Диагностика хронической дуоденальной непроходимости у детей

Chronic duodenal obstruction is a disorder of the motor-evacuation function of the duodenum and remains a complex and understudied problem in abdominal surgery. The importance of this pathology is due to its widespread prevalence and high rate of complications, especially when associated with duodenal ulcer disease. A study of patients with chronic duodenal obstruction and duodenal ulcer disease was conducted. The main group of patients was examined using a developed technique of double-contrast hydroultrasound of the duodenum under drug-induced hypotension. The control group consisted of patients whose medical records were analyzed retrospectively. The diagnostic algorithm included a combination of radiological, endoscopic, ultrasound, and Doppler studies. In the control group (n=601), 82% were men and 18% were women. In the study group (n=152), the similar ratio was 82.9% and 17.1%, respectively. Analysis of the disease duration showed that in 41.4% of patients in the study group, it lasted less than 3 years, while in the control group this figure was 18.9%. In the study group, arteriomesenteric compression, congenital anomalies of the duodenum, and cicatricial-ulcerative stenosis were diagnosed more often. Elective surgical interventions in the study group amounted to 50.6% versus 28.9% in the control group, indicating more effective diagnostics and early detection of pathology. The use of a comprehensive diagnostic algorithm, including double-contrast hydroultrasound, allows for increased detection of chronic duodenal obstruction, reduced diagnostic times, and an increase in the proportion of elective surgeries, which improves the prognosis for patients with this pathology.

Presently, there is no single opinion concerning the method preferable for surgical treatment of chronic pancreatitis (CP) with dysfunction of adjacent organs. Surgical treatment was applied to 144 patients with CP. In 54 (37.5%) patients, CP was complicated by dysfunction of adjacent organs. Particularly these were biliary hypertension (BH) in 36 (25%) patients and chronic duodenal obstruction (CDO) in 8 (5.5%) patients. In 5 (3.5%) patients, BH was combined with CDO, and another 5 (3.5%) patients had a combination of BH, CDO and venous hypertension (VH) of the portomesenteric area. In 24 patients with BH, we applied intraoperative monitoring of biliary pressure (IOM BP) in the process of performing duodenum-preserving pancreas resections. Frey's procedure was applied in 26 (48.1%) cases, where CP was complicated by the development of CDO, BH or CDO + BH. To correct BH, Frey's procedure was supplemented by application of hepatico-entero anastomosis (HEA) in 10 patients, pancreas lingual was excised; internal biliopancreatic anastomosis was applied in two patients. Beger's procedure was used in 2 (3.7%) patients, in which CP was complicated by BH + CDO + VH. Pancreaticoduodenal resection (PDR) according to Whipple was used in 5 (9.2%) cases. Longitudinal pancreatic-enteric anastomosis (LPEA) supplemented by HEA due to BH was applied to 8 (14.8%) patients. The results of chronic treatment were traced in 23 (42.5%) patients throughout the period of 6 to 36 months. Life quality indicators appeared to be the best among the patients who underwent resection surgeries on the pancreas. The method selected to treat surgically the patients with CP that involves adjacent organs and causes their dysfunction is duodenum-preserving resection surgeries on pancreas head, which in some cases should be supplemented by application of biliodigestive anastomosis or biliopancreatic diversion in the area of pancreas resection to eliminate the BH.

Brief literature review devoted to chronic duodenal obstruction is presented in the article. We described an experience of treatment of 5 children with mechanical form of chronic duodenal obstruction. Duodenal stenosis was observed in 2 patients. Arteriomesenteric compression caused chronic duodenal obstruction in other children. Duodenal obstruction was cured using laparoscopy in all cases. Thus enteroalimentation has been started in early terms and intensive care unit stay and hospital stay was reduced.

The article describes a case of treatment of a giant gastric polyp complicated by bleeding and chronic duodenal obstruction by a new method of endoscopic surgical hemostasis by endoscopic polypectomy using a polymer alginate hemostatic sorbent. The proposed endoscopic polypectomy method using a local hemostatic agent made it possible to prevent hemorrhagic complications, create conditions for full-fledged reparative regeneration, which made it possible to exclude recurrence of the polyp at the site of its removal in the long term.

Complications of intestinal malrotation commonly manifest in the first months of life. However, cases of diagnosis in later age, including in adults, have been described. The clinical presentation is highly variable, and a significant amount of time often passes before the accurate diagnosis is made. This study presents a clinical case of a 17-year-old girl with chronic duodenal obstruction caused by isolated malrotation and fixation of the duodenum. Considering the patient’s comorbidities and developmental disorders, the diagnostic search was significantly challenging. In this situation, surgery involves mobilization of the duodenum and correction of the pathological fixation. However, considering the significant changes in the duodenal wall and the combined pathology, duodenojejunostomy was performed. Despite the additional surgical intervention, the postoperative period was characterized by prolonged gastric–duodenal stasis. Adequate diet, frequent feeding with a mixture, maximal “verticalization,” and activation of the patient played a key role in alleviating anastomositis and motor disturbances after the operation. Thus, using a strictly individualized approach to treat adolescents with a complex of surgical and therapeutic pathology and psychiatric disorders results in a satisfactory treatment outcome.

1. Six cases are presented that indicate that chronic duodenal obstruction from a variety of causes, such as superior mesenteric compression, proximal loop obstruction, inflammatory stricture, annular pancreatic stenosis, and malignant constriction, is an etiologic factor in the induction of pancreatic inflammatory disease.

Introduction. Chilaiditi syndrome—hepatodiaphragmatic interposition—is a rare condition in which bowel loops are compressed in the space between the liver and the dome of the diaphragm, which can lead to the development of a wide range of complications. In the available literature data on the clinical manifestations of this condition in children with omphalocele are not described.Materials and methods. The article describes rare clinical cases of patients 1 year 1 month, 2 years 11 month and 12 years old, previously operated on in the neonatal period for omphalocele, in whom, in the long term after surgery, signs of hepatodiaphragmatic interposition persisted, which led to the development of chronic duodenal obstruction.Conclusion: It has been proven that the leading role in restoring the normal topography of the abdominal organs in children with omphalocele is played by the complete mobilization of the liver and the great vessels (IVC) fi xing it, which provide the possibility of its subphrenic localization. Chronic duodenal obstruction in children with a similar pathology has not been previously described. The proposed original method of surgical treatment seems to be pathogenetically justifi ed.

BACKGROUND: Superior mesenteric artery syndrome causes chronic duodenal obstruction. Studies on this disease are limited; therefore, several difficulties in the diagnosis and treatment of such patients remain. AIM: This study aimed to present the experience of treating children with superior mesenteric artery syndrome. MATERIALS AND METHODS: The treatment results of 45 patients with superior mesenteric artery syndrome was retrospectively studied. The children complained of abdominal pain, nausea, occasional vomiting, belching, bloating, and constipation. The diagnosis was confirmed during a comprehensive examination, including ultrasound, esophagogastroduodenoscopy, X-ray contrast examination, computed tomography, and relaxation duodenography. Conservative therapy was performed in 38 (84,4%) children, and 21 (55,3%) children showed satisfactory results. In case of ineffectiveness of conservative measures (17 cases) or in a decompensated state (7 cases), indications for surgical treatment were provided. Furthermore, 24 (53,3%) children underwent surgery. Duodenal drainage surgeries were performed in 20 (83,3%) patients with subcompensation of duodenostasis. Of these patients, 10 (41,7%) underwent lower duodenojejunostomy with a switched-off Roux-en-Y loop (Gregory–Smirnov’s operation) and the other 10 (41,7%) underwent anterior mesenteric duodenojejunostomy (Robinson’s operation). Laparotomic access was used in 14 cases (70,0%) and laparoscopic in 6 (30,0%) cases. Owing to decompensation of duodenostasis, the duodenum was excluded from passage by economical resection of the gastric outlet with gastrojejunostomy on a short loop with additional formation of a lower duodenojejunostomy according to Roux in 4 (16,7%) cases. Laparotomic access was used in all cases. RESULTS: No intraoperative complications were noted. In the early postoperative period, two children developed anastomositis after Robinson’s operation and two patients after Gregory–Smirnov’s operation, which was treated with conservative measures. In long-term followup (up to 15 years), a satisfactory result was achieved in 87.5% of cases. CONCLUSIONS: Superior mesenteric artery syndrome is a relatively rare cause of chronic duodenal obstruction in children. When selecting patients for surgical treatment, other diseases should be excluded. Surgical correction includes various options for duodenal drainage operations that can be successfully performed using laparoscopic access. In case of decompensation of duodenostasis, it may be crucial to exclude the duodenum from the passage.

Superior mesenteric artery syndrome (SMAS) in children is a rare cause of chronic duodenal obstruction (CDO), in which the inferior horizontal branch of the duodenum is compressed between the aorta and the acutely angled superior mesenteric artery. There are not many publications of clinical cases of SVBA in the literature, especially in the pediatric population. The main cause of the disease is weight loss due to various reasons, including anorexia nervosa, trauma, burns and other conditions. Currently, there is a frequent association of the syndrome with mental disorders. Literature data on the treatment of SVBA associated with various psychosomatic conditions vary; both conservative and surgical treatment methods are used. We present two clinical cases of SVBA in adolescent children, in which the cause of patient weight loss was concomitant mental disorders and previous surgical interventions. Both patients underwent laparoscopic side-to-side duodenojejunostomy with good long-term treatment results, confirmed during follow-up examination.

We report a case of fat-soluble vitamin deficiency in a 14-year old boy who had chronic duodenal obstruction. He presented with periodic unexplained bleeding tendency. The laboratory results showed positive fat globules in stool and prolonged prothrombin time. His further investigation revealed low plasma vitamin A and undetectable plasma vitamin E. After parenteral vitamin K and oral vitamin A and E supplement, these abnormalities resolved although he still had absent knee jerk. We propose that fat malabsorption and fat-soluble vitamin deficiency can occur after prolonged duodenal obstruction that induce bacterial overgrowth following by bile acid deconjugation. Despite very few case reports, screening for fat malabsorption and fat-soluble vitamin deficiency might be warranted in patients with chronic small bowel obstruction.

Chronic intermittent duodenal obstruction or ileus has attracted increasing attention in recent years and is generally being accepted as a clinical entity. There are still a few who hold that it is not a clinical entity but a radiographic sign caused by and associated with various intra-abdominal lesions. However, most competent observers in this field have come to consider it as a distinct clinical condition. Various descriptive terms have been applied to it, such as arteriomesenteric occlusion, congenital fixation of the duodenum, stenosis of the duodenum, megaduodenum, chronic duodenal ileus or stasis and chronic intermittent duodenal obstruction. There are several causes of the condition. But in this discussion we shall confine ourselves to the two that are the most frequent and important. First, there is the group of cases due to peritoneal adhesions or bands, congenital or inflammatory, fixing the first and second parts of the duodenum. Secondly, there is

A STUDY of medical literature and hospital records would indicate that chronic duodenal obstruction is rarely recognized or even suspected. Surgeons of wide experience report that they have never seen a case. That such a condition may exist is beyond doubt and that a positive diagnosis can usually be made, preoperatively, must be conceded. I believe that when more cases have been studied and reported, then the medical profession will become acquainted with this pathologic entity and keep it in mind when confronted with a patient who presents definite and persistent dyspeptic symptoms associated with vague physical findings. From the surgeon's point of view, certain phases of chronic duodenal obstruction are of paramount importance. A pre-operative recognition of this condition is necessary for the surgeon if he is to apply efficient and rational treatment. The diagnosis may be extremely difficult unless there is marked duodenal dilatation and we know that under certain conditions little if any dilatation ...

AimSuperior Mesenteric Artery Syndrome is rare manifestation of duodenal obstruction arising due to external compression between the superior mesenteric artery and the aorta. The classic presentation involves postprandial abdominal pain...

Wilkie's syndrome is an unusual cause of proximal intestinal obstruction. It is a clinical entity characterized by compression of the third or transverse portion of the duodenum between the aorta and superior mesenteric artery (SMA). This results in chronic, intermittent, or acute complete or partial duodenal obstruction. We present the case of a 40-year-old lady who presented with postprandial abdominal pain at the epigastric region, colic type, without radiation accompanied by nausea, postprandial vomiting, and weight loss. She was evaluated and diagnosed with SMA syndrome with duodenojejunal diverticulosis. She was taken for surgery due to chronic malnutrition that did not improve with conservative management. Duodenojejunostomy with transgastric feeding jejunostomy was done. To alleviate postoperative refractive gastroparesis, kinking, and angulation as is our previous few cases, transgastric feeding jejunostomy was done in contrast to modified Witzel's technique. The patient was free of symptoms and recurrence during follow-up. Wilkie's syndrome is an unusual cause of intestinal obstruction. Prompt diagnosis and appropriate surgical intervention are associated with good outcome.

We analysed nine autopsy cases of ossification of the posterior longitudinal ligament (OPLL) to elucidate the relationship between morphology and pathology of the spinal cord. The cross-sectional shape of the spinal cord at the most severely affected segment was classified into two categories: boomerang (convex lateral surfaces and concave anterior surface) and triangular (angular lateral surfaces and flat anterior surface). In the cases with a boomerang shape, even when the compression was severe, major pathological changes were restricted to the grey matter and the white matter was relatively well preserved. No secondary descending degeneration of the lateral columns was seen, and ascending degeneration of the posterior column was restricted to the fasciculus cuneatus whose fibres were derived from the affected segments. In the cases with a triangular shape, pathological changes were more severe, both white matter and grey matter were involved, and only the anterior columns were free of pathological changes. There were severe pathological changes over more than one segment, and both descending degeneration of the lateral pyramidal tracts and ascending degeneration of the posterior column, including the fasciculus gracilis, were observed. The transverse area of the spinal cord was > 60% of normal in most of the cases with a boomerang shape, but it was reduced to < 60% of normal in more than one segment in the cases with a triangular shape. The compression ratio of the spinal cord (sagittal diameter/transverse diameter x 100%) was not related to pathological changes. In conclusion, a triangular-shaped spinal cord with transverse area of < 60% of normal in more than one segment appeared to be associated with severe and irreversible pathological changes in cases of OPLL.