MedWorm: Duodenal Stenosis

Bile duct duplication as a cause of distal bowel gas in neonatal duodenal obstruction

Journal of Pediatric Surgery — Thu, 01 Dec 2011 05:00:00 +0100

Conclusions: Neonatal DA presenting with distal bowel gas via an anomalous bifurcated bile duct conduit is more common than initially thought and occurs more frequently than duodenal stenosis. These patients might be at risk for cholestasis, possibly owing to duodeno-biliary reflux through the ampulla. (Source: Journal of Pediatric Surgery)

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Pancreatic carcinoma masquerading as groove pancreatitis: case report and review of literature.

JOP — Sun, 20 Nov 2011 13:48:02 +0100

CONCLUSION: Several studies have been attempted to clarify the points of differentiation between carcinoma and pancreatitis in the groove area. This discrimination has been proved to be difficult; frequently the definitive diagnosis is only obtained after surgical intervention. This condition should be considered when making the differential diagnosis in pancreatic groove pathology and duodenal stenosis. PMID: 22072250 [PubMed - in process] (Source: JOP)

Double bubble sign

Emergency Medicine Journal — Fri, 18 Nov 2011 05:00:00 +0100

A 4-day-old full-term male neonate presented with postprandial non-bilious vomiting. Delayed meconium passage had been recorded at 36 h of age. Progressive abdominal distention was noted. A supine radiograph of the abdomen showed marked distention of the stomach and proximal duodenum with double bubble sign (figure 1). Air density was not identified distal to the duodenum. Duodenal obstruction was strongly suspected. Exploratory laparotomy revealed duodenal atresia proximal to the ampulla of Vater and severe dilatation in the first part of the duodenum, which were repaired by duodenoduodenostomy. The double bubble sign is a classic radiographic manifestation of duodenal obstruction, the cause of which could be intrinsic (such as duodenal atresia, duodenal stenosis or duodenal web) or ...

Temporary placement of stent grafts in postsurgical benign biliary strictures: a single center experience.

Korean J Radiol — Tue, 01 Nov 2011 04:00:00 +0100

CONCLUSION: Treatment of benign biliary strictures with temporary placement of stent-grafts has a positive effect, but is less successful in patients with strictures developed following a liver transplant. PMID: 22043153 [PubMed - in process] (Source: Korean J Radiol)

Superobese and super-superobese patients: 2-step laparoscopic duodenal switch

Surgery for Obesity and Related Diseases — Mon, 19 Sep 2011 04:00:00 +0100

Conclusion: In the treatment of superobese and super-superobese patients with 2-step LBPD/DS, we experienced no deaths and achieved acceptable morbidity, considering the high operative risk in this group. This procedure is effective for both weight loss and resolution of co-morbidities. (Source: Surgery for Obesity and Related Diseases)

Superobese and super-superobese patients: 2-step laparoscopic duodenal switch.

Sat, 17 Sep 2011 04:00:00 +0100

CONCLUSION: In the treatment of superobese and super-superobese patients with 2-step LBPD/DS, we experienced no deaths and achieved acceptable morbidity, considering the high operative risk in this group. This procedure is effective for both weight loss and resolution of co-morbidities. PMID: 22014481 [PubMed - as supplied by publisher] (Source: Surgery for Obesity and Related Diseases : official journal of the American Society for Bariatric Surgery)

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Gastrectomy with isoperistaltic jejunal parallel pouch in a 15-year-old adolescent boy with gastric adenocarcinoma and autosomal recessive agammaglobulinemia

Journal of Pediatric Surgery — Thu, 01 Sep 2011 04:00:00 +0100

Abstract: A 15-year-old adolescent boy with autosomal recessive agammaglobulinemia underwent endoscopy because of unexplained growth failure and malnutrition. Esophagogastroduodenoscopy revealed antropyloric stenosis, and a biopsy showed an invasive gastric adenocarcinoma. Chronic atrophic corpus gastritis type A and Helicobacter pylori were also identified. Abdominal magnetic resonance imaging confirmed the stenosis resulting from a semicircular intramural tumor without obvious local or distant metastatic spread. Gastrectomy with an extended lymphadenectomy was performed. Esophagoduodenal continuity was restored by an interposed jejunal parallel pouch developed from the first jejunal loop. Oral feeding was supplemented by parenteral nutrition via a Broviac catheter, and the patient is wel...

Carcinoid of the minor duodenal papilla causing upper GI bleeding

Gastrointestinal Endoscopy — Tue, 16 Aug 2011 04:00:00 +0100

An 80-year-old woman with a history of hypertension, aortic stenosis, and chronic renal failure was referred to our unit because of hematemesis. Gastroscopy showed a polypoid lesion in the second duodenal portion, and duodenoscopy demonstrated a firm mass resembling an enlarged major papilla. Forceps biopsy was reported as insufficient for diagnosis. EUS identified a 12-mm heterogeneous, hypoechoic mass that seemed to involve the submucosa (, white arrow). A second duodenoscopy clarified it as the minor papilla, which was clearly prominent and eroded (), and it was completely resected with snare. Histopathological analysis confirmed mucosal epithelial proliferation that deeply infiltrated the submucosa (, thin arrow), the minor papilla sphincter (, thick arrow), and duct (). Cellular cords...

Endoscopic Submucosal Dissection of Gastric Neoplasia Involving the Pyloric Channel by Retroflexion in the Duodenum

Digestive Diseases and Sciences — Sat, 13 Aug 2011 06:12:37 +0100

Conclusions Tumors involving the pyloric channel could be successfully resected by ESD using retroflexion in the duodenum without severe complication. This technique appears to be a feasible and effective method for the treatment of tumors involving the pyloric channel. Content Type Journal ArticlePages 1-7DOI 10.1007/s10620-011-1863-zAuthors Chul-Hyun Lim, Division of Gastroenterology, Department of Internal Medicine, The Catholic University of Korea College of Medicine, #505, Banpo-dong, Seocho-gu, Seoul, 137-701 KoreaJae Myung Park, Division of Gastroenterology, Department of Internal Medicine, The Catholic University of Korea College of Medicine, #505, Banpo-dong, Seocho-gu, Seoul, 137-701 KoreaChung-Hwa Park, Division of Gastroenterology, Department of Internal...

Duodenal metastasis from recurrent invasive lobular carcinoma of breast: a case report and literature review

International Journal of Clinical Oncology — Fri, 03 Jun 2011 05:56:56 +0100

We present a rare case of duodenal metastasis from invasive breast lobular carcinoma, which first presented clinically as elevated serum tumor marker levels, followed by jaundice but with no other clinical evidence of recurrence and metastasis. A 53-year-old woman underwent modified radical mastectomy of the left breast (pT2 N3 M0 stage III c) followed by postoperative chemo-radiotherapy and hormonal therapy. After about 3 years, the patient presented with elevated serum tumor marker levels and mild jaundice. She was subsequently admitted to the hospital for nausea and severe vomiting. A duodenoscopy revealed the thickening of duodenal papilla on the lateral wall and stenosis. A duodenal tissue biopsy revealed poorly differentiated adenocarcinoma, and immunohistochemical stainin...

Isolated congenital tracheal stenosis in a preterm newborn

European Journal of Pediatrics — Wed, 18 May 2011 06:09:23 +0100

Conclusion Successful treatment of severe congenital tracheal stenosis and tracheal atresia depends on either prenatal diagnosis or recognition of this condition immediately after birth to perform tracheotomy without delay. Nevertheless, despite any efforts, the therapeutical results of severe tracheal stenosis and tracheal atresia are still unsatisfactory. Content Type Journal ArticlePages 1-5DOI 10.1007/s00431-011-1490-xAuthors Ulrich Krause, Department of Pediatric Cardiology and Intensive Care Medicine, University Hospital, Georg-August-University, Robert-Koch-Str. 40, 37099 Göttingen, GermanyRalph M. W. Rödel, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital, Georg-August-University, Göttingen, GermanyThomas Paul, Department of Pediatric Cardio...

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Empiric Transcatheter Arterial Embolization for Massive Bleeding From Duodenal Ulcers: Efficacy and Complications

Journal of Vascular and Interventional Radiology : JVIR — Sun, 15 May 2011 23:00:00 +0100

Conclusions: A high rate of technical and clinical success was obtained with empiric TAE comparable to identifiable TAE in patients with massive bleeding from duodenal ulcers. There were no severe complications. Empiric TAE is an effective and safe method when a bleeding site cannot determined by angiography. (Source: Journal of Vascular and Interventional Radiology : JVIR)

Trans-anastomotic tubes reduce the need for central venous access and parenteral nutrition in infants with congenital duodenal obstruction

Pediatric Surgery International — Fri, 08 Apr 2011 07:07:06 +0100

Conclusions A TAT significantly shortens time to full enteral feeds in infants with CDO significantly reducing the need for central venous access and PN. Content Type Journal ArticlePages 1-5DOI 10.1007/s00383-011-2896-2Authors N. J. Hall, Wessex Regional Centre for Paediatric Surgery, Southampton University Hospitals NHS Trust, Mailpoint 44, Tremona Road, Southampton, SO16 6YD UKM. Drewett, Wessex Regional Centre for Paediatric Surgery, Southampton University Hospitals NHS Trust, Mailpoint 44, Tremona Road, Southampton, SO16 6YD UKR. A. Wheeler, Wessex Regional Centre for Paediatric Surgery, Southampton University Hospitals NHS Trust, Mailpoint 44, Tremona Road, Southampton, SO16 6YD UKD. M. Griffiths, Wessex Regional Centre for Paediatric Surgery, Southampton Unive...

An Unusual Case of Duodenal Stenosis

Gastroenterology — Sun, 03 Apr 2011 23:00:00 +0100

Question: A 57-year-old woman was admitted to our unit complaining of abrupt onset of upper abdominal pain, nausea, and vomiting. Her symptoms occurred the previous evening and worsened throughout the day until sudden onset of severe upper abdominal fullness and vomiting. She had no history of abdominal trauma, pancreatitis, alcohol abuse, previous surgery, or other specific disease, except for mild hypertension. Upon admission, she had tenderness and muscle defense in the upper to umbilical portion of the abdomen. Laboratory findings revealed a C-reactive protein level of 29 mg/L, an elevation of the serum amylase level (281 U/L), and mild hypertransaminasemia. In addition, serum bilirubin and tumor markers (carcinoembryonic antigen and carbohydrate antigen 19–9) were normal. Endoscopic...

Laparoscopy-assisted subtotal gastrectomy with very small remnant stomach: a novel surgical procedure for selected early gastric cancer in the upper stomach

Gastric Cancer — Wed, 23 Feb 2011 23:13:13 +0100

Abstract Total gastrectomy or proximal gastrectomy is usually performed either as an open procedure or laparoscopically for the treatment of early gastric cancer (EGC) in the upper stomach. However, quality of life after either total or proximal gastrectomy is not so satisfactory. The authors report a novel surgical procedure, laparoscopy-assisted subtotal gastrectomy (LAsTG), by which a very small remnant stomach is preserved, for the surgery of selected EGCs in the upper stomach. Twenty-three patients with EGC in the upper stomach underwent LAsTG. After lymph node dissection and mobilization of the stomach, the stomach was transected about 2 cm proximal to the tumor and a very small remnant stomach was preserved. An anvil was inserted transorally into the remnant st...

A novel association of alveolar capillary dysplasia, atypical duodenal atresia, and subglottic stenosis

Journal of Anesthesia — Thu, 30 Dec 2010 18:03:40 +0100

This report highlights the hazards of the onset and worsening of ACD, and the importance of thorough echocardiography before surgery when atypical duodenal atresia is suspected. Anesthesiologists should also be prepared for the difficulty of intubation. Content Type Journal ArticleDOI 10.1007/s00540-010-1080-5Authors Takeru Shimizu, Department of Anesthesiology and Critical Care Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, JapanTaeko Fukuda, Department of Anesthesiology and Critical Care Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, JapanShinichi Inomata, Department of Anesthesiology and Critical Care Medicine, Graduate Scho...

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A Newly Developed Variable Stiffness Duodenoscope for Diagnostic and Therapeutic Endoscopic Retrograde Cholangiopancreatography

Diagnostic and Therapeutic Endoscopy — Fri, 10 Dec 2010 22:49:26 +0100

In conclusion, while the VSD performed well, the present models do not appear to offer obvious advantages over the standard duodenoscopes for routine diagnostic and therapeutic ERCP. Prospective studies may be warranted to identify those patients who would benefit from this new technology. (Source: Diagnostic and Therapeutic Endoscopy)

Ectopic opening of the common bile duct and duodenal stenosis: an overlooked association

BioMed Central — Sat, 04 Dec 2010 00:00:00 +0100

Conclusions: The presence of EO-CBD-DB should be considered particularly in middle-aged male patients who have duodenal deformity/stenosis. Endoscopic treatment is feasible in these patients. The long-term outcomes of endoscopic therapy need to be compared with surgical treatment. (Source: BioMed Central)

[Metastatic prostate cancer complicated with chronic disseminated intravascular coagulopathy causing acute renal failure mimicking thrombotic thrombocytopenic purpura and hemolytic uremic syndrome: pathomechanism, differential diagnosis and therapy related to a case.]

Magyar Onkologia — Wed, 01 Dec 2010 00:00:00 +0100

Authors: Deme D, Ragán M, Kalmár K, Kovács L, Varga E, Varga T, Rakonczai E Disseminated intravascular coagulopathy (DIC) is characterized as activation of the clotting system resulting in fibrin thrombi, gradually diminishing levels of clotting factors with increased risk of bleeding. Basically two types of DIC are distinguished: (1) chronic (compensated) - with alteration of laboratory values and (2) acute (non-compensated) - with severe clinical manifestations: bleeding, shock, acute renal failure (ARF), transient focal neurologic deficit, delirium or coma. Chronic DIC related to metastatic neoplasia is caused by pancreatic, gastric or prostatic carcinoma in most of the cases. Incidence rate of DIC is 13-30% in prostate cancer, among those only 0.4-1.65% of patients had clinical ...

[Metastatic prostate cancer complicated with chronic disseminated intravascular coagulopathy causing acute renal failure, mimicking thrombotic thrombocytopenic purpura and hemolytic uremic syndrome: pathomechanism, differential diagnosis and therapy related to a case].

Magyar Onkologia — Wed, 01 Dec 2010 00:00:00 +0100

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Pancreatic resection for metastasis to the pancreas from colon and lung cancer, and osteosarcoma.

JOP — Fri, 12 Nov 2010 21:45:06 +0100

CONCLUSION: Pancreatic resection for metastatic disease may be suggested for selected patients, even those with limited extrapancreatic disease. In this setting, it may offer good palliation and may prolong survival. In cases of acute duodenal bleeding resistant to conservative measures, pancreaticoduodenectomy may represent the only alternative for survival; however, significant morbidity and mortality should be expected. PMID: 21068492 [PubMed - in process] (Source: JOP)

Duodenal switch with omentopexy and feeding jejunostomy—a safe and effective revisional operation for failed previous weight loss surgery

Surgery for Obesity and Related Diseases — Thu, 11 Nov 2010 00:00:00 +0100

Conclusion: Revisional surgery to a duodenal switch is a complex operation and carries a high potential for major complications. Nonetheless, it can be accomplished safely with good long-term results. Omentopexy, drainage, and feeding jejunostomy should be considered at surgery to treat the high potential for delayed ischemic leaks. (Source: Surgery for Obesity and Related Diseases)

Endosonography-Guided Biliary Drainage with One-Step Placement of a Newly Developed Fully Covered Metal Stent Followed by Duodenal Stenting for Pancreatic Head Cancer

Diagnostic and Therapeutic Endoscopy — Tue, 19 Oct 2010 17:31:07 +0100

An 83-year-old man was admitted to our department, presenting with jaundice, fever, and nausea. CT revealed a pancreatic head tumor with duodenal invasion. Endoscopic transpapillary biliary drainage was unsuccessful due to stenosis at the second portion of the duodenum and tumor invasion to the papilla of Vater. Using a convex linear array echoendoscope, a fully-covered metal stent was placed across the puncture tract to bridge the duodenum and the bile duct. After improvement of jaundice, a duodenal metal stent was placed across the stricture of the duodenum. No procedure-related complications occurred. Neither migration nor obstruction of the two stents was observed during the three months followup period. Combination of ESBD using a fully covered metal stent and duodenal stenting is a ...

Complications of Congenital and Developmental Abnormalities of the Gastrointestinal Tract in Adolescents and Adults: Evaluation with Multimodality Imaging [Gastrointestinal Imaging]

Radiographics recent issues — Tue, 12 Oct 2010 19:58:40 +0100

There is a wide variety of congenital anomalies that may affect the gastrointestinal tract. Most symptomatic congenital anomalies are found in newborns and infants. Such anomalies are relatively rare in adolescents and adults, and they may be difficult to identify because clinical symptoms often are nonspecific and insidious, causing them to be mistaken for other common abdominal conditions. Multimodality imaging is useful in evaluating congenital anomalies of the gastrointestinal tract in adults. The imaging features at radiography, fluoroscopy, ultrasonography, computed tomography, and magnetic resonance imaging may help identify congenital gastrointestinal anomalies such as congenital esophageal stenosis, gastric volvulus, duodenal web, annular pancreas, heterotopic pancreas, cecal volv...

Sphincterotome stricturoplasty for long ampullary stenoses and benign biliary strictures (with video)

Surgical Endoscopy — Sat, 11 Sep 2010 05:43:24 +0100

Conclusions Compared with balloon stricturoplasty ± biliary stenting, SS is a simple and cost-effective alternative option in managing long ampullary stenosis and/or distal fibrotic biliary stricture during the initial ERCP. Content Type Journal ArticleDOI 10.1007/s00464-010-1340-3Authors Shou-jiang Tang, Division of Gastroenterology, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USASundeep Singh, Division of Gastroenterology, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USAShailender Singh, Division of Gastroenterology, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 093...

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Laparoscopic repeat sleeve gastrectomy versus duodenal switch after isolated sleeve gastrectomy for obesity

Surgery for Obesity and Related Diseases — Fri, 20 Aug 2010 00:00:00 +0100

Conclusion: The results of the present study have shown that laparoscopic re-SG is feasible but carries the risk of fistula development, which is difficult to treat. Laparoscopic DS was also shown to be feasible at a cost of not negligible complications, which are easier to manage than with re-SG. The efficacy seemed greater after DS than after re-SG. (Source: Surgery for Obesity and Related Diseases)

De novo pericentric inversion of chromosome 9 in congenital anomaly.

Yonsei Medical Journal — Mon, 19 Jul 2010 01:39:25 +0100

Conclusion: Since our results indicate that the incidence of inv(9)(p11q13) in patients with congenital anomalies was not significantly different from the normal population, inv(9)(p11q13) does not appear to be pathogenic with regard to the congenital anomalies. Some other, to date unknown, causes of the anomalies remain to be identified. PMID: 20635455 [PubMed - in process] (Source: Yonsei Medical Journal)

Endoscopic ultrasound-guided transduodenal placement of a fully covered metal stent for palliative biliary drainage in patients with malignant biliary obstruction

Surgical Endoscopy — Fri, 16 Jul 2010 16:50:39 +0100

Conclusions EUSBD with a fully covered SEMS in whom ERCP is unsuccessful is effective for palliation of biliary obstruction. The limitations of our study are that we had a small number of patients and a limited follow-up time. Content Type Journal ArticleDOI 10.1007/s00464-010-1216-6Authors Ali A. Siddiqui, Dallas Veterans Affairs Medical Center Department of Internal Medicine 4500 S. Lancaster Road (111B1) Dallas TX 75216 USAJayaprakash Sreenarasimhaiah, Dallas Veterans Affairs Medical Center Department of Internal Medicine 4500 S. Lancaster Road (111B1) Dallas TX 75216 USALuis F. Lara, Baylor Medical Center Departments of Internal Medicine Dallas TX USAWilliam Harford, Dallas Veterans Affairs Medical Center Department of Internal Medicine 4500 S. Lancaster Road (11...

Umbilical crease incision for duodenal atresia achieves excellent cosmetic results

Pediatric Surgery International — Sun, 11 Jul 2010 12:14:23 +0100

Conclusions The outcome of duodenal atresia is satisfactory with excellent cosmesis after a duodenoduodenostomy performed via the umbilical crease incision. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00383-010-2645-yAuthors Yukiko Takahashi, Kyushu University Department of Pediatric Surgery, Graduate School of Medical Sciences 3-1-1 Maidashi, Higashi-ku Fukuoka 812-8582 JapanTatsuro Tajiri, Kyushu University Department of Pediatric Surgery, Graduate School of Medical Sciences 3-1-1 Maidashi, Higashi-ku Fukuoka 812-8582 JapanKouji Masumoto, Kyushu University Department of Pediatric Surgery, Graduate School of Medical Sciences 3-1-1 Maidashi, Higashi-ku Fukuoka 812-8582 JapanYoshiaki Kinoshita, Kyushu University Department of Pediatric Surgery, G...

Annular pancreas associated with duodenal carcinoma.

World Journal of Gastroenterology : WJG — Sun, 04 Jul 2010 05:36:13 +0100

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. Duodenopancreatectomy revealed a duodenal adenocarcinoma, surrounded by an incomplete AP. Thus, co-existent malignancy with AP can be present without obstructive jaundice and without being visible through preoperative diagnostics. PMID: 20593508 [PubMed - in process] (Source: World Journal of Gastroenterology : WJG)

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Virtual enteroscopy using air as the contrast material: a preliminary feasibility study

Digestive Endoscopy — Sun, 20 Jun 2010 23:00:00 +0100

Conclusions: Air is a feasible enteral contrast material for virtual enteroscopy. (Source: Digestive Endoscopy)

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

World Journal of Gastroenterology — Fri, 11 Jun 2010 00:30:09 +0100

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 new biliary metal stent mounted in a slim delivery catheter was placed via a thin forward viewing endoscope after passage across the duodenal stenosis without balloon dilation. In both patients, with our new placement technique, metallic stents were successfully placed in a short time without adverse events. After biliary stenting, one patient received curative resection and the other received duodenal stenting for palliation. Metallic stent placement with a forward-viewing thin endoscope is a beneficial technique, which can avoid percutaneous drainage ...

Current issues regarding endosonography-guided biliary drainage for biliary obstruction

Digestive Endoscopy — Fri, 07 May 2010 23:00:00 +0100

Transpapillary endoscopic biliary drainage is a well-accepted technique for patients with biliary obstruction. However, transpapillary access to the bile duct is not always possible, especially in patients with duodenal stenosis or difficult cannulation of the bile duct during endoscopic retrograde cholangiopancreatography. Percutaneous transhepatic biliary drainage or surgical bypass has been performed in cases of unsuccessful endoscopic retrograde cholangiopancreatography. Recently, endosonography-guided biliary drainage (ESBD) has been developed as a new biliary drainage technique. Current issues regarding ESBD are discussed in this article. Proper indications for ESBD should be established for widespread performance. Technical standardization and dedicated instruments for ESBD are also...

Disappearance of an ampullary pseudotumor after steroid therapy for autoimmune pancreatitis

Gastrointestinal Endoscopy — Wed, 31 Mar 2010 23:00:00 +0100

A 58-year-old man with obstructive jaundice was admitted to our hospital. An abdominal CT scan showed diffuse enlargement of the pancreas, dilated intrahepatic bile ducts and a dilated gallbladder, a thick-walled common bile duct, and enlarged peripancreatic lymph nodes. The CT scan also showed a 1-cm diameter, round, nodular lesion in the ampullary lesion that was well-enhanced in the early phase (). Serum immunoglobinG (IgG) and IgG4 levels were elevated to 2398 mg/dL (normal 600-1500 mg/dL) and 970 mg/dL (normal 8-140 mg/dL), respectively. During ERCP, duodenoscopy revealed a markedly enlarged major duodenal papilla showing a swollen, smooth-surfaced protrusion (). The orifice of the major duodenal papilla showed a slightly nodular erosion. ERCP demonstrated diffuse irregular narrowing ...

T1437: EUS-Guided Choledochoduodenostomy Followed by Endoscopic Antegrade Biliary Stenting via the Fistula for Treatment of Obstructive Jaundice With Duodenal Stenosis

Gastrointestinal Endoscopy — Wed, 31 Mar 2010 23:00:00 +0100

EUS-guided choledochoduodenostomy (EUS-CDS) with insertion of a stent from the duodenal bulb to the extrahepatic bile duct is a possible drainage route in the treatment of patients with obstructive jaundice, when ERCP is unsuccessful. However, stagnant gastroduodenal juice sometimes causes reflux cholangitis through the inserted stent in case that outlet of the gastroduodenal juice is disturbed by stenosis of the duodenum. In those patients, subsequent biliary drainage toward the anal side of the stenosis is desired to prevent the bile duct from reflux of the stagnant fluid. We evaluated the utility of the endoscopic antegrade biliary stenting (EABS) via the fistula for refractory reflux cholangitis. (Source: Gastrointestinal Endoscopy)

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W1578: Successful Treatment of Tumors Involving the PYLORIC Channel by ESD Using Retroflexion in the Duodenum

Gastrointestinal Endoscopy — Wed, 31 Mar 2010 23:00:00 +0100

In conclusion, tumor involving pyloric channel could be successfully resected by ESD wihtout complications. (Source: Gastrointestinal Endoscopy)

Six-month repeated dose toxicity of orally administered metacavir in rhesus monkeys.

Experimental and Toxicologic Pathology — Fri, 26 Mar 2010 00:00:00 +0100

CONCLUSION: The main target organs of the toxic effects of metacavir are gastrointestinal tract, liver, blood, and kidneys. The no-observed-adverse-effect-level (NOAEL) of metacavir for rhesus monkey were considered to be 50mg/kg/day. PMID: 20347583 [PubMed - as supplied by publisher] (Source: Experimental and Toxicologic Pathology)

Adenocarcinoma arising in a heterotopic pancreas (Heinrich type III): a case report

BioMed Central — Sat, 06 Feb 2010 00:00:00 +0100

Conclusion: Adenocarcinoma arising within the heterotopic pancreas appears to be rare. It is difficult to obtain a correct diagnosis preoperatively. The management of heterotopic pancreas depends on the presence or absence of symptoms. If the patient is asymptomatic or benign, conservative treatment with regular follow-up is recommended. When the patient is symptomatic or there is a suspicion of malignancy, surgical management with intra-operative frozen section diagnosis is indicated. (Source: BioMed Central)

Duodenum - Endoscopic Management of a Windsock Diveticulum

The Digital Atlas of Video Education - Gastroenterology — Tue, 19 Jan 2010 09:01:09 +0100

A 24 year old female was referred for complaints intermittent nausea and vomiting and weight loss. The upper GI barium study demonstrates an enlarged diverticulum in the second portion of the duodenum. A thin radiolucent stripe is seen around the diverticulum which has been described as the halo sign. Upper endoscopy is performed which identifies a large diverticulum which intermittently obstructs the duodenal lumen. The endoscopic appearance is consistent with a windsock diverticulum. This intraluminal diverticulum is thought to result from incomplete recanalization of the duodenum during embryological development and with complete obstruction, symptoms present during childhood. In contrast, when there is a small aperture in the duodenum, patients may initially remain asymptomatic. Howeve...

Endoscopic resection of ampullary adenoma after a new insulated plastic pancreatic stent placement: A pilot study

Journal of Gastroenterology and Hepatology — Thu, 14 Jan 2010 00:00:00 +0100

Conclusions: Pre-resection stenting with a polytetrafluoroethylene-insulated stent in patients with adenomas of the major duodenal papilla is a feasible and useful technique to prevent pancreatitis. (Source: Journal of Gastroenterology and Hepatology)

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Percutaneous transcatheter arterial embolization of inferior pancreatico-duodenal artery aneurysms associated with celiac artery stenosis or occlusion

Catheterization and Cardiovascular Interventions — Thu, 17 Dec 2009 00:00:00 +0100

Conclusion:IPDA aneurysms associated with celiac axis stenosis can be successfully treated with percutaneous embolization with minimal recurrence. © 2009 Wiley-Liss, Inc. (Source: Catheterization and Cardiovascular Interventions)

Stereotactic body radiotherapy for unresectable cholangiocarcinoma

Radiotherapy and Oncology — Mon, 07 Dec 2009 00:00:00 +0100

Conclusion: The outcomes of SBRT for unresectable cholangiocarcinoma appear comparable to conventionally fractionated chemoradiotherapy with or without brachytherapy boost. The practical advantages of SBRT are of particular interest for such poor prognosis patients. Patient selection, however, is key in order to avoid compromising such practical gains with excessive gastrointestinal toxicity. (Source: Radiotherapy and Oncology)

Stereotactic body radiotherapy for unresectable cholangiocarcinoma.

Fri, 04 Dec 2009 00:00:00 +0100

CONCLUSION: The outcomes of SBRT for unresectable cholangiocarcinoma appear comparable to conventionally fractionated chemoradiotherapy with or without brachytherapy boost. The practical advantages of SBRT are of particular interest for such poor prognosis patients. Patient selection, however, is key in order to avoid compromising such practical gains with excessive gastrointestinal toxicity. PMID: 19963295 [PubMed - as supplied by publisher] (Source: Radiotherapy and Oncology : journal of the European Society for Therapeutic Radiology and Oncology)

Infantile hypertrophic pyloric stenosis in a regional centre

Irish Journal of Medical Science — Wed, 14 Oct 2009 17:05:13 +0100

Conclusion The majority of infants with IHPS may be safely managed in regional centres with transfer to specialist paediatric centres reserved for ‘high risk’ cases. The management of IHPS at a regional level has important implications and presents opportunities for surgical training. Content Type Journal ArticleCategory Original PaperDOI 10.1007/BF03166908Authors P. D. Kiely, Mid-Western Regional Hospital and the University of Limerick Biomedical Institute Department of Surgery Limerick IrelandS. Tierney, Mid-Western Regional Hospital and the University of Limerick Biomedical Institute Department of Surgery Limerick IrelandM. Barry, Mid-Western Regional Hospital and the University of Limerick Biomedical Institute Department of Surgery Limerick IrelandP. V. Delane...

Duodenal stenosis caused by cystic dystrophy in heterotopic pancreas: Report of a case

Surgery Today — Wed, 23 Sep 2009 05:51:29 +0100

Abstract We herein describe the first reported case of duodenal stenosis caused by cystic dystrophy in heterotopic pancreas (CDHP) in Asia. A 63-year-old man was admitted to the hospital presenting with nausea and vomiting of 2 days’ duration. Laboratory examinations showed an elevation in both the serum amylase level (275 IU/l) and white blood cell count (13 600/µl). A 3-cm-diameter tumor close against the duodenum was pointed out from the results of computed tomography (CT) and magnetic resonance cholangiopancreatography (MRCP); the tumor contained a cystic and solid component. Endoscopic examinations and an upper gastrointestinal series showed stenosis of the second portion of the duodenum without any mucosal change. The tumor was considered to be located at the submu...

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Sleeve gastrectomy as revisional procedure for failed gastric banding or gastroplasty

Surgery for Obesity and Related Diseases — Tue, 15 Sep 2009 23:00:00 +0100

Conclusion: LSG seems to be effective as revisional procedure for failed LAGB/vertical banded gastroplasty, although with greater complication rates than the primary procedures. Larger series and longer follow-up are needed to confirm these promising results. (Source: Surgery for Obesity and Related Diseases)

A novel association of duodenal atresia, malrotation, segmental dilatation of the colon, and anorectal malformation

Pediatric Surgery International — Fri, 21 Aug 2009 15:27:09 +0100

We describe two female neonates who suffered from four gastrointestinal anomalies, including duodenal stenosis or atresia, malrotation, segmental dilatation of the colon, and anorectal malformation. Each patient was managed by two or three operations, resulting in good bowel movements. Since this is the first report of four gastrointestinal anomalies, these cases may provide clues to elucidate the etiology of gastrointestinal tract developmental abnormalities. Content Type Journal ArticleCategory Case ReportDOI 10.1007/s00383-009-2459-yAuthors Nobuyuki Morikawa, National Center for Child Health and Development Division of General Surgery 2-10-1 Okura Setagaya-ku Tokyo 157-8535 JapanTatsuo Kuroda, National Center for Child Health and Development Division of General Surgery 2-10-1 Ok...

Duodenal stenosis resulting from a preduodenal portal vein and an operation for scoliosis.

World Journal of Gastroenterology : WJG — Thu, 20 Aug 2009 23:00:00 +0100

Authors: Masumoto K, Teshiba R, Esumi G, Nagata K, Nakatsuji T, Nishimoto Y, Yamaguchi S, Sumitomo K, Taguchi T A preduodenal portal vein (PDPV) is known to be a rare cause of duodenal stenosis. We treated a 22-year-old 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...

Papillectomy for ampullary neoplasm: results of a single referral center over a 10-year period

Gastrointestinal Endoscopy — Thu, 16 Jul 2009 00:00:00 +0100

Conclusions: Most ampullary adenomas are amenable to endoscopy. Underlying malignancy and lateral extension may be risk factors for bleeding and perforation. Smaller lesion size and the absence of dilated ducts are factors favorably affecting success. (Source: Gastrointestinal Endoscopy)

ESPEN Guidelines on Parenteral Nutrition: Pancreas

Clinical Nutrition — Tue, 14 Jul 2009 23:00:00 +0100

Summary: Assessment of the severity of acute pancreatitis (AP), together with the patient's nutritional status is crucial in the decision making process that determines the need for artificial nutrition. Both should be done on admission and at frequent intervals thereafter. The indication for nutritional support in AP is actual or anticipated inadequate oral intake for 5–7days. This period may be shorter in those with pre-existing malnutrition. Substrate metabolism in severe AP is similar to that in severe sepsis or trauma. Parenteral amino acids, glucose and lipid infusion do not affect pancreatic secretion and function. If lipids are administered, serum triglycerides must be monitored regularly. The use of intravenous lipids as part of parenteral nutrition (PN) is safe and feasible whe...

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Large-balloon technique for one-step endoscopic biliary stenting in patients with an inaccessible major papilla owing to difficult duodenal stricture (with video)

Gastrointestinal Endoscopy — Wed, 01 Jul 2009 23:00:00 +0100

Conclusions: Use of large-balloon dilation can contribute to successful ERCP in patients with difficult duodenal strictures. (Source: Gastrointestinal Endoscopy)

Stenosis of the third portion of the duodenum due to bleeding from the anterior pancreaticoduodenal artery: assessment by multiphase contrast-enhanced examination with multislice CT

Abdominal Imaging — Wed, 01 Jul 2009 06:16:49 +0100

Conclusions Multiphase contrast-enhanced CT examination using a multislice CT scanner helps to establish the diagnosis of this pathological process. Content Type Journal ArticleDOI 10.1007/s00261-009-9547-2Authors Shigeki Itoh, Nagoya University School of Health Sciences Department of Technical Radiology 1-1-20 Daikou-minami, Higashi-ku Nagoya Aichi 461-8673 JapanYoshine Mori, Nagoya University Graduate School of Medicine Department of Radiology 65 Tsurumai-cho, Showa-ku Nagoya 466-8550 JapanKojiro Suzuki, Nagoya University Graduate School of Medicine Department of Radiology 65 Tsurumai-cho, Showa-ku Nagoya 466-8550 JapanHiroko Satake, Nagoya University Graduate School of Medicine Department of Radiology 65 Tsurumai-cho, Showa-ku Nagoya 466-8550 JapanToyohiro Ota, Nago...

Encoscopic management of stenotic anastomosis using a rendezvous technique after pancreatogastrostomy

Digestive Endoscopy — Sun, 21 Jun 2009 23:00:00 +0100

A 46-year-old female patient was referred to our hospital for endoscopic treatment of stenotic pancreatogastrostomy. She had undergone pylorus-preserving pancreatoduodenectomy due to duodenal carcinoma of the papilla of Vater 5 years before referral. Two years after the operation, she had to be hospitalized several times during a 1-year period because of acute recurrent pancreatitis caused by stenosis of the anastomosis of the pancreatoduodenostomy. An endoscopic ultrasound (EUS)-guided rendezvous technique was selected to puncture the main pancreatic duct via a transgastric approach. We identified the dilated main pancreatic duct with a convex array echoendoscope from the lower gastric body near the anastomosis and successfully punctured the dilated main pancreatic duct. The guidewire pas...

Appropriate management of special situations in Crohn's disease (upper gastro-intestinal; extra-intestinal manifestations; drug safety during pregnancy and breastfeeding): Results of a multidisciplinary international expert panel—EPACT II

Journal of Critical Care — Mon, 18 May 2009 00:00:00 +0100

Conclusion: EPACT II recommendations are freely available online (www.epact.ch). The validity of these criteria should now be tested by prospective evaluation. (Source: Journal of Critical Care)

Laparoscopic duodenoduodenostomy in the neonate

Journal of Pediatric Surgery — Fri, 01 May 2009 04:00:00 +0100

Conclusions: Laparoscopic duodenoduodenostomy in the neonate can be safely and successfully performed with excellent short-term outcome. (Source: Journal of Pediatric Surgery)

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Surgical treatment for right colon cancer directly invading the duodenum.

The American Surgeon — Thu, 30 Apr 2009 23:00:00 +0100

In conclusion, duodenal invasion by a right-sided colon carcinoma does not necessarily represent incurable disease. If carefully applied based on the extent of duodenal invasion, active surgical management is very useful for improving patient prognosis without increasing the risks associated with surgery. PMID: 19445288 [PubMed - indexed for MEDLINE] (Source: The American Surgeon)

Pure monosomy and pure trisomy of 13q21.2-31.1 consequent to a familial insertional translocation: Exclusion of PCDH9 as the responsible gene for autosomal dominant auditory neuropathy (AUNA1)

American Journal of Medical Genetics Part A — Tue, 07 Apr 2009 04:00:00 +0100

We describe an IT between chromosomes 3 and 13 segregating in a three-generation pedigree. Short tandem repeat (STR) segregation analysis and array-comparative genomic hybridization were used to define the IT as a 25.1 Mb segment spanning 13q21.2-q31.1. The phenotype of pure monosomy included deafness, duodenal stenosis, developmental and growth delay, vertebral anomalies, and facial dysmorphisms; the trisomy was manifested by only minor dysmorphisms. As the AUNA1 deafness locus on 13q14-21 overlaps the IT in the PCDH9 (protocadherin-9) gene region, PCDH9 was investigated as a candidate gene for deafness in both families. Genotyping of STRs and single nucleotide polymorphisms defined the AUNA1 breakpoint as 35 kb 5[prime] to PCDH9, with a 2.4 Mb area of overlap with the IT. DNA sequencing ...

Congenital absence of the splenic artery and splenic vein accompanied with a duodenal ulcer and deformity.

World Journal of Gastroenterology : WJG — Fri, 20 Mar 2009 19:39:15 +0100

We report a case of the absence of the splenic artery and vein in a 61-year-old woman who presented with postprandial epigastric discomfort. Upper gastrointestinal endoscopy showed a dilated, pulsatile vessel in the fundus and duodenal stenosis. An abdominal computed tomography (CT) scan revealed absence of the splenic vein with a tortuously engorged gastroepiploic vein. Three-dimensional CT demonstrated the tortuously dilated left gastric artery and the left gastroepiploic artery with non-visualization of the splenic artery. After administration of a proton pump inhibitor, abdominal symptoms resolved without any recurrence of symptoms during 6 mo of follow-up. PMID: 19294774 [PubMed - in process] (Source: World Journal of Gastroenterology : WJG)

Management of Complications Associated with Partially Covered Biliary Metal Stents

Digestive Diseases and Sciences — Sat, 07 Mar 2009 12:28:14 +0100

Conclusions Major complications associated with PCMS placement include migration and cholecystitis. Their management includes endoscopic revision, cholecystectomy, and gallbladder drainage. Further improvements in the structure and composition of PCMS may prevent these complications. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s10620-009-0756-xAuthors Henry Ho, University of Virginia Health System Digestive Health Center Charlottesville Box 800708 VA 22908-0708 USAAnshu Mahajan, University of Virginia Health System Digestive Health Center Charlottesville Box 800708 VA 22908-0708 USASonia Gosain, University of Virginia Health System Digestive Health Center Charlottesville Box 800708 VA 22908-0708 USAAnimesh Jain, University of Virginia Health System Digestive Hea...

Congenital internal Duodenal Stenosis

Pediatric Radiology RSS News, Cases, Teaching Files and Publications — Fri, 06 Feb 2009 18:39:50 +0100

In the prenatal ultrasound, there is evidence of foreshortened extremities (history of hip dysplasia/chondrodystrophy in the family). Prenatal ultrasound with dilated stomach, double-bubble phenonemo... (Source: Pediatric Radiology RSS News, Cases, Teaching Files and Publications)

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Laparoscopic Seromyotomy for Long Stenosis After Sleeve Gastrectomy with or Without Duodenal Switch

Obesity Surgery — Sat, 24 Jan 2009 10:16:43 +0100

Conclusion Laparoscopic seromyotomy after SG for long stenosis is feasible, and efficient for the treatment of symptomatic dysphagia. It has a beneficiary influence on de novo GERD symptoms improvement. There is, however, the risk of postoperative leak. Content Type Journal ArticleCategory New ConceptsDOI 10.1007/s11695-009-9803-0Authors Giovanni Dapri, Saint-Pierre University Hospital Department of Gastrointestinal Surgery, European School of Laparoscopic Surgery 322 rue Haute 1000 Brussels BelgiumGuy Bernard Cadière, Saint-Pierre University Hospital Department of Gastrointestinal Surgery, European School of Laparoscopic Surgery 322 rue Haute 1000 Brussels BelgiumJacques Himpens, Saint-Pierre University Hospital Department of Gastrointestinal Surgery, European School...

Access to the Hypertrophic Pylorus: Does It Make a Difference to the Patient?

European Journal of Pediatric Surgery — Tue, 09 Dec 2008 12:24:05 +0100

Eur J Pediatr SurgDOI: 10.1055/s-2008-1039006Abstract The aim of the study was to evaluate the effects of different access methods for the treatment of pyloric stenosis (PS). Since 2001, we have operated on children with PS using three different access methods: classic right upper quadrant transverse incision (TI), incision on the superior umbilical fold (UI) and laparoscopic (L). We reviewed the records of these children with special emphasis on the number and characteristics of complications, operative time, and length of stay (LOS). We identified 256 patients (212 M, 44 F) with a mean age of 36 days. 138 procedures were performed using TI, 18 with UI and 100 laparoscopically. The mean operative time for patients with TI was 35.9 ± 8.6 min, and for those wi...

Congenital gastrointestinal defects in Down syndrome: a report from the Atlanta and National Down Syndrome Projects.

Clinical Genetics — Mon, 17 Nov 2008 05:00:00 +0100

We report Down syndrome (DS)-associated congenital gastrointestinal (GI) defects identified during a 15 year, population-based study of the etiology and phenotypic consequences of trisomy 21. Between 1989 and 2004, six sites collected DNA, clinical and epidemiological information on live-born infants with standard trisomy 21 and their parents. We used chi-squared test and logistic regression to explore relationships between congenital GI defects and infant sex, race, maternal age, origin of the extra chromosome 21, and presence of a congenital heart defect. Congenital GI defects were present in 6.7% of 1892 eligible infants in this large, ethnically diverse, population-based study of DS. Defects included esophageal atresia/tracheoesophageal fistula (0.4%), pyloric stenosis (0.3%), duodenal...

Intermittent Wound Perfusion for Postoperative Pain Relief Following Upper Abdominal Surgery: A Surgeon's Perspective

Pain Practice — Tue, 04 Nov 2008 05:00:00 +0100

Conclusion: Intermittent wound perfusion with 0.25% bupivacaine is a safe and efficient method to reduce pain scores and opioid requirement in the early postoperative period. Wound perfusion, however, had no beneficial effect on the postoperative respiratory function. (Source: Pain Practice)

Annular pancreas causing localized recurrent pancreatitis in a child: Report of a case

Surgery Today — Wed, 29 Oct 2008 07:02:24 +0100

We report a case of relapsing acute pancreatitis localized in the annulus of an annular pancreas in a young child. A 6-year-old boy complained of abdominal pain and we made a diagnosis of acute pancreatitis based on blood biochemistry results. Over the subsequent 12 months, he experienced two more pancreatitis-like attacks. Endoscopy revealed a duodenal stenosis in the second portion of the duodenum. Ultrasound, computed tomography, and magnetic resonance imaging depicted a ring of pancreatic tissue encircling the duodenum with a duct in the tissue, manifesting dilatation with a characteristic circular pattern around the duodenum. No dilatation of the dorsal pancreatic duct or pancreatic divisum was found. Based on these findings, we diagnosed acute pancreatitis localized in an annul...

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Two-stage laparoscopic biliopancreatic diversion with duodenal switch as treatment of high-risk super-obese patients: analysis of complications

Surgical Endoscopy — Wed, 24 Sep 2008 08:11:03 +0100

Conclusions Complications after SG greatly decrease after the learning curve period and can be successfully managed without need of reoperation. Suture-line reinforcement, at least selectively in the middle-upper portion of the staple line and in super-super-obese patients, is recommended to decrease the incidence of specific complications. Content Type Journal ArticleDOI 10.1007/s00464-008-0113-8Authors G. Silecchia, University of Rome “La Sapienza” Department of Surgery “Paride Stefanini”, Policlinico “Umberto I” Viale del Policlinico 00161 Rome ItalyM. Rizzello, University of Rome “La Sapienza” Department of Surgery “Paride Stefanini”, Policlinico “Umberto I” Viale del Policlinico 00161 Rome ItalyG. Casella, University of Rome “La Sapienza...

An Effective Duodenum Bulb Mobilization for Extracorporeal Billroth I Anastomosis of Laparoscopic Gastrectomy

Journal of Gastrointestinal Surgery — Tue, 16 Sep 2008 09:25:37 +0100

Conclusions Feasible duodenal bulb mobilization by complete dissection of the greater omentum allows easy performance of extracorporeal B-I anastomosis and minimizes complications related to anastomosis in LADG. Content Type Journal ArticleDOI 10.1007/s11605-008-0686-5Authors Naoki Hiki, Japanese Foundation for Cancer Research Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital 3-10-6 Ariake, Koto-ku Tokyo 135-8550 JapanTestsu Fukunaga, Japanese Foundation for Cancer Research Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital 3-10-6 Ariake, Koto-ku Tokyo 135-8550 JapanMasanori Tokunaga, Japanese Foundation for Cancer Research Gastroenterological Center, Department of Gastroentero...

Transumbilical approach for neonatal surgical diseases: woundless operation

Pediatric Surgery International — Fri, 15 Aug 2008 06:41:54 +0100

Conclusion The transumbilical approach with or without laparoscopic assistance is considered to be a feasible, safe, and cosmetically excellent surgical procedure in neonates with a wide variety of surgical intraabdominal diseases. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00383-008-2230-9Authors Tatsuro Tajiri, Kyushu University Department of Pediatric Surgery, Graduate School of Medical Sciences 3-1-1 Maidashi Higashi-ku Fukuoka 812-8582 JapanSatoshi Ieiri, Kyushu University Department of Pediatric Surgery, Graduate School of Medical Sciences 3-1-1 Maidashi Higashi-ku Fukuoka 812-8582 JapanYoshiaki Kinoshita, Kyushu University Department of Pediatric Surgery, Graduate School of Medical Sciences 3-1-1 Maidashi Higashi-ku Fukuoka 812-8582 JapanK...

Combined Use of Factor XIII and Endoscopic Balloon Dilatation in a Patient With Crohn's Disease, Duodenal Stenosis, and Associated Internal Fistulas: The Efficacy of Coagulation Factor XIII for the Internal Fistulas

The American Journal of Gastroenterology — Tue, 10 Jun 2008 02:19:08 +0100

The American Journal of Gastroenterology, Volume 103, Issue 6, Page 1573-1574, June 2008. (Source: The American Journal of Gastroenterology)

The influence of trisomy 21 on the incidence and severity of congenital heart defects in patients with duodenal atresia

Pediatric Surgery International — Fri, 30 May 2008 05:57:47 +0100

Abstract Duodenal atresia is associated with a wide variety of congenital malformations. Trisomy 21 occurs in approximately one-thirds of infants with duodenal atresia. Congenital heart disease in patients with trisomy 21 and duodenal atresia is well known. However, the frequency and spectrum of congenital heart defects in infants with duodenal atresia and a normal karyotype has not been outlined in the literature. Therefore, we conducted a retrospective chart review to clarify our knowledge about this population. Retrospective review of the medical record was performed on patients with duodenal atresia/stenosis from January 1995 to September 2007. Demographic data included birth weight and gestational age. Variables of interest included cardiac defects and karyotype. Surg...

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Combined Use of Factor XIII and Endoscopic Balloon Dilatation in a Patient With Crohn's Disease, Duodenal Stenosis, and Associated Internal Fistulas: The Efficacy of Coagulation Factor XIII for the Internal Fistulas

The American Journal of Gastroenterology — Wed, 28 May 2008 15:29:16 +0100

The American Journal of Gastroenterology, Volume 0, Issue 0, Page ???, OnlineEarly Articles. (Source: The American Journal of Gastroenterology)

Duodenum - Endoscopic Management of a

The Digital Atlas of Video Education - Gastroenterology — Mon, 19 May 2008 07:05:59 +0100

A 24-year old female was referred for complaints of intermittent nausea and vomiting with progressive weight loss. An upper GI barium study demonstrates a large diverticulum in the second portion of the duodenum. A thin radiolucent stripe is seen surrounding the diverticulum, which has been described as the “halo” sign. Upper endoscopy is performed which identifies a large diverticulum which intermittently obstructs the duodenal lumen. The endoscopic appearance is consistent with a “windsock” diverticulum. This intraluminal diverticulum is thought to result from incomplete recanalization of the duodenum during embryonic development and, with complete obstruction, symptoms present during childhood. In contrast, when there is a small aperture in the duodenum, patients...

Duodenum - Endoscopic Management of a Windsock Diverticulum

The Digital Atlas of Video Education - Gastroenterology — Mon, 19 May 2008 07:05:59 +0100

Strongyloides stercoralis: A Rare Cause of Obstructive Duodenal Stenosis

Digestion — Mon, 28 Apr 2008 13:55:05 +0100

Digestion 2008;77:141-144 (DOI:10.1159/000128597) (Source: Digestion)

Pancreaticobiliary malunion and incomplete pancreas divisum: an unusual cause of common bile duct obstruction.

Advances in Medical Sciences — Fri, 18 Apr 2008 04:00:00 +0100

Conclusion: This is the first report of coexistent PBM and incomplete pancreas divisum in a Caucasian patient with unusually late clinical manifestation. PMID: 18467273 [PubMed - as supplied by publisher] (Source: Advances in Medical Sciences)

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Transnasal endoscopic placement of nasoenteric feeding tubes: outcomes and limitations in non-critically ill patients.

Nutrition in Clinical Practice — Tue, 01 Apr 2008 04:00:00 +0100

Authors: Mahadeva S, Malik A, Hilmi I, Qua CS, Wong CH, Goh KL Transnasal endoscopic placement of nasoenteric tubes (NETs) has been demonstrated to be useful in the critical care setting, with limited data on its role in non-critically ill patients. The authors collected data on consecutive patients from a non-critical care setting undergoing transnasal endoscopic NET placement. All NETs were endoscopically placed using a standard over-the-guidewire technique, and positions were confirmed with fluoroscopy. Patients were monitored until the removal of NETs or death. Twenty-two patients (median age = 62.5 years, 36.4% female) were referred for postpyloric feeding, with main indications of persistent gastrocutaneous fistula (n = 6), gastroparesis or gastric outlet obstruction (n = 5), duo...

Annular pancreas in an adult managed by laparobotic surgery: a case report

Journal of Robotic Surgery — Sat, 29 Mar 2008 08:58:56 +0100

We report a case of annular pancreas in a 55-year-old male that was successfully treated with robotic duodenoduodenostomy. Content Type Journal ArticleCategory Case ReportDOI 10.1007/s11701-008-0076-8Authors Kumaran Chinnappan, Bronx-Lebanon Hospital Center and The Valley Hospital Suite 4A, Department of Surgery Bronx NY 10457 USAA. Yiengpruksawan, The Valley Hospital Department of Surgery Ridgewood NJ 07450 USA Journal Journal of Robotic SurgeryOnline ISSN 1863-2491Print ISSN 1863-2483 (Source: Journal of Robotic Surgery)

Modification of the endoscopic management of congenital duodenal stenosis.

The Turkish Journal of Pediatrics — Sat, 01 Mar 2008 05:00:00 +0100

This report documents a new endoscopic management modality for congenital membranous stenosis in the third portion of the duodenum. Standard approaches to duodenal stenosis in newborns include a laparotomy with an enteroenterostomy, bypassing the obstruction, or a duodenoduodenostomy with excision. We successfully developed a modification of the endoscopic treatment modality for congenital duodenal diaphragm. PMID: 18664086 [PubMed - in process] (Source: The Turkish Journal of Pediatrics)

Laparotomy enables retrograde dilatation and stent placement for malignant esophago-respiratory fistulas

World Journal of Surgical Oncology — Sat, 26 Jan 2008 05:00:00 +0100

Conclusions: Open surgery enables a safe access for retrograde endoscopic therapy in patients who had undergone esophageal resection with gastric interposition. (Source: World Journal of Surgical Oncology)

Pancreaticoduodenal artery pseudoaneurysm embolization.

Vascular — Tue, 01 Jan 2008 05:00:00 +0100

We report a case of successful transcatheter arterial embolization of a pancreaticoduodenal artery pseudoaneurysm (PSA) caused by erosion of the pancreatic pseudocyst content near pancreaticoduodenal arteries. A 55-year-old man was admitted to a local hospital for investigation of severe, stabbing epigastric pain confined to the upper abdomen. He had a history of previous alcohol abuse, chronic pancreatitis, and a duodenal ulcer. Upper gastrointestinal endoscopy revealed narrowing in the pyloric channel along with an ulcer located at the first and second portions of the duodenum with oozing beneath an adherent cloth and duodenal distortion. Computed tomography additionally revealed an enlarged head of the pancreas with numerous spot calcifications and round cystic formation inside, with a ...

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Late morbidity after duodenum-preserving pancreatic head resection with bile duct reinsertion into the resection cavity

British Journal of Surgery — Thu, 27 Dec 2007 05:00:00 +0100

Reinsertion of the distal common bile duct (CBD) into the pancreatic resection cavity during duodenum-preserving pancreatic head excision (DPPHE) may be an alternative option to Whipple resection or bilioenteric anastomosis when chronic pancreatitis is associated with CBD stenosis.Outcome in 82 patients with chronic pancreatitis who underwent DPPHE with CBD reinsertion was compared with that in 432 who had DPPHE without reinsertion and 50 who had a Whipple procedure or pylorus-preserving pancreatoduodenectomy (PPPD).There were no deaths after DPPHE with CBD reinsertion, compared with four (0·9 per cent) after DPPHE without reinsertion and three (6 per cent) after classical resection. Overall morbidity rates were 30, 28·9 and 36 per cent respectively. Fifteen patients (18 per cent) who ha...

The efficacy and safety of duodenal stenting: a prospective multicenter study

Endoscopy — Mon, 22 Oct 2007 00:55:13 +0100

Endoscopy 2007; 39: 784-787DOI: 10.1055/s-2007-966594 Duodenal stenting has become a popular treatment in cases of malignant stenosis. However, a prospective evaluation of the efficacy and morbidity of this procedure has not been performed. A prospective multicenter study of duodenal stenting was conducted by the Société Française d’Endoscopie Digestive (SFED).[...]© Georg Thieme Verlag KG Stuttgart · New YorkGet connected:Table of contents | Abstract | Full text (Source: Endoscopy)

Successful treatment of a colonic ulcer penetrating the urinary bladder caused by the administration of calcium polystyrene sulfonate and sorbitol.

Journal of Nippon Medical School — Mon, 01 Oct 2007 04:00:00 +0100

Authors: Shioya T, Yoshino M, Ogata M, Shibuya T, Tokunaga A, Matsumoto K, Tajiri T A 77-year-old woman was urgently admitted for the treatment of diabetic ketoacidosis and a duodenal ulcer hemorrhage in March 1999. She had a history of diabetes and angina pectoris. After admission, she received oral calcium polystyrene sulfonate and sorbitol to treat hyperkalemia. Nine days later, severe abdominal pain developed. A colonoscopic examination revealed a sigmoid colonic ulcer and stenosis; the patient was treated conservatively. At a 1-year follow-up examination, the colonic stenosis was found have worsened; pneumaturia developed in January 2001. The patient was found to have a sigmoidovesical fistula and underwent sigmoidectomy and partial resection of the ileum and urinary bladder. The ...

Comparison of MR enteroclysis with MR enterography and conventional enteroclysis in patients with Crohn’s disease

European Radiology — Thu, 27 Sep 2007 15:49:09 +0100

Abstract To prospectively compare the diagnostic accuracy of MR enteroclysis with duodenal intubation with MRI after drinking oral contrast agent only (MR enterography) with conventional enteroclysis (conv-E) as reference standard in patients with Crohn’s disease. Forty consecutive patients (22 males and 18 females; mean age 36; range 16–74 years) with proven Crohn’s disease underwent conv-E and MR imaging. Twenty-two patients underwent MR enteroclysis with intubation (MRE) and 18 underwent MR-enterography (MR per OS). Two radiologists reached a consensus about the following imaging findings: luminal distension and visualization of superficial mucosal, mural and mesenteric abnormalities. Standard descriptive statistics and a Wilcoxon rank sum test were used. Sta...

Groove pancreatitis: a case report and review of literature.

JOP — Wed, 19 Sep 2007 00:31:47 +0100

CONCLUSIONS: Groove pancreatitis often masquerades as pancreatic head carcinoma. This condition should be kept in mind when making the differential diagnosis between pancreatic masses and duodenal stenosis. In all cases of focal pancreatitis involving the head or uncinate process of the pancreas with involvement of the adjacent duodenum, the possibility of groove pancreatitis should be considered. PMID: 17873465 [PubMed - in process] (Source: JOP)

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Transgastric pancreatography and EUS-guided drainage of the pancreatic duct

Journal of Hepato-Biliary-Pancreatic Surgery — Thu, 26 Jul 2007 18:31:54 +0100

Conclusions Transgastric pancreatography and EUS-guided drainage of the pancreatic duct are reasonable and feasible alternative options for diagnostic and therapeutic management for selected indications (chronic pancreatitis; anomaly of the congenital pancreatic or postoperative gastrointestinal anatomy), with an acceptable periinterventional risk, which broaden the therapeutic spectrum and may avoid surgery but need further evaluation and follow-up investigation. Content TypeJournal Article JournalJournal of Hepato-Biliary-Pancreatic SurgeryOnline ISSN 1436-0691Print ISSN 0944-1166 Journal VolumeVolume 14 Journal IssueVolume 14, Number 4 / July, 2007 (Source: Journal of Hepato-Biliary-Pancreatic Surgery)

Groove pancreatitis: MRI and pathologic findings

Abdominal Imaging — Thu, 12 Jul 2007 07:11:47 +0100

Conclusions MRI findings are demonstrative of the pathologic features characteristic of this entity: the fibrous tissue in the pancreaticoduodenal groove, the duodenal wall inflammation and the groove and/or duodenal wall cyst formation. Content TypeJournal Article JournalAbdominal ImagingOnline ISSN 1432-0509Print ISSN 0942-8925 (Source: Abdominal Imaging)

Groove pancreatitis: MRI and pathologic findings.

Abdominal Imaging — Thu, 12 Jul 2007 04:00:00 +0100

CONCLUSIONS: MRI findings are demonstrative of the pathologic features characteristic of this entity: the fibrous tissue in the pancreaticoduodenal groove, the duodenal wall inflammation and the groove and/or duodenal wall cyst formation. PMID: 17624569 [PubMed - as supplied by publisher] (Source: Abdominal Imaging)

Breast Signet-ring Cell Lobular Carcinoma Presenting with Duodenal Obstruction and Acute Pancreatitis.

Asian Journal of Surgery — Sun, 01 Jul 2007 04:00:00 +0100

We report here an extremely rare case of breast signet-ring cell carcinoma (SRCC) initially manifesting as duodenal metastasis and acute pancreatitis. A 62-year-old female presented with duodenal obstruction and swollen head of the pancreas, and the diagnosis of acute pancreatitis was initially made. Upper gastrointestinal endoscopy revealed duodenal stenosis with erosive mucosa, with signet-ring cells infiltrating the submucosal layer, suggesting duodenal metastasis of SRCC. Despite absence of a palpable mass in both breasts, computed tomography revealed diffuse enhancement of the left breast in addition to left axillary lymphadenopathy. Histological examination of mammary needle biopsy samples revealed SRCC with a non-invasive lobular carcinoma component. Primary breast SRCC with duodena...

Anomalies of intestinal rotation and fixation: consequences of late diagnosis beyond two years of age

Pediatric Surgery International — Wed, 27 Jun 2007 08:04:15 +0100

We present nine cases of anomalies in the embryonic development of the digestive tract which were diagnosed and treated in infants or young, all above 2 years old. Eight cases were of more or less complete intestinal malrotation; one of them was a complete malrotation with an intrinsic duodenal stenosis associated (no bands of Ladd) and another one was a right paramesocolic hernia, always accompanied by malrotation. The association with other extra-digestive anomalies, especially urological, was 70%. The predominant symptom was intermittent abdominal pain (IAP)—80%—sometimes accompanied by vomiting (35%) and episodes of diarrhoea (25%). In all the cases, while the clinical background was early, diagnosis was late. Indeed, in 60% of the cases diagnosis was made intra-operativ...

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Foregut atresias and bile duct anomalies: rare, infrequent or common?!

Pediatric Surgery International — Thu, 17 May 2007 07:05:00 +0100

Abstract The association of foregut atresias and bile duct anomalies is reportedly rare. We encountered five referrals within 2 years where the secondary diagnosis was missed at operation. Four patients initially presented on antenatal scans as a foregut atresia whereas the fifth presented at nine years with abdominal pain due to a choledochal cyst. The biliary anomalies (cholecysto-hepatic duct, liver cyst and choledochal cysts) in the first four presented as postoperative jaundice during infancy whereas the fifth patient developed subacute intestinal obstruction due to congenital duodenal stenosis at fifteen years. In the patients with duodenal atresia neither did the preoperative X ray reveal any distal bowel gas nor did the subsequent intraoperative cholangiograms ...

Gastric outlet obstruction caused by gallstone: Bouveret’s syndrome

European Surgery — Wed, 02 May 2007 09:32:17 +0100

Conclusions: In case of symptoms of gastric outlet obstruction with an unoperated gallstone in the history of the patient, we have to think of Bouveret’s syndrome. Content TypeJournal Article JournalEuropean SurgeryOnline ISSN 1682-4016Print ISSN 1682-8631 Journal VolumeVolume 31 Journal IssueVolume 31, Number 1 / January, 1999 (Source: European Surgery)

Matthew-Wood Syndrome Is Caused by Truncating Mutations in the Retinol-Binding Protein Receptor Gene STRA6

Am J Hum Genet Latest Articles — Wed, 11 Apr 2007 21:05:57 +0100

Retinoic acid (RA) is a potent teratogen in all vertebrates when tight homeostatic controls on its endogenous dose, location, or timing are perturbed during early embryogenesis. STRA6 encodes an integral cell-membrane protein that favors RA uptake from soluble retinol-binding protein; its transcription is directly regulated by RA levels. Molecular analysis of STRA6 was undertaken in two human fetuses from consanguineous families we previously described with Matthew-Wood syndrome in a context of severe microphthalmia, pulmonary agenesis, bilateral diaphragmatic eventration, duodenal stenosis, pancreatic malformations, and intrauterine growth retardation. The fetuses had either a homozygous insertion/deletion in exon 2 or a homozygous insertion in exon 7 predicting a premature stop codon in ...

Duodenum - Enteral Stenting of Malignant Duodenal Stenonis

The Digital Atlas of Video Education - Gastroenterology — Tue, 10 Apr 2007 16:04:50 +0100

A 68-year-old man with a history of metastatic pancreatic carcinoma presented with a gastric outlet obstruction and was referred for enteral stenting. Gastroscopy revealed a marked stenosis in the first portion of the duodenum from extrinsic compression. The first step in stenting such a stenosis is to pass a wire safely through the area. One method is to impact an inflated balloon catheter up aga (Source: The Digital Atlas of Video Education - Gastroenterology)

Bilateral ureteral stenosis and duodenal perforation in a patient with dermatomyositis

Modern Rheumatology — Sat, 03 Feb 2007 09:53:38 +0100

We report the case of a 19-year-old man with dermatomyositis who developed abdominal pain and anuria. The examination revealed bilateral ureteral stenosis. The patient also developed multiple ulcerations of the duodenum with perforations. The clinical feature was considered to represent that of juvenile dermatomyositis, which is characterized by systemic necrotizing vasculitis. Rheumatologists should be alerted about this serious complication in patients with childhood or young adult dermatomyositis presenting with abdominal complaints. Content TypeJournal Article JournalModern RheumatologyOnline ISSN 1439-7609Print ISSN 1439-7595 Journal VolumeVolume 17 Journal IssueVolume 17, Number 1 / February, 2007 (Source: Modern Rheumatology)

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[Surgical treatment of duodenal stenosis in Crohn's disease]

Annales de Chirurgie — Mon, 22 Jan 2007 16:24:02 +0100

We report herein the case of a 22 year-old male in whom Crohn disease was diagnosed due to weight loss in relation with a stenosis of the first and second parts of the duodenum. A gastrojejunostomy was performed with a good subsequent result. The initial management of a Crohn's disease with involvement of the duodenum is medical. When there is an indication for surgery, a gastroenterostomy is preferred, albeit with a high incidence of outlet obstruction and marginal ulceration. PMID: 16836971 [PubMed - in process] (Source: Annales de Chirurgie)

Congenital duodenal stenosis and annular pancreas: a delayed diagnosis in an adolescent patient with Down syndrome

European Journal of Pediatrics — Tue, 17 Oct 2006 08:00:29 +0100

Content TypeJournal Article JournalEuropean Journal of PediatricsOnline ISSN 1432-1076Print ISSN 0340-6199 (Source: European Journal of Pediatrics)

Anatomical features of the minor duodenal papilla in pancreas divisum

Surgical and Radiologic Anatomy — Fri, 06 Oct 2006 07:13:09 +0100

AbstractBackground Clinical expression of pancreas divisum is often explained as a consequence of relative or true stenosis of the minor papilla with dorsal duct obstruction. This anatomo-functional study of the minor papilla in pancreas divisum has included its topographical, functional and structural features. Content TypeJournal Article JournalSurgical and Radiologic AnatomyOnline ISSN 1279-8517Print ISSN 0930-1038 (Source: Surgical and Radiologic Anatomy)

Laparoscopic resection of duodenal diverticulum. A case report.

Romanian Journal of Gastroenterology — Fri, 06 Oct 2006 03:03:04 +0100

We report the case of a laparoscopic resection of a symptomatic duodenal diverticulum. A 35 year old female with history of pain in the upper abdomen, nausea and regurgitation was diagnosed with a diverticulum of the second portion of the duodenum on the external border at upper gastrointestinal radiography. The diverticulum size was medium (2 cm in diameter). Under general anesthesia, a pneumoperitoneum was created. Four trocars were inserted into the peritoneal cavity for this intervention. After the sectioning of posterior parietal peritoneum on the external border of the second portion of duodenum, the diverticulum was dissected. The resection was performed with an endo-GIA linear stapler at the base of the diverticulum. One subhepatic drain was inserted. The operative time was 30 min....

Can pyloromyotomy for infantile hypertrophic pyloric stenosis be performed in any hospital?

European Journal of Pediatrics — Fri, 15 Sep 2006 08:02:47 +0100

Abstract In order to document the incidence of perioperative complications in patients with infantile hypertrophic pyloric stenosis, a descriptive cohort study was performed in two teaching hospitals in the Netherlands. One hospital specialized in pediatric surgery and the other was a general surgery teaching hospital. All consecutive infants who underwent pyloromyotomy for the diagnosis hypertrophic pyloric stenosis in both hospitals between 1998 and 2002 were included. The children were diagnosed and treated according to a standard protocol. From all charts, complications durante- and post-operationem were recorded. A total of 256 pyloromyotomies were performed. Registered perioperative complications were duodenal mucosal perforation (n=6; 2%). Perioperatively unrecognized duodenal mu...

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New method of stenting treatment for malignant duodenal stenosis: using double-balloon enteroscopy

Digestive Endoscopy — Wed, 22 Feb 2006 10:32:50 +0100

Digestive Endoscopy Volume 18, Issue 2, Page 147-150, Apr 2006 (Source: Digestive Endoscopy)

Outcome of pancreaticoduodenectomy for chronic pancreatitis.

J Formos Med Assoc — Mon, 14 Nov 2005 07:00:00 +0100

CONCLUSIONS: In selected patients with chronic pancreatitis, PD is a safe procedure and can effectively relieve pain and control local complications. Deterioration of pancreatic endocrine function after PD was mainly related to disease progression. Pancreatic resection plays an important role in progressing pancreatic exocrine function. PMID: 16496060 [PubMed - indexed for MEDLINE] (Source: J Formos Med Assoc)

Radiofrequency ablation of the pancreas. II: Intra-operative ablation of non-resectable pancreatic cancer. A description of technique and initial outcome.

JOP — Mon, 14 Nov 2005 07:00:00 +0100

CONCLUSION: This report demonstrates that operative radiofrequency ablation is feasible and was safely carried out in this case. More experience is required to assess the spectrum of complications and if there is true oncological efficacy. PMID: 16286710 [PubMed - indexed for MEDLINE] (Source: JOP)

Laparoscopic pancreas-preserving distal duodenectomy for duodenal stricture related to nonsteroidal antiinflammatory drugs (NSAIDs)

Surgical Endoscopy — Thu, 19 Feb 2004 20:46:59 +0100

Conclusion: Laparoscopic pancreas-preserving distal duodenectomy for the management of benign duodenal strictures is feasible and safe. Moreover, we have demonstrated the beneficial role of relaparoscopy for the management of postoperative complications and for revision surgical procedures. Content Type Journal ArticlePages -DOI 10.1007/s00464-002-4201-xAuthors B.J. Ammori Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794 (Source: Surgical Endoscopy)