 cases in group C suffered duodenal stump leakage. P <0.01). The surgical cost in groups A and C was significantly lower than in group B (P <0.01),with no significant difference between groups A and C. The processing time for duodenal stump closure in groups A and B was significantly shorter than in group C (P <0.01),with no significant difference between groups A and B. There was no significant difference in blood loss and postoperative recovery among the groups.Conclusions Duodenal stump closure using purse-string suture seems to be a promising approach with shorter operative time,and lower

  7. 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

  8. 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.

  9. Histomorphometric study of changes in duodenal mucosa of patients presenting with Giardiasis

    OpenAIRE

    Kachnar Varma; Vatsala Misra; Sri Prakash Misra; Manisha Dwivedi

    2015-01-01

    Context: Giardia lambia is a common intestinal protozoon with a higher prevalence rate in tropical countries as compared to the Western world. Histological changes occur in duodenal mucosa in cases of chronic giardiasis that may be similar to celiac disease or tropical sprue. Aim: As the prevalence of giardiasis is high in our country, the present study was undertaken to study the changes in duodenal mucosa of patients with asymptomatic giardiasis and endoscopically normal duodenum. Study Des...

  10. A rare case of Burkitt’s lymphoma of the duodenal bulb

    OpenAIRE

    Carvalho, Joana Rita; Carrilho-Ribeiro, Luís; Zagalo, Alexandra; Medeiros, Fábio Cota; Ferreira, Cristina; Velosa, José

    2016-01-01

    Gastrointestinal tract involvement in immunodeficiency-related Burkitt’s lymphoma is not common and the duodenal involvement is very rare. We report the case of a 35-year-old man admitted because of abdominal pain, vomiting and weight loss. Human immunodeficiency virus infection was diagnosed and upper digestive tract endoscopy showed marked edema and hyperemia of the duodenal bulb with some violaceous areas. Immunohistochemical study of the bulbar tissue samples confirmed the diagnosis of Bu...

  11. Cystic dystrophy of the duodenal wall in heterotopic pancreas: A case report

    OpenAIRE

    Ahmed Mohamed Aly; Tarek Saied

    2014-01-01

    Cystic dystrophy of the duodenal wall is a rare benign disease characterized by development of multiple cysts in heterotopic pancreatic tissue in the duodenal wall. A forty-five-year-old male came to the emergency department of our hospital complaining of severe abdominal pain and vomiting. Computerized tomography (CT) scan of the chest, abdomen and pelvis had been done. The patient was treated by pancreaticoduodenectomy.

  12. Cystic dystrophy of the duodenal wall in heterotopic pancreas: A case report

    Directory of Open Access Journals (Sweden)

    Ahmed Mohamed Aly

    2014-06-01

    Full Text Available Cystic dystrophy of the duodenal wall is a rare benign disease characterized by development of multiple cysts in heterotopic pancreatic tissue in the duodenal wall. A forty-five-year-old male came to the emergency department of our hospital complaining of severe abdominal pain and vomiting. Computerized tomography (CT scan of the chest, abdomen and pelvis had been done. The patient was treated by pancreaticoduodenectomy.

  13. Anxiety and depression in association with morbid obesity: changes with improved physical health after duodenal switch

    OpenAIRE

    Sletteskog Nils; Bergsholm Per; Aasprang Anny; Andersen John; Våge Villy; Natvig Gerd

    2010-01-01

    Background Patients with morbid obesity have an increased risk for anxiety and depression. The "duodenal switch" is perhaps the most effective obesity surgery procedure for inducing weight loss. However, to our knowledge, data on symptoms of anxiety and depression after the duodenal switch are lacking. Furthermore, it has been hypothesized that self-reported physical health is the major predictor of symptoms of depression in patients with morbid obesity. We therefore investigated the symptom...

  14. Successful Treatment with Ganciclovir for Cytomegalovirus Duodenitis following Allogenic Bone Marrow Transplantation

    OpenAIRE

    Ahn, Jin Hee; Lee, Je-Hwan; Lee, Kyoo-Hyung; Kim, Woo-Kun; Lee, Jung-Shin; Bahng, Hyeseung; Jung, Hwoon-Yong; Kim, Yang-Soo; Kim, Onja; Kim, Sang-Hee

    1999-01-01

    Cytomegalovirus (CMV) disease is a major cause of morbidity and mortality in immunocompromised patients. CMV enteritis should be considered when nausea and vomiting continue 3 to 4 weeks after bone marrow transplantation (BMT). The treatment of CMV enteritis is not well established. We report a CMV duodenitis patient following allogenic bone marrow transplantation. The patient had prolonged nausea and vomiting for 5 weeks after bone marrow transplantation and CMV duodenitis was diagnosed by t...

  15. Histology of chronic gastritis with and without duodenitis in patients with Helicobacter pylori infection.

    OpenAIRE

    Phull, P S; Price, A. B.; Stephens, J; Rathbone, B J; Jacyna, M R

    1996-01-01

    AIM: To compare the histological characteristics of Helicobacter pylori positive chronic gastritis in patients with and without associated duodenitis. METHODS: Gastric mucosal biopsy specimens were obtained from patients undergoing endoscopy for dyspepsia. Severity of gastritis and density of H pylori infection were graded according to the Sydney system. RESULTS: Of the 69 patients studied, 15 had normal histology, 22 had chronic gastritis only (77.3% H pylori positive), 21 had duodenitis (90...

  16. Primary endoscopic approximation suture under cap-assisted endoscopy of an ERCP-induced duodenal perforation

    Institute of Scientific and Technical Information of China (English)

    Tae; Hoon; Lee; Byoung; Wook; Bang; Jee; In; Jeong; Hyung; Gil; Kim; Seok; Jeong; Seon; Mee; Park; Don; Haeng; Lee; Sang-Heum; Park; Sun-Joo; Kim

    2010-01-01

    Duodenal perforation during endoscopic retrograde cholangiopancreatography(ERCP) is a rare complication,but it has a relatively high mortality risk.Early diagnosis and prompt management are key factors for the successful treatment of ERCP-related perforation.The management of perforation can initially be conservative in cases resulting from sphincterotomy or guide wire trauma.However,the current standard treatment for duodenal free wall perforation is surgical repair.Recently,several case reports of endosco...

  17. Morphological, immunophenotypic and clinical characteristics of dogs with lymphocytic - plasmacytic duodenitis

    OpenAIRE

    Đorđević Milena; Krstić V.; Krstić N.; Vasiljević Maja; Ilić V.; Vučićević Ivana; Aleksić-Kovačević Sanja

    2012-01-01

    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 ...

  18. A survey on Candida colonization prevalence in patients with gastritis, duodenitis and peptic ulcer

    OpenAIRE

    Hashemi, S.J.; Kordbacheh, P.; Malekzadeh, R.; M Mehrabani

    2006-01-01

    Background: Prolonged antiacid and antibiotic usage in gasterointestinal diseases may predispose candidial colonization in GI tract. In order to isolate and diagnose of candida infections in patients with gastritis, duodenitis, gastric ulcer and duodenal ulcer, this study have been planned. Methods: We studied 300 biopsy specimens of patients referred to hospital, 51.7% of the patients were male and the others were female. The isolated fungi were identified by direct examination and culture o...

  19. Russell body duodenitis in a patient with retroperitoneal metastasis of ureteral cancer

    OpenAIRE

    Takahashi, Yoshihisa; Shimizu, Seiichiro; Uraushihara, Koji; Fukusato, Toshio

    2013-01-01

    Russell bodies are globular and eosinophilic inclusion bodies in the cytoplasm of mature plasma cells. Plasma cells whose cytoplasm is filled with Russell bodies are designated as Mott cells. Russell body duodenitis (RBD) is a unique form of chronic duodenitis that is characterized by infiltration of numerous Mott cells. RBD is very rare; only two cases have been reported to date. In this paper, we report a case of RBD in a patient with retroperitoneal metastasis of ureteral cancer. A 77-year...

  20. Effect of Helicobacter Pylori Eradication on Extent of Duodenal Gastric Metaplasia and Grade of Gastritis

    OpenAIRE

    Bago, J; Strinić, D.; Belošić Halle, Ž.; Jandrić, D.; Tomić, M.; Bilić, A.; Bago, P.

    2002-01-01

    The extent of the regression of duodenal gastric metaplasia (DGM) after the eradication of Helicobacter pylori infection is controversial. Therefore, we decided to assess the degree of DGM before, sex weeks and one year after H. pylori eradication. 105 consecutive Helicobacter pylori positive patients with endoscopically proven duodenal ulcer, with DGM and Helicobacter pylori infection were recruited for this study. The diagnosis of Helicobacter pylori infection was based on CL...

  1. 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:

  2. 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.

  3. Assessment of duodenal circular drainage in treatment of superior mesenteric artery syndrome

    Institute of Scientific and Technical Information of China (English)

    Wei-Liang Yang; Xin-Chen Zhang

    2008-01-01

    AIM: To assess the clinical value of duodenal circular drainage for superior mesenteric artery syndrome (SMAS).METHODS: Forty-seven cases of SMAS were treated with duodenal circular drainage from 1959 to 2001.Clinical data were analyzed retrospectively.RESULTS: In this group, good effects were achieved in 39 cases treated with duodenal circular drainage after 2-15 years of follow-up. The other eight cases were first treated with anterior repositioning of the duodenum (two cases), duodenojejunostomy (five cases), subtotal gastrectomy and billroth 11 gastrojejunostomy (one case), but vomiting was not relieved until duodenal circular drainage was performed again. A follow-up study of 8-10 years revealed satisfactory results in these eight patients.CONCLUSION: In SMAS, if the reversed peristalsis is strong and continuous, and vomiting occurs frequently,the symptom can not be relieved even if the obstruction of duodenum is removed surgically. The key treatment is the relief of reversed peristalsis. The duodenal circular drainage can resolve the drainage direction of duodenal content, thus relieving the symptom of vomiting.

  4. 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.

  5. 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

  6. The effect of dietary calcium and vitamin D3 on the duodenal cadmium transport in the rat

    International Nuclear Information System (INIS)

    The effect of dietary Ca and vitamin D3 on the duodenal Cd transport was observed in the rat using everted gut sac technique in vitro, 1. Duodenal Cd transport was significantly increased in vitamin D deficient rat, however, it was not influenced by dietary Ca. The duodenal tissue binding and/or uptake of Cd from mucosal incubation medium was neither influenced by vitamin D3 nor dietary Ca. 2. The transported Cd to serosal medium was very little compared to the Cd binding and/or uptake of duodenal tissue, suggesting two steps mechanism for intestinal Cd transport. The first step is the transfer from mucosal medium to duodenal mucosa and the second step is from duodenal mucosa to serosal medium. The second step was influenced by vitamin D. These results suggested that a significant increase in hepatic Cd accumulation of vitamin D deficient rat could be ascribed to the increase in the intestinal Cd absorption. (author)

  7. EUS mini probes in diagnosis of cystic dystrophy of duodenal wall in heterotopic pancreas: A case report

    OpenAIRE

    Jovanovic, Ivan; Knezevic, Srbislav; Micev, Marjan; Krstic, Miodrag

    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-year-old man was admitted to the hospital for abdominal pain and vomiting after food intake. The 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...

  8. Cerebroventricular calcitonin gene-related peptide inhibits rat duodenal bicarbonate secretion by release of norepinephrine and vasopressin.

    OpenAIRE

    Lenz, H. J.; Brown, M R

    1990-01-01

    Proximal duodenal bicarbonate secretion is an important factor in humans and animals protecting the mucosa against acid-peptic damage. This study examined the mechanisms responsible for the central nervous system regulation of duodenal bicarbonate secretion by calcitonin gene-related peptide (CGRP) in unrestrained rats. Cerebroventricular administration of rat CGRP significantly inhibited basal duodenal bicarbonate secretion as well as the stimulatory effects of vasoactive intestinal peptide,...

  9. Histopathology of duodenal mucosal lesions in pediatric patients with inflammatory bowel disease: statistical analysis to identify distinctive features.

    Science.gov (United States)

    Hardee, Steven; Alper, Arik; Pashankar, Dinesh S; Morotti, Raffaella A

    2014-01-01

    Histopathologic lesions of the upper gastrointestinal tract (UGT) are common in inflammatory bowel disease (IBD) patients. Pediatric patients have a higher incidence of IBD-associated gastritis and duodenitis than do adults. This study aimed to identify histopathologic features of duodenal lesions in the pediatric population that are characteristic of IBD, compared to duodenal pathology of different etiopathogenesis. We performed a retrospective analysis of UGT biopsies from pediatric patients with a histopathologic diagnosis of duodenitis (0-18 years of age) over a 7-year period. We identified 40 cases of duodenitis associated with Crohn's disease (CD) and 10 cases associated with ulcerative colitis (UC) and compared the histopathologic characteristics of the duodenitis with age-matched controls consisting of 40 cases duodenitis associated with celiac disease and 40 non-Helicobacter pylori-associated (NOS) etiology duodenitis cases. The histologic features that were evaluated included presence of granulomas, duodenal cryptitis, erosion, lamina propria eosinophils, villous blunting, increased intraepithelial lymphocytes (IELs), and crypt hyperplasia, among others. Additionally, we evaluated the presence of associated gastritis in all of these groups. Statistical analysis to identify significant differences was performed using Kruskal-Wallis testing. Cryptitis was the most distinctive feature of IBD-associated duodenitis. Granulomas were exceptionally rare. The severity of villous blunting and presence of IELs was significantly different in the IBD versus the celiac group. There is a significant overlap with duodenal lesions of different etiopathogenesis, including villous blunting and eosinophilia. With the exclusion of granulomas, cryptitis seems the most distinctive feature of the duodenal lesions associated with IBD. PMID:25207874

  10. Meckel's Diverticulum as a Conduit in Abdominal Mesothelial Nodular Hyperplasia Due To Cancer Stomach: a Case Report

    Directory of Open Access Journals (Sweden)

    D. Srinivasan

    2015-01-01

    Full Text Available A 23-year-old male patient presented to surgical department for acute intestinal obstruction of 3 days duration, emergency laparotomy revealed 500-600 ml of ascetic fluid, most of the small and whole of the large bowel omentum and anterior wall of the stomach was studded with numerous tubercles, the mesentery was tethered to the posterior abdominal wall due to extensive fibroses and the ileo-caecal junction was also fibrosed. During surgery we encountered technical difficulty of mobilizing any part of bowel for diversion, it so happened that a patient was blessed to have Meckel's diverticulum and diversion was performed similar to loop illeostomy. Histopathology of the omentum revealed nodular mesothelial hyperplasia, Oesopho-gastroduodenoscopy revealed antral growth of the stomach. Whole of case scenario been depicted.

  11. MECKEL’S DIVERTICULUM AS A CONDUIT IN ABDOMINAL MESOTHELIAL NODULAR HYPERPLASIA DUE TO CASTOMACH: A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Srinivasan

    2014-09-01

    Full Text Available A 23-year-old male patient presented to Surgical department for acute intestinal obstruction of 3 days duration, emergency laparotomy revealed 500-600ml of ascetic fluid, most of the small and whole of the large bowel omentum and anterior wall of the stomach was studded with numerous tubercles, the mesentery was tethered to the posterior abdominal wall due to extensive fibroses and the ileo-caecal junction was also fibrosed. During surgery we encountered technical difficulty of mobilizing any part of bowel for diversion, it so happened that a patient was blessed to have Meckel's diverticulum and diversion was performed similar to loop illeostomy. Histopathology of the omentum revealed nodular mesothelial hyperplasia, Oesopho-gastroduodenoscopy revealed antral growth of the stomach. Whole of case scenario been depicted.

  12. 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.)

  13. Effects of duodenal switch alone or in combination with sleeve gastrectomy on body weight and lipid metabolism in rats

    OpenAIRE

    Gudbrandsen, Oddrun Anita; Kodama, Yosuke; Mjøs, Svein Are; Zhao, Chun-Mei; Johannesen, Helene; Brattbakk, Hans-Richard; Haugen, Christine; Kulseng, Bård Eirik; Mellgren, Gunnar; Chen, Duan

    2014-01-01

    Background: A combined procedure of sleeve gastrectomy and duodenal switch (SG+DS) has been applied to the treatment of super obesity. The aim of the present study was to test whether duodenal switch alone (DS) leads to similar weight loss and changes in lipid metabolism as SG+DS. Methods: Male Sprague–Dawley rats underwent sham surgery (Sham, N=7), duodenal switch alone (DS, N=5) or sleeve gastrectomy followed by duodenal switch (SG+DS, N=5). Body weight, feed and water intakes, and ambul...

  14. 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

  15. 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...

  16. 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.

  17. 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.

  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. 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.

  20. 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

  1. Long-term risk of gastrointestinal cancers in persons with gastric or duodenal ulcers.

    Science.gov (United States)

    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. PMID:26923747

  2. 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. PMID:26947045

  3. Long-term risk of gastrointestinal cancers in persons with gastric or duodenal ulcers.

    Science.gov (United States)

    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.

  4. 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

    Directory of Open Access Journals (Sweden)

    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

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

    Directory of Open Access Journals (Sweden)

    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.

  6. Ultrastructural study of the mast cells of the human duodenal mucosa.

    Science.gov (United States)

    Moneret-Vautrin, D A; de Korwin, J D; Tisserant, J; Grignon, M; Claudot, N

    1984-09-01

    The ultrastructure of the process of degranulation of mast cells of human duodenal mucosa was examined. In normal controls little degranulation was seen, but in persons with false food allergy (pseudo-allergy) considerable degranulation of mast cells was detected. This is consistent with the hypothesis that some persons have an abnormal fragility of duodenal mast cells in the presence of histamine-releasing substances. Incubation of duodenal biopsy material with various histamine-releasing agents (compound 48/80, Concanavalin A, the calcium ionophore A 23187, and anti-IgE) confirmed the susceptibility of duodenal mast cells for antigen non-specific release of histamine, or that mediated by IgE. In a group of patients with immediate-type, anaphylactic, food allergy, mast cells in the absence of antigen are in a normal state, but degranulation occurs on exposure in vitro or in vivo to specific antigen. The susceptibility to degranulation continues in persons cured of their food allergy. This suggests that a clinical cure is not due to a change of susceptibility of duodenal mast cells to release histamine, but is possibly associated with formation of blocking antibodies, and/or a modification in reactivity of basophils and mast cells of other organs. PMID:6207955

  7. Intramural Duodenal Haematoma after Endoscopic Biopsy: Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    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.

  8. 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.

  9. Magnified endoscopic features of duodenal follicular lymphoma and other whitish lesions.

    Science.gov (United States)

    Iwamuro, Masaya; Okada, Hiroyuki; Takata, Katsuyoshi; Kawai, Yoshinari; Kawano, Seiji; Nasu, Junichiro; Kawahara, Yoshiro; Tanaka, Takehiro; Yoshino, Tadashi; Yamamoto, Kazuhide

    2015-01-01

    The sensitivity and specificity of magnified endoscopic features for differentiating follicular lymphoma from other diseases with duodenal whitish lesions have never been investigated. Here we compared the magnified endoscopic features of duodenal follicular lymphoma with those of other whitish lesions. We retrospectively reviewed the cases of patients with follicular lymphoma (n=9), lymphangiectasia (n=7), adenoma (n=10), duodenitis (n=4), erosion (n=1), lymphangioma (n=1), and hyperplastic polyp (n=1). The magnified features of the nine follicular lymphomas included enlarged villi (n=8), dilated microvessels (n=5), and opaque white spots of various sizes (n=9). The lymphangiectasias showed enlarged villi, dilated microvessels, and white spots, but the sizes of the white spots were relatively homogeneous and their margin was clear. Observation of the adenoma and duodenitis revealed only whitish villi. Although the lymphangioma was indistinguishable from the follicular lymphomas by magnified features, it was easily diagnosed based on the macroscopic morphology. In conclusion, magnified endoscopic features, in combination with macroscopic features, are useful for differentiating follicular lymphomas from other duodenal diseases presenting whitish lesions. PMID:25703169

  10. 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.

  11. 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.

  12. Duodenal fistula after gastrectomy: retrospective study of 13 new cases

    Directory of Open Access Journals (Sweden)

    María de los Ángeles Cornejo

    2016-01-01

    Full Text Available Introduction: Duodenal stump fistula (DSF after gastrectomy has a low incidence but a high morbidity and mortality, and is therefore one of the most aggressive and feared complications of this procedure. Material and methods: We retrospectively evaluated all DSF occurred at our hospital after carrying out a gastrectomy for gastric cancer, between January 1997 and December 2014. We analyzed demographic, oncologic, and surgical variables, and the evolution in terms of morbidity, mortality and hospital stay. Results: In the period covered in this study, we performed 666 gastrectomies and observed DSF in 13 patients (1.95%. In 8 of the 13 patients (61.5% surgery was the treatment of choice and in 5 cases (38.5% conservative treatment was carried out. Postoperative mortality associated with DSF was 46.2% (6 cases. In the surgical group, 3 patients developed severe sepsis with multiple organ failure, 2 patients presented a major hematemesis which required endoscopic haemostasis, 1 patient had an evisceration and another presented a subphrenic abscess requiring percutaneous drainage. Six patients (75% died despite surgery, with 3 deaths in the first 24 hours of postoperative care. The 2 patients who survived after the second surgical procedure had a hospital stay of 45 and 84 days respectively. In the conservative treatment group the cure rate was 100% with no significant complications and an average postoperative hospital stay of 39.5 days (range, 26-65 days. Conclusion: FMD is an unusual complication but it is associated with a high morbidity and mortality. In our experience, conservative management has shown better results compared with surgical treatment.

  13. Quantitative histological study of mucosal inflammatory cell densities in endoscopic duodenal biopsy specimens from dyspeptic patients using computer linked image analysis.

    OpenAIRE

    Collins, J. S.; Hamilton, P W; Watt, P C; Sloan, J. M.; Love, A H

    1990-01-01

    Inflammatory cell counting in endoscopic biopsy sections was carried out on duodenal mucosal samples from defined sites in patients with duodenal ulcer, duodenitis but no ulcer, non-ulcer dyspepsia, and asymptomatic controls using computer linked image analysis. The variables measured included polymorphonuclear and mononuclear cells per mm of superficial epithelium and per mm2 lamina propria. Duodenal ulcer crater margin and mucosal biopsy specimens from endoscopically inflamed mucosa in the ...

  14. Duodenal Gastrointestinal Stromal Tumor Treated by Wedge Resection in a Patient with Neurofibromatosis Type 1: Report of a Case and Review of the Japanese Literature

    OpenAIRE

    Takeuchi, Hideya; Matsumoto, Toshihumi; Kusumoto, Tetsuya; Yoshikawa, Yasuji; Muto, Yoichi

    2009-01-01

    A case of duodenal gastrointestinal stromal tumor (GIST) treated by wedge resection in a patient with neurofibromatosis type 1 (NF-1) is reported. A 55-year-old man with a history of NF-1 was admitted for surgery for a duodenal tumor. Upper gastrointestinal endoscopy revealed a 2.5 cm duodenal submucosal tumor. Abdominal computed tomography showed a homogenously enhanced mass in the third portion of the duodenum. The patient successfully underwent wedge resection of the duodenal tumor. Histol...

  15. 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

  16. 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.

  17. 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.

  18. Duodenal Tube Feeding: An Alternative Approach for Effectively Promoting Weight Gain in Children with Gastroesophageal Reflux and Congenital Heart Disease

    Directory of Open Access Journals (Sweden)

    Seiko Kuwata

    2013-01-01

    Full Text Available We tested whether duodenal tube feeding effectively improves the clinical symptoms and body weight gain in children with congenital heart disease (CHD and gastroesophageal reflux (GER. In the retrospective analysis of 17 consecutive children with CHD who were treated with duodenal tube feeding for symptomatic GER, we found that clinical symptoms of persistent emesis or respiratory wheezing after feeding disappeared with duodenal tube feeding in all patients. Duodenal tube feeding facilitated a stable nutritional supply, resulting in marked improvement of weight gain from 6 to 21 g/day (. In a patient with trisomy 21 and persistent pulmonary hypertension after the closure of a ventricular septal defect, duodenal tube feeding ameliorated pulmonary hypertension, as evidenced by the improvement of the pressure gradient of tricuspid regurgitation from 77 to 41 mm Hg. In 14 of the 17 patients, the duodenal tube was successfully removed, with the spontaneous improvement of GER (median duration of duodenal tube feeding: 7 months. In conclusion, duodenal tube feeding improves the weight gain of infants with GER who need treatment for CHD-associated heart failure. It also allows for the improvement of pulmonary hypertension.

  19. 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......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...

  20. 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.

  1. 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.

  2. Perforated duodenal ulcer in high risk patients: Is percutaneous drainage justified?

    Directory of Open Access Journals (Sweden)

    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.

  3. 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...

  4. 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...

  5. 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.

  6. 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.

  7. Values of endoscopic ultrasonography for diagnosis and treatment of duodenal protruding lesions

    Institute of Scientific and Technical Information of China (English)

    Guo-qiang XU; Yi-qun WU; Li-jun WANG; Hong-tan CHEN

    2008-01-01

    Objective: The diagnoses of patients with duodenal protruding lesions are difficult when using conventional examinations such as computed tomography (CT) and conventional endoscope etc. Thus, we investigated the clinical value of endoscopic ultrasonography (EUS) with miniature ultrasonic probes on the diagnosis and treatment of duodenal protruding lesions. Methods: Patients with duodenal protruding lesions who were indicated for EUS were examined by EUS with 12-15 MHz miniature ultrasonic probes and double-cavity electronic endoscope. According to diagnosis of EUS, those patients were indicated for biopsy and treatment received biopsy, endoscopic resection or surgical excision. The postoperative histological results were compared with the preoperative diagnosis of EUS. Those patients without endoscopic resection or surgical excision were periodically followed up with EUS. Results: A total of 169 patients with duodenal protruding lesions were examined by EUS, of which 40 were diagnosed with cysts, 36 with inflammatory protruding or polyp, 25 with Brunner's gland adenoma, 19 with ectopic pancreas, 17 with gastrointestinal stromal tumor, 12 with extrinsic compression, 12 with minor papilla, 6 with lipoma, 1 with adenocarcinoma and 1 with lymphoma. After EUS examinations, 75 patients received biopsy, endoscopic resection or surgical excision respectively. The postoperative histological results of 70 patients were completely consistent with the preoperative diagnosis of EUS, with 93.33% diagnostic accuracy. The results of follow-up with EUS indicated that duodenal cyst, Brunner's gland adenoma, ectopic pancreas, gastrointestinal stromal tumor and lipoma remained unchanged within 1-3 years. No related complications occurred among all patients that received EUS examinations. Conclusion: EUS is an effective and reliable diagnostic method for duodenal protruding lesions.

  8. 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.

  9. 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.

  10. Diverticulopexia no tratamento do divertículo de Zenker Diverticulopexy for the treatment of Zenker's diverticulum

    Directory of Open Access Journals (Sweden)

    Renato Micelli Lupinacci

    2013-02-01

    Full Text Available O divertículo de Zenker é um pseudodivertículo que se origina de um defeito muscular na parede posterior da faringe, na área de transição entre o músculo constritor inferior da faringe e o músculo cricofaringeo. Apesar do avanço das técnicas endoscópicas, o tratamento cirúrgico persiste como o tratamento padrão. Duas técnicas são possíveis: diverticulectomia (ressecção do divertículo e a diverticulopexia. As vantagens da diverticulopexia estão ligadas à ausência de anastomose esofágica e suas possíveis complicações: fistulas cervicais, mediastinite, estenose esofágica e infecção de ferida. Em ambas as técnicas a secção das fibras musculares do músculo cricofaringeo (ou, esfíncter superior do esôfago é fundamental. O objetivo do presente artigo é descrever em detalhes a técnica de diverticulopexia junto ao ligamento pré-vertebral associada à miotomia do músculo cricofaríngeo.Zenker´s diverticulum is a pseudodiverticulum through a muscular defect in the posterior pharyngeal wall at the area between the inferior pharyngeal constrictor muscles of the pharynx and the cricopharyngeus muscle. Although endoscopic techniques have made significant progress, the surgical treatment remains the gold standard. There are two main techniques: diverticulectomy (resection of the diverticulum and diverticulopexy. The main advantages of diverticulopexy are mostly linked to the absence of an esophageal anatomosis and its possible complications: cervical fistulae, mediastinitis, esophageal stenosis and wound infection, which allows a rapid recover with satisfactory oral intake. The purpose of this article is to describe in details the technique for diverticulopexy to the prevertebral ligament in association with a miotomy of the cricopharyngeus muscle.

  11. 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.

  12. Effect of dopamine-related drugs on duodenal ulcer induced by cysteamine or propionitrile: prevention and aggravation may not be mediated by gastrointestinal secretory changes in the rat

    Energy Technology Data Exchange (ETDEWEB)

    Gallagher, G.; Brown, A.; Szabo, S.

    1987-03-01

    Dose- and time-response studies have been performed with dopamine agonists and antagonists using the cysteamine and propionitrile duodenal ulcer models in the rat. The experiments demonstrate that the chemically induced duodenal ulcer is prevented by bromocriptine, lergotrile and reduced by apomorphine or L-dopa. Aggravation of cysteamine-induced duodenal ulcer was seen especially after (-)-butaclamol, (-)-sulpiride, haloperidol and, less effectively, after other dopaminergic antagonists. The duodenal antiulcerogenic action of dopamine agonists was more prominent after chronic administration than after a single dose, whereas the opposite was found concerning the proulcerogenic effect of dopamine antagonists. In the chronic gastric fistula rat, both the antiulcerogens bromocriptine or lergotrile and the proulcerogens haloperidol, pimozide or (-)-N-(2-chlorethyl)-norapomorphine decreased the cysteamine- or propionitrile-induced gastric secretion. No correlation was apparent between the influence of these drugs on duodenal ulcer development and gastric and duodenal (pancreatic/biliary) secretions. In the chronic duodenal fistula rat, decreased acid content was measured in the proximal duodenum after haloperidol, and diminished duodenal pepsin exposure was recorded after bromocriptine. Furthermore, the aggravation by dopamine antagonists of experimental duodenal ulcer probably involves a peripheral component. The site of dopamine receptors and physiologic effects which modulate experimental duodenal ulcer remain to be identified, but their elucidation may prove to be an important element in the pathogenesis and treatment of duodenal ulcer.

  13. 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. PMID:22047890

  14. Duodenal hematoma following blunt abdominal injury. A case in a young child

    International Nuclear Information System (INIS)

    We report a case of traumatic duodenal hematoma. The patient's age (2.5 y.) and the absence of evidence of trauma when the symptoms began led to perform plain films of the abdomen, upper GI series, US, CT and MR. This excess of imaging modalities emphasize the diagnostic value of plain X Rays of the abdomen and opacification of the duodenum. (authors)

  15. [Prognostic factors of efficacy of eradication therapy in patients with duodenal ulcer].

    Science.gov (United States)

    Kozlova, I V; Eliseev, Iu Iu; Pakhomova, A L; Khan, Sadzhad Akhmad

    2005-01-01

    The aim of the study was to determine microorganism-associated predictors of efficacy of eradication therapy in patients with Helicobacter pylori-associated duodenal ulcer. The subjects were 129 such patients. Clinical, endoscopic, microbiological, and immunological examination revealed differences in the initial immune status, the structure of gastroduodenal zone mucosa, and large bowel biocenosis, which predict efficacy of eradication therapy. PMID:16117427

  16. Intramural Duodenal Hematoma with Acute Pancreatitis in a Patient With an Overt Pancreatic Malignancy

    OpenAIRE

    Khurana, Tanvi; Shah, Apeksha; Ali, Ijlal; Islam, Raafa; Siddiqui, Ali A.

    2014-01-01

    Intramural hematomas have rarely been associated with pancreatitis, and to date there is only 1 case report of an intramural hematoma occurring with pancreatic adenocarcinoma. We describe a patient who presented with gastric outlet obstruction secondary to a spontaneous intramural duodenal hematoma and was found to have a pancreatic adenocarcinoma on endoscopic ultrasound (EUS) after it was not visualized by computed tomography (CT).

  17. 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.

  18. 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.

  19. Histomorphometric study of changes in duodenal mucosa of patients presenting with Giardiasis

    Directory of Open Access Journals (Sweden)

    Kachnar Varma

    2015-01-01

    Full Text Available Context: Giardia lambia is a common intestinal protozoon with a higher prevalence rate in tropical countries as compared to the Western world. Histological changes occur in duodenal mucosa in cases of chronic giardiasis that may be similar to celiac disease or tropical sprue. Aim: As the prevalence of giardiasis is high in our country, the present study was undertaken to study the changes in duodenal mucosa of patients with asymptomatic giardiasis and endoscopically normal duodenum. Study Design: The study included 47 duodenal biopsies out of 372 total cases of endoscopic biopsies examined, in which trophozoites of Giardia were identified. A detailed histo-morphological study of these cases was carried out and the histological findings were evaluated. The major histopathological features as observed in cases of giardiasisi.e inflammation, increased intra epithelial lymphocytes (IELs and villous abnormalities were compared between patients without giardiasis and those with giardiasis. Statistical Analysis Used: P-value using chi-square test was calculated. Results: P-value was found to be significant for inflammation and villous abnormalities whereas increased IEL′s were found to be an insignificant histological parameter. Conclusion: Although the histological features associated with giadiasis were non-specific, a higher incidence of villous changes with increased IEL′s was found. This study highlighted the importance of identification of Giardia trophozoites in duodenal biopsies to avoid misdiagnosis of celiac disease or tropical sprue which may have similar clinical and histological features but have different management strategies.

  20. Primary duodenal Burkitt lymphoma presenting as sessile, button-like bleeding polyps

    Directory of Open Access Journals (Sweden)

    Ching-Chih Hu

    2015-03-01

    Full Text Available Primary gastrointestinal (GI lymphoma accounts for 30–50% of all extranodal non-Hodgkin’s lymphomas, making the GI tract the most common site of extranodal non-Hodgkin’s lymphomas. Most GI lymphomas belong to the B cell lineage. Burkitt lymphoma (BL is a highly aggressive mature B cell neoplasm that occurs in three forms: endemic, sporadic, and immunodeficiency-associated. Sporadic BL accounts for 1–2% of all adult lymphomas and usually presents as an abdominal manifestation of extranodal disease involving the distal ileum or cecum. Primary BL of the duodenum is rare. However, this report emphasizes the importance of awareness of the malignancy potential of duodenal polyps. We report the case of a 70-year-old woman admitted to our ward with upper GI bleeding due to duodenal polyps. An upper GI endoscopic examination showed button-like polyps with central depression, and an immunohistochemical study of the polyps revealed a high-grade B cell malignancy (BL. Consequently, the patient was treated with aggressive chemotherapy. The tumors regressed after chemotherapy. Although primary duodenal Burkitt lymphoma is very rare, the possibility of malignancy should be considered if a patient presents with duodenal button-like polyps with a central depressed surface.

  1. Effects of supraphysiologic concentration glucose on pancreatic duodenal homeobox-1 expression and insulin secretion in rats

    Institute of Scientific and Technical Information of China (English)

    XIAO Chang-qing; DENG Hong-ming; HUANG Yun

    2007-01-01

    @@ The islet transcription factor pancreatic duodenal homeobox-1 (PDX-1, also known as insulin promoter factor-1 or IPF-1) is an orphan homeodomain protein that plays an important role in the development, proliferation,differentiation and maturation of pancreatic cells.

  2. 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.

  3. 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.

  4. Duodenal perforation by an inferior vena cava filter in a polyarteritis nodosa sufferer

    Directory of Open Access Journals (Sweden)

    Anthony Dat

    2014-01-01

    CONCLUSION: Duodenal perforation is a rare complication of IVC filter insertion. This case however illustrates the potentially catastrophic consequences of a relatively common endovascular procedure. Caution should be taken when considering the insertion of IVC filters in patients with longstanding vasculopathies who are on immunosuppressants.

  5. 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.

  6. Safety experience with the duodenal-jejunal bypass liner: an endoscopic treatment for diabetes and obesity

    NARCIS (Netherlands)

    Betzel, B; Koehestanie, P.; Aarts, E.O.; Dogan, K.; Homan, J.; Janssen, I.M.C.; Wahab, P.J.; Groenen, M.J.; Berends, F.J.

    2015-01-01

    BACKGROUND: The duodenal-jejunal bypass liner (DJBL) is a new, device-based endoscopic treatment for type 2 diabetes mellitus (T2DM) and obesity. OBJECTIVE: To report serious safety events of subjects treated with the DJBL while offering a simple guideline to mitigate risk. DESIGN: Single-center obs

  7. 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...... stressful life events before entrance to the study (P less than 0.05) and, like the neurotic patients, they had lowerego-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 with...

  8. The mechanism of gastrin release in cysteamine-induced duodenal ulcer

    DEFF Research Database (Denmark)

    Poulsen, Steen Seier

    1982-01-01

    Duodenal ulcer can be induced in rats by a single dose of cysteamine. The ulcer formation is accompanied by acid hypersecretion and elevated serum gastrin levels. This study was performed to elucidate the mechanisms of gastrin release after an ulcerogenic dose of cysteamine. Cysteamine induced a...

  9. Morphological, immunophenotypic and clinical characteristics of dogs with lymphocytic - plasmacytic duodenitis

    Directory of Open Access Journals (Sweden)

    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

  10. A case of invasive cytomegalovirus duodenitis in an immunosuppressed patient 15 months after renal transplantation.

    Science.gov (United States)

    Kazanji, N; Davila, F; Manickam, P; Wang, Y; Bossory, L

    2015-06-01

    Cytomegalovirus (CMV) remains one of the most important infections in kidney transplantation. Only a handful of images have been reported in the literature thus far. We present classic pathologic and gross images of CMV duodenitis in an immunosuppressed patient more than one year post-renal transplantation. PMID:25582982

  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 novel...

  12. Choledochoduodenal fistula complicating duodenal ulcer disease (a report of 3 cases.

    Directory of Open Access Journals (Sweden)

    Shah P

    1990-07-01

    Full Text Available Choledochoduodenal fistula complicating duodenal ulcer disease is a rare occurrence. The present paper describes 3 such cases which were incidentally picked up on upper gastro-intestinal (GI radiographic study and endoscopy done for ulcer like symptoms. The relevant literature is reviewed.

  13. Spontaneous duodenal fistulization of pseudocyst of pancreas: A rare entity in children

    Directory of Open Access Journals (Sweden)

    Yadav Sunil

    2010-01-01

    Full Text Available The spontaneous resolution of pseudopancreatic cyst due to internal fistulization into the duodenum in a 4-year-old male child is described here. This is rare and the child presented initially with features of duodenal obstruction. Upper gastrointestinal endoscopy and computed tomography scan confirmed the diagnosis and the unusual mode of resolution of this entity.

  14. 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.

  15. 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.

  16. 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.

  17. A note on the duodenum of the West Indian manatee (Trichechus manatus), with emphasis on the duodenal glands.

    Science.gov (United States)

    Reynolds, J E; Krause, W J

    1982-01-01

    The anatomy of the duodenum of the West Indian manatee has both macroscopic and microscopic features that are unusual when compared to other mammalian forms. Macroscopically, the voluminous duodenal ampulla and the paired duodenal diverticula are distinctive. The general microscopic structure of the manatee duodenum is not unusual, but the duodenal glands secrete an acid mucin (sialomucin). The cells of these glands appear to be intermediate between classical serous and mucous cell types. These cells also contain granules with regions of high peripheral electron density. The overall structure of the manatee duodenum most strongly resembles that of the dugong, another member of the order Sirenia. PMID:7148376

  18. Longitudinal study of influence of Helicobacter pylori on current risk of duodenal ulcer relapse. The Hvidovre Ulcer Project Group

    DEFF Research Database (Denmark)

    Clausen, M R; Franzmann, M B; Holst, C;

    1992-01-01

    Seventy-four patients with duodenal ulcer were followed up longitudinally for 2 years after initial ulcer healing. Endoscopy including biopsy of the antral mucosa was performed every 3rd month and whenever clinical symptoms of relapse occurred. The presence of Helicobacter pylori in the biopsy...... acid output, time of healing of the preceding ulcer, treatment of the present ulcer (cimetidine, antacids, or no treatment), or type and degree of gastritis. Thus, although H. pylori is prevalent in patients with duodenal ulcer disease, the present study indicates that H. pylori does not have a...... substantial note in the precipitation of active duodenal ulcer....

  19. 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

  20. 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

    Directory of Open Access Journals (Sweden)

    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

  1. [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.

  2. 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...... 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...... the role of H. pylori in duodenal ulcer disease. The rates were higher among gastroenterologists than among general practitioners. Eighty-four per cent of the British doctors, 80% of the Dutch doctors, and 48% of the Danish doctors used diagnostic tests for H. pylori, most frequently histological...

  3. Pyloro-duodenal hernia with formation of enterocutaneous fistula in a buffalo calf following a dog attack

    Directory of Open Access Journals (Sweden)

    G. Kamalakar

    2015-09-01

    Full Text Available A body wall hernia entrapping abomasum and concurrent duodenal fistula in a buffalo calf aged about 8 months, secondary to a dog bite was successfully treated by closure of fistulous orifice and ventro lateral herniorrhaphy.

  4. Anomalous opening of the common bile duct into the duodenal bulb: endoscopic treatment

    Directory of Open Access Journals (Sweden)

    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

  5. 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...

  6. 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.

  7. Mechanism of increased iron absorption in murine model of hereditary hemochromatosis: Increased duodenal expression of the iron transporter DMT1

    OpenAIRE

    Fleming, Robert E.; Migas, Mary C.; Zhou, Xiaoyan; Jiang, Jinxing; Britton, Robert S.; Brunt, Elizabeth M.; Tomatsu, Shunji; Waheed, Abdul; Bacon, Bruce R; Sly, William S.

    1999-01-01

    Hereditary hemochromatosis (HH) is a common autosomal recessive disorder characterized by tissue iron deposition secondary to excessive dietary iron absorption. We recently reported that HFE, the protein defective in HH, was physically associated with the transferrin receptor (TfR) in duodenal crypt cells and proposed that mutations in HFE attenuate the uptake of transferrin-bound iron from plasma by duodenal crypt cells, leading to up-regulation of transporters for dietary iron. Here, we tes...

  8. Usefulness of surgical closure following intraoperative endoscopic additional stenting of duodenal perforation by stent: Report of a case

    OpenAIRE

    Shimizu, Kenji; Takamori, Hiroshi; Baba, Hideo

    2016-01-01

    Introduction Malignant duodenal stenosis occurs in patients with advanced periampullary cancer. Insertion of a self-expanding metal stent for the treatment of this condition carries the risk of subsequent perforation of the duodenum. We report successful treatment of duodenal perforation induced by a stent. Presentation of case An 80-year-old woman suffering from stenosis caused by advanced periampullary cancer underwent metallic stent placement and her symptoms improved. While attempting bil...

  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. Non-operative treatment for perforated gastro-duodenal peptic ulcer in Duchenne Muscular Dystrophy: a case report

    OpenAIRE

    Wever Jan; van Royen Barend J; Oddens Jorg R; Brinkman Justus-Martijn; Olsman Jan G

    2004-01-01

    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 treat...

  12. Differences in Surface-Exposed Antigen Expression between Helicobacter pylori Strains Isolated from Duodenal Ulcer Patients and from Asymptomatic Subjects

    OpenAIRE

    Thoreson, Ann-Catrin E.; Hamlet, Annika; Çelik, Janet; Byström, Mona; Nyström, Susanne; Olbe, Lars; Svennerholm, Ann-Mari

    2000-01-01

    We have analyzed possible qualitative and quantitative differences in antigen expression between Helicobacter pylori strains isolated from the antrum and different locations in the duodenum of 21 duodenal ulcer (DU) patients and 20 asymptomatic subjects (AS) by enzyme-linked immunosorbent assay (ELISA) and inhibition ELISA. Almost all antral and duodenal strains grown in vitro expressed the N-acetyl-neuroaminyllactose-binding hemagglutinin, flagellins (subunits FlaA and FlaB), urease, a 26-kD...

  13. An examination of the relationship between the endoscopic appearance of duodenitis and the histological findings in patients with epigastric pain

    OpenAIRE

    Lewis, Stephen; Stableforth, William; Awasthi, Rachana; Awasthi, Ashish; Pitts, Narrie; Ottaway, Janet; Sherwood, Anthea; Robertson, Neil; Cochrane, Sean; Wilkinson, Stephen

    2012-01-01

    The endoscopic appearance of duodenitis is a common finding in patients undergoing endoscopy because of epigastric pain however, the relationship of the visual findings to histology is poorly defined. We set out to ascertain if there was a correlation between the endoscopic and histological appearances of the duodenal mucosa. Consecutive patients with epigastric pain referred for diagnostic gastroduodenoscopy were studied. The visual appearances of ‘duodenitis’ (erythema, erosions and sub-epi...

  14. 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.

  15. 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.

  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. [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). PMID:17042205

  18. 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.

  19. Membranous duodenal stenosis: Initial experience with balloon dilatation in four children

    International Nuclear Information System (INIS)

    Introduction: We present a novel approach to the treatment of membranous duodenal stenosis (MDS). To our knowledge this is the first paper to describe balloon dilatation for this entity. Material and methods: Four children, 2 boys and 2 girls, aged between 8 and 28 days, underwent duodenal balloon dilatation. Balloon dilatation was performed under general anaesthesia using standard angiography balloons per os. Balloon diameters ranged from 6 to 14 mm. Results: All balloon dilatations were successful. None of the procedures showed procedural or post-procedural complications. None of the patients subsequently required surgical intervention. To date all children are doing well. Discussion: The initial experience with balloon dilation of MDS showed a 100% success rate, without procedural or post-procedural complications. The results obtained in this small group of patients suggest that the use of balloon dilatation in cases of MDS may be a safe technique that can be readily performed by an experienced interventional radiologist

  20. 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.

  1. 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

    OBJECTIVE: To assess fluctuations in quality of life (QoL) and motor performance in patients with advanced Parkinson disease (PD) treated with continuous daytime duodenal levodopa/carbidopa infusion or conventional therapy. METHODS: Of 18 patients completing a 6-week trial (DIREQT), 12 were...... 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...... with significantly more favourable outcomes compared with conventional treatment for satisfaction with overall functioning, 'off' time and ability to walk, with improved outcomes with PDQ-39. CONCLUSIONS: Relative to conventional treatment, infusion therapy may stabilize and significantly improve motor function...

  2. 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)

  3. Recurrent Episodes of Acute Pancreatitis Due to Duodenal Gangliocytic Paraganglioma: Report of a Case

    Directory of Open Access Journals (Sweden)

    Natalia Asimakopoulou

    2014-03-01

    Full Text Available Context Gangliocytic paraganglioma is a rare tumor, almost always located in the second portion of the duodenum, andmanifested with upper gastrointestinal bleeding and abdominal pain. To date, only one case of duodenal gangliocyticparaganglioma presented with recurrent acute pancreatitis has been reported in the literature. Case report We present a72-year-old woman admitted to the hospital due to recurrent episodes of acute pancreatitis. Paraclinical examinationsshowed a polypoid mass in the second portion of duodenum which was removed surgically by local excision. Thepreoperative differential diagnosis was suggestive with gastrointestinal stromal tumor or adenoma. The histopathologyexamination revealed a duodenal gangliocytic paraganglioma. After a follow up period of seventeen months the patientremained without clinical evidence of tumor recurrence. Conclusion Our case report draws attention to the need forincluding in our differential diagnosis of recurrent acute pancreatitis the mechanical obstruction of the pancreatic duct dueto this tumor.

  4. 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.

  5. 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

  6. 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.

  7. Spontaneous pneumobilia revealing choledocho-duodenal fistula: A rare complication of peptic ulcer disease

    Directory of Open Access Journals (Sweden)

    Massimo Tonolini

    2013-01-01

    Full Text Available Spontaneous pneumobilia without previous surgery or interventional procedures indicates an abnormal biliary-enteric communication, most usually a cholelithiasis-related gallbladder perforation. Conversely, choledocho-duodenal fistulisation (CDF from duodenal bulb ulcer is currently exceptional, reflecting the low prevalence of peptic disease. Combination of clinical data (occurrence in middle-aged males, ulcer history, absent jaundice and cholangitis and CT findings including pneumobilia, normal gallbladder, adhesion with fistulous track between posterior duodenum and pancreatic head allow diagnosis of CDF, and differentiation from usual gallstone-related biliary fistulas requiring surgery. Conversely, ulcer-related CDF are effectively treated medically, whereas surgery is reserved for poorly controlled symptoms or major complications.

  8. Duodenal administered seal oil for patients with subjective food hypersensitivity: an explorative open pilot study

    OpenAIRE

    Gregersen, Kine; Lind, Ragna Anne; Valeur, Jørgen; Bjørkkjær, Tormod; Berstad, Arnold; Lied, Gülen Arslan

    2010-01-01

    Short-term duodenal administration of n-3 polyunsaturated fatty acid (PUFA)-rich seal oil may improve gastrointestinal complaints in patients with subjective food hypersensitivity, as well as joint pain in patients with inflammatory bowel disease (IBD). The aim of the present explorative pilot study was to investigate whether 10-day open treatment with seal oil, 10 mL self-administrated via a nasoduodenal tube 3 times daily, could also benefit nongastrointestinal complaints and...

  9. Extra-Adrenal Retroperitoneal Paraganglioma with Extensive Duodenal Invasion and Inferior Vena Cava Tumor Thrombus.

    Science.gov (United States)

    Sadamori, Hiroshi; Monden, Kazuteru; Hioki, Masayoshi; Yoshimoto, Masashi; Ueki, Toru; Hyodo, Tsuyoshi; Omonishi, Kunihiro; Kioka, Yukio; Kuriyama, Mitsuhito; Ohno, Satoshi; Sakaguchi, Kohsaku; Matsuda, Tadakazu; Takakura, Norihisa

    2016-08-01

    We report a case of extra-adrenal retroperitoneal paraganglioma (RP) with extensive duodenal invasion and tumor thromboses both in the right testicular vein and in the inferior vena cava (IVC). Because there was rigid adherence between the RP and the abdominal aorta, pancreatoduodenectomy with replacement of the IVC and aorta was performed for complete surgical resection. In the present case, both the mode of progression of the RP and the surgical approach were extremely rare. PMID:26921027

  10. 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.

  11. Endoscopic Fenestration of a Duodenal Duplication Cyst to Resolve Recurrent Pancreatitis

    OpenAIRE

    Marie-Antoinette J Rockx; McAlister, Vivian C.

    2007-01-01

    Non-invasive tools such as endoscopic ultrasound and magnetic resonance cholangiopancreatography have assisted the diagnosis of unexplained or recurrent acute pancreatitis prior to endoscopic retrograde cholangiopancreatography (ERCP). The majority of these patients are improved by endoscopic therapy with ERCP. Duodenal duplication cyst is a known but rare cause of recurrent acute pancreatitis that is also amenable to ERCP. We document the diagnosis and treatment of a 26-year-old man who had ...

  12. 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.

  13. Management of Duodenal Atresia in the setting of Congenital Leukemia with Massive Hepatomegaly

    Directory of Open Access Journals (Sweden)

    Sathyaprasad C Burjonrappa

    2013-06-01

    Full Text Available Down's syndrome (DS is associated with duodenal atresia (DA in about 8-10% of cases. Transient Myeloproliferative Disorder (TMD/Acute Myeloid Leukemia (AML is also associated with the trisomy 21 mutation. The occurrence of the two conditions together complicates the diagnosis and surgical management of the DA. We discuss the technical aspects of management of the DA in this clinical setting.

  14. Clinical value of duodenal biopsies--beyond the diagnosis of coeliac disease.

    Science.gov (United States)

    Walker, Marjorie M; Talley, Nicholas J

    2011-09-15

    At upper gastrointestinal endoscopy to investigate unexplained diarrhea and iron deficiency anemia, duodenal biopsies are often taken to exclude a diagnosis of coeliac disease. While histology remains the gold standard for this diagnosis, recent developments in serological testing may overtake this as a first line test and biopsy restricted to confirming the diagnosis. Established coeliac disease on biopsy is straightforward, but early lesions may pose a challenge. Newer endoscopic procedures such as push-pull enteroscopy (balloon enteroscopy) with biopsy allow access to the small bowel beyond the second part of the duodenum. Controversy remains as to what constitutes the normal histology of the duodenum, and small bowel. Lymphocytic duodenosis (increased intraepithelial lymphocytes with normal villous architecture) in patients with negative coeliac serology can be associated with Helicobacter pylori, drugs, autoimmune and other diseases including food allergy. Full thickness small intestinal biopsies can aid in investigation of enteric neuropathies in severe dysmotility disorders. Biopsies are also taken to investigate malabsorption due to suspected infectious and metabolic disorders. Despite highly active anti-retroviral therapy (HAART), immunosuppressed patients may be affected by duodenal pathogens. The histology of duodenal mucosa in acid related disorders reflects the damage seen at endoscopy. Although the prevalence of duodenal ulcer disease is decreasing, drugs causing ulceration remain an important disease entity. Recent observations in functional bowel disorders suggest that the duodenum may be a key site for pathology. In functional dyspepsia, patients with early satiety may have excess eosinophil infiltration, and the mast cell is probably a key player in the irritable syndrome in the small intestine. PMID:21940106

  15. Variations in duodenal cross-sectional area during the interdigestive migrating motility complex.

    Science.gov (United States)

    Gregersen, H; Kraglund, K; Djurhuus, J C

    1990-07-01

    A probe for measurement of intestinal cross-sectional area (CA) was used to elucidate variations of human gut CA during the interdigestive migrating motility complex (MMC). A balloon was inflated by saline at a pressure of 1 kPa, and variations of balloon CA (BCSA) were measured by means of the field-gradient principle. Duodenal phasic activity was measured by perfused side holes proximal to, distal to, and inside the balloon. In vitro characterization of probe performance showed that static measurement of BCSA was very accurate regardless of the configuration of the balloon. However, during dynamic measurements, BCSA was valid only for slow variations in BCSA due to resistance in the evacuation and inflation system. Eight duodenal MMCs were recorded. BCSA increased consistently from the start of phase I to the end of phase II from 72 (45-100) to 136 (87-154) mm2. During late phase II, a large BCSA increase was recorded. A positive correlation between the phasic activity level in phases I and II of MMC and maximal BCSA in duodenum was demonstrated (proximal P less than 0.01; distal P less than 0.05). BCSA during phase III was small but could not be estimated accurately because steady-state conditions were not obtained. The large BCSA in late phase II suggests a relaxation of the duodenal wall secondary to a decrease in smooth muscle tone. The results add evidence to previous findings of a low-resistance or large-capacitance situation in late phase II, observed as a large pancreaticobiliary excretion into the duodenum and an increased flow of duodenal contents. PMID:2372063

  16. 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...... minimal invasive and fully reversible endoscopic treatment modality approved for treatment of obesity with or without concomitant type 2 diabetes. Here we review present data for the efficacy and safety of this treatment modality....

  17. Emergency transcatheter arterial embolization for patients with acute massive duodenal ulcer hemorrhage

    Institute of Scientific and Technical Information of China (English)

    Yong-Li Wang; Ying-Sheng Cheng; Li-Zhen Liu; Zhong-Hui He; Kun-Hong Ding

    2012-01-01

    AIM:To evaluate the efficacy and safety of emergency transcatheter arterial embolization (ETAE) for patients with acute massive duodenal ulcer hemorrhage.METHODS:Twenty-nine consecutive patients with acute massive bleeding of duodenal ulcer were admitted to our hospital from 2006 to 2011.Superselective angiography of the celiac and gastroduodenal arteries was performed to find out the bleeding sites before ETAE,then,embolotherapy was done with gelatin sponge particles or microstrips via a 5 French angiographic catheter or 3 French microcatheter.After ETAE,further superior mesenteric arteriography was undertaken in case collateral circulation supplied areas of the duodenal ulcer.Technical and clinical success rates were analyzed.Changes in the mucous membrane were observed using endoscopy following ETAE.RESULTS:Angiography showed active bleeding with extravasation of contrast medium in seven cases with a 24% positive rate of celiac artery bleeding,and in 19 cases with a 65.5% rate of gastroduodenal artery bleeding.There were no angiographic signs of bleeding in three patients who underwent endoscopy prior to ETAE.Twenty-six patients achieved immediate hemostasis and technical success rate reached 90%.No hemostasis was observed in 27 patients within 30 d after ETAE and clinical success rate was 93%.Recurrent hemorrhage occurred in two patients who drank a lot of wine who were treated by a second embolotherapy in the same way.Five patients underwent transient ischem with light abdominal pain under xiphoid,spontaneous restoration without special treatment.No mucous necrosis happened to 29 cases for ischem of gastroduodenal arteries embolized.CONCLUSION:ETAE is an effective and safe measure to control acute massive bleeding of duodenal ulcer.

  18. Risk factors for healing of duodenal ulcer under antacid treatment: do ulcer patients need individual treatment?

    OpenAIRE

    Massarrat, S; Müller, H. G.; Schmitz-Moormann, P

    1988-01-01

    In order to identify the risk factors affecting the healing of duodenal ulcer, a clinical trial with effective dose of antacid was carried out in 53 patients. Duration of ulcer history, number of relapses, duration of the last and present relapse, number, duration and severity of pain attacks in the present ulcer relapse, pain radiation to back, vomiting, appetite, smoking habit, intake of analgesics and previous haemorrhage were registered. Number of ulcers, ulcer depth, bublar narrowing, er...

  19. Coeliac disease with histological features of peptic duodenitis: value of assessment of intraepithelial lymphocytes.

    OpenAIRE

    Jeffers, M D; Hourihane, D O

    1993-01-01

    AIMS--To determine if a clinically important polymorphonuclear leucocyte infiltrate and surface gastric epithelial metaplasia occur in the second part of the duodenum in coeliac disease; to evaluate the utility of these morphological criteria in the differential diagnosis of coeliac disease and peptic duodenitis. METHODS--49 mucosal biopsy specimens of the second part of the duodenum reported as showing inflammation were reviewed. Sections were prepared with haematoxylin and eosin, periodic a...

  20. Co-existence of Sarcina Organisms and Helicobacter pylori Gastritis/Duodenitis in Pediatric Siblings

    OpenAIRE

    Sauter, Jennifer L.; Nayar, Suresh K.; Anders, Paige D.; D’Amico, Michael; Butnor, Kelly J.; Wilcox, Rebecca L.

    2013-01-01

    Sarcina are gram-positive anaerobic bacteria found to be associated with delayed gastric emptying and gastric outlet obstruction. We describe two cases of Sarcina co-existing with Helicobacter pylori organisms in pediatric siblings presenting within four months of each other with pyloric obstruction secondary to severe gastritis/duodenitis. The co-existence of Sarcina and Helicobacter pylori has not, to our knowledge, been previously reported. Its characteristic tetrad packeted morphology per...