Duodenal Obstruction Research Articles

Coagulation Parameters as a Prognostic Factor for Mortality in a Neonate with Duodenal Obstruction

Background: Although the mortality cases of duodenal obstruction are only about 5%, this abnormality remains a burden in pediatric surgery. Several conditions can worsen a patient’s outcome and a proper understanding of the coagulation parameters is vital for a good outcome. Methods: This study was a descriptive-analytic study. Data of duodenal obstruction in neonate patients were taken from medical records from 2016 to 2020 . The data were then processed using SPSS 26.0 Results: From 59 samples of neonates with duodenal obstruction, most of them were born aterm pregnancy 38 (64%) patients, with male 32 patients and female 27 patients. There were neonates died based on complete obstruction 12 (20.3%), there was no significantly different neonates died between low birth weight and normal birth weight 9 (15.3%). The most commonly performed surgical procedure was kimura procedure 43 patients, with 14% patients was died. Coagulation parameters platelets, Protrombine time (PT), and Activated Partial Thromboplastin Time (APTT), only APTT there was significance correlation with P- value (0.016) , OR 3.98 Conclusion: There was a significant correlation between Activated Partial Thromboplastin Time (APTT) and mortality, with abnormal APTT had 3.98 times higher risk of dying than normal.

Study of Correlation between Fetal Bowel Dilation and Congenital Gastrointestinal Malformation.

Ultrasound serves as a valuable tool for the early detection of fetal bowel dilatation, yet the correlation between fetal bowel dilatation and gastrointestinal malformations remains to be further investigated. This study aims to explore the relationship by conducting a follow-up and analysis of fetuses with bowel dilation. A retrospective analysis was conducted on 113 fetuses with bowel dilatation at our center from July 2014 to December 2019. The location and degree of bowel dilatation were analyzed. ROC curves were constructed based on the diameter of the bowel and its ratio to fetal gestational age. In total, 40 of 41 cases (97.6%) with upper gastrointestinal dilatation (double-bubble sign) and 46 of 72 cases (63.9%) with lower gastrointestinal dilatation were diagnosed with gastrointestinal malformations postnatally. The AUC of the dilatation diameter was 0.854 with a cutoff value of 18.05 mm in patients with lower gastrointestinal dilatation. The ratio of the diameter to gestational age (D/GA) showed a higher AUC of 0.906 with a cutoff value of 0.4931. The presence of the double-bubble sign in fetuses indicates a close association with duodenal obstruction. The risk of gastrointestinal malformations increases when the bowel diameter exceeds 18.05 mm, particularly when the D/GA surpasses 0.4931.

Recurrent Brunneroma: A Rare Cause of Duodenal Obstruction

Abstract Brunneroma, also known as Bruner’s gland adenoma or hamartoma, is a rare benign tumor of the duodenum. It is usually asymptomatic and sometimes presents with an upper gastrointestinal (UGI) bleed or obstruction. The majority of the cases are detected incidentally during endoscopy for UGI bleeding and may require endoscopic excision. Here, we attempt to highlight a case of recurrent large Brunneroma in a 52-year-old male and reassess the representative features that surgeons need to be aware of. We had to go for a major surgical intervention to relieve the duodenal obstruction.

Multidisciplinary approach to a complex duodenal obstruction: From duodenal atresia to superior mesenteric artery syndrome

We present a 21yo female with a nausea, vomiting, and weight loss. Her history was remarkable for duodenal atresia repair as an infant. Following extensive evaluation, she was found to have progressive dilation of the proximal duodenum and loss of motility without obstruction (megaduodenum) which eventually lead to substantial weight loss resulting in superior mesenteric artery (SMA) syndrome. Given her symptomatic presentation, she was offered surgery and underwent a lateral duodenal tapering procedure and division of the ligament of Treitz and duodenal derotation (Strong procedure). Through the collaborative efforts of gastroenterology, pediatric surgery, radiology, and acute care surgery, she now has excellent functional status, has gained weight, and is asymptomatic. This case serves as an important example that congenital anomalies are a lifelong consideration when caring for patients

Congenital Malrotation of the Midgut Presenting as Acute Duodenal Obstruction in a Teenager — A Case Report

Background: Intestinal malrotation, a congenital anomaly, typically presents in neonates with midgut volvulus. However, recent studies suggest it may occur in adolescents and adults at a higher rate than previously thought. This case report investigates the presentation and management of malrotation with volvulus in an adolescent. Case Presentation: A 14-year-old boy presented with acute onset abdominal pain, vomiting, and a history of intermittent abdominal pain for several years. Initial diagnosis was gastritis, but imaging revealed malrotation with volvulus. He underwent a successful Ladd's procedure. Conclusion: This case emphasizes that malrotation can present with chronic or acute symptoms in adolescents. A high index of suspicion for malrotation is crucial, particularly in adolescents with recurrent abdominal pain. Early diagnosis and Ladd's procedure can prevent life-threatening complications.

Clinical Outcomes of Secondary Duodenal Self-Expandable Metallic Stenting for Duodenal Stent Dysfunction in Patients with Malignant Duodenal Obstruction: A Retrospective Multicenter Study.

Malignant duodenal obstruction has become more common with the development of palliative therapies.The outcomes of endoscopic ultrasound-guided gastrojejunostomy (EUS-GJ) are comparable to those of surgical gastrojejunostomy or duodenal stenting. However, EUS-GJ is technically challenging. Duodenal self-expandable metallic stent (SEMS) placement is popular; however, obstructions are common. Duodenal SEMS obstruction can be managed with the insertion of a second SEMS in a stent-in-stent manner. Therefore, we aimed to analyze the clinical outcomes of secondary duodenal SEMS placement in patients with malignant duodenal obstruction. We retrospectively analyzed the data of patients who underwent secondary duodenal stent insertion for duodenal stent dysfunction between January 2016 and December 2021. The primary outcome was stent patency. The secondary outcomes were clinical success, factors associated with dysfunction, patient survival, and adverse events. A total of 109 patients were included. The mean age was 64.4±11.2 years, and 63 patients (57.8%) were male. Ninety-two patients (84.4%) had pancreaticobiliary cancer. Clinical success was achieved in 94 cases (86.2%). Twenty-three patients experienced stent dysfunction with 231 days of median stent patency (95% confidence interval [CI], 169 to not available). After a multivariable Cox hazard analysis of stent patency, the Eastern Cooperative Oncology Group performance status (hazard ratio [HR], 2.13; 95% CI, 1.20 to 3.81; p=0.010) and the first stent patency ≥6 months (HR, 0.33; 95% CI, 0.11 to 0.95; p=0.050) remained significant associated factors. Adverse events occurred in five patients (4.6%). Secondary duodenal stent insertion is a viable option for first duodenal stent obstruction. Further comparative studies involving surgery or EUS-GJ for obstructed duodenal stents are warranted.

The beneficial effects of the transanastomotic feeding tube in the management of congenital duodenal obstruction: a meta-analysis

The beneficial effects of the transanastomotic feeding tube in the management of congenital duodenal obstruction: a meta-analysis

A Rare Case: Stenosis Doudeni Congenital et Causa Ladd Band Eet Causa Malrotation with Situs Inversus in 12 Days Old Baby

We are sharing a rare presentation of congenital duodenal obstruction with combined intrinsic and extrinsic causes with situs inversus, namely, duodenal stenosis with gastrointestinal malrotation in a neonate. The patient underwent successful exploratory laparotomy, Ladd's procedure, and appendicectomy were carried out. Early recognition of signs and symptoms, prompt corrective surgery, and adequate optimization of metabolic components post-operatively are important to determine the decreased morbidity and mortality of neonates.

Clinical application of endoscopic diaphragmotomy and dilation in a congenital duodenal diaphragm.

A congenital duodenal diaphragm (CDD) is a rare cause of duodenal obstruction in infants and children. The traditional approach to treatment has been surgical intervention either with excision and duodenoplasty or with bypass through a duodenoduodenostomy, which is invasive and carries the risk of anastomotic leakage. To summarize the key points of differential diagnosis and treatment of a CDD under gastroscopy and to evaluate its efficacy and safety. The clinical data of patients with a duodenal obstruction diagnosed and treated by gastroscopy in our hospital between January 2019 and December 2022 were retrospectively analyzed. The gastroscopic features of the CDD were summarized. The clinical outcomes of patients with CDD treated by gastroscopy were collected and investigated. A total of 13 children with a duodenal obstruction underwent a gastroscopic examination and/or treatment, and of these, 10 were diagnosed as having a CDD and 3 were finally diagnosed as having an annular pancreas. A dome-shaped structure during inspiration (9/10) and a guidewire that could be inserted through the opening into the distal lumen (6/10) were the gastroscopic features of the CDD, while the annular pancreas had none of these features. The 10 patients, 4 men and 6 women with the CDD, were treated through endoscopic diaphragmotomy and dilation. The age and weight at operation was 15 days to 7 years (M: 2.25 years) and 2.85-22 kg (M: 13.6 kg), respectively. A total of 11 endoscopic operations were performed in the 10 patients. The time of single operation was 15-55 min (M: 38 min). The patients did not experience complications such as bleeding, pneumoperitoneum, and duodenal papilla injury during the operation. Feeding was started 12-24 h after surgery, and the patients were discharged 2-10 days (M: 7 days) postoperatively. The patients were followed up for 3-36 months (M: 17 months), and none of them had a recurrence of vomiting. However, three showed a recurrence of stenosis in upper gastrointestinal imaging, one of whom underwent a partial diaphragm resection again 2 months after the primary treatment. A CDD can be confirmed by endoscopy based on its characteristic features. Endoscopic diaphragmotomy and balloon dilation are safe and effective, which can be a new option for minimally invasive treatment of a CDD.

Best supportive care in advanced pancreas cancer: a systematic review to define a patient-care bundle.

The majority of patients with pancreatic adenocarcinoma (PDAC) have advanced disease at presentation, preventing treatment with curative intent. Management of these patients is often provided by surgical teams for whom there are a lack of widely accepted strategies for care. The aim of this study was to conduct a systematic review to identify key issues in patients with advanced PDAC and integrate the evidence to form a care bundle checklist for use in surgical clinics. A systematic review of the literature was performed regarding best supportive care for advanced PDAC according to the PRISMA guidelines. Interventions pertaining to supportive care were included whilst preventative and curative treatments were excluded. A narrative review was planned. Forty-four studies were assessed and four themes were developed: (i) Pain is an undertreated symptom, requiring escalating analgesics and sometimes invasive modalities. (ii) Health-related quality of life necessitates optimisation by involving family, carers and multi-disciplinary teams. (iii) Malnutrition and weight loss can be mitigated with early assessment, replacement therapies and resistance exercise. (iv) Biliary and duodenal obstruction can often be relieved by endoscopic/radiological interventions with surgery rarely required. This is the first systematic review to evaluate the different types of interventions utilized during best supportive care in patients with advanced PDAC. It provides a comprehensive care bundle for surgeons that informs management of the common issues experienced by patients within a multidisciplinary environment.

Comparative results of treatment of superior mesenteric artery syndrome in children by forming bypass anastomoses

Introduction. Superior mesenteric artery syndrome (SMAS) is a rare cause of chronic duodenal obstruction in children. It is defined as a compression of the inferior horizontal branch of the duodenum (DU) between aorta and the superior mesenteric artery (SMA). Various methods of surgical correction of the disease have been proposed in the literature, but a comparative analysis of their effectiveness has not been carried out. Objective: the comparative analysis of using various options of bypass anastomoses (side-to-side duodenojejunostomy, Roux-en-Y duodenojejunostomy) for SMAS in children was carried out. Materials and methods: thirty-four patients were treated with SMAS at the clinic of the Federal State Budgetary Institution of Children’s City Clinical Hospital named after. N.F. Filatov for the period from 2012 to 2023. Patients were divided into 2 groups: operated on by forming a side-to-side bypass duodenojejunostomy (group 1 - 21 children (61.8%)) and Roux-en-Y (group 2 - 13 children (38.2%). A retro- and prospective analysis of the results of their treatment was carried out. The average age was 15 years 7 months (from 8 years 5 months to 17 years 8 months). Girls were predominant 85.3%. Standard investigations were performed: ultrasound, fluoroscopy, and computer tomography of the organs of the abdominal cavity with contrast, esophagogastroduodenoscopy, laboratory research methods. The WHO AntroPlus program was used to assess the physical condition of the children. Results: the groups were assessed in terms of anthropometric indicators, gender composition and age. The following causes of SMAS were identified in both groups: weight loss caused by neuropsychiatric diseases - 29.4%; growth spurt - 26.5%; weight loss due to other reasons (repeated surgeries, diseases accompanied by weight loss, etc.) - 23.5%; without an obvious reason - 17.6% (6 people), correction of scoliotic deformity - 2.9%. The analysis showed that statistically significant differences were identified in the duration of surgery. The average duration of the operation in group 1 was 78.10±21.53 minutes, in group 2 - 103.46 ±18.19 minutes (p=0.001*). There was no statistically significant difference between groups in the postoperative period and in the complications (bleeding from the surgical site 8.8% (3 people) and reactive pancreatitis 5.9% (2 people)). Conclusion: no statistically significant difference was found in the results of both types of operations. However, the laparoscopic side-to-side duodenojejunostomy bypass is preferable due to the simplicity and quickness of performing.

Conversion surgery for initially unresectable locally advanced pancreatic ductal adenocarcinoma after chemotherapy followed by carbon-ion radiotherapy: a case report

BackgroundRecent advances in chemotherapy and chemoradiotherapy have enabled conversion surgery (CS) to be performed for selected patients with initially unresectable locally advanced (LA) pancreatic ductal adenocarcinoma (PDAC). Many studies indicate CS might extend the survival of patients with initially unresectable LA PDAC. However, several clinical questions concerning CS remain, such as the optimal preoperative treatment. Carbon-ion radiotherapy (CIRT) is a unique radiotherapy that offers higher biological effectiveness than conventional radiotherapy. Here, we report a long-term survival case with initially unresectable LA PDAC who underwent CS after chemotherapy followed by CIRT.Case presentationThe patient was a 72-year-old Japanese woman with unresectable LA pancreatic head cancer with tumor contact to the superior mesenteric artery (SMA). She underwent four courses of chemotherapy (gemcitabine plus nanoparticle albumin-bound paclitaxel). However, the lesion did not shrink and tumor contact with the SMA did not improve after chemotherapy. Because the probability of achieving curative resection was judged to be low, she underwent radical dose CIRT, and chemotherapy was continued. She complained of vomiting 2 months after CIRT. Although imaging studies showed no tumor growth or metastasis, a duodenal obstruction which was speculated to be an adverse effect of CIRT was observed. She could not eat solid food and a trans-nasal feeding tube was inserted. Therapeutic intervention was required to enable enteral nutrition. We proposed several treatment options. She chose resection with the expectation of an anti-tumor effect of chemotherapy and CIRT rather than course observation with tube feeding or bypass surgery. Therefore, subtotal-stomach-preserving pancreatoduodenectomy with portal vein resection was performed as CS. Pathological examination of the resected specimen revealed an R0 resection with a histological response of Evans grade IIA. Postoperatively, she recovered uneventfully. Adjuvant chemotherapy with tegafur/gimeracil/oteracil (S1) was administrated. At the time of this report, 5 years have passed since the initial consultation and she has experienced no tumor recurrence.ConclusionsThe present case suggests that multidisciplinary treatment consisting of a combination of recent chemotherapy and CIRT may be beneficial for unresectable LA PDAC. However, further studies are required to assess the true efficacy of this treatment strategy.

Superior mesenteric artery syndrome: A case report

Superior Mesenteric Artery (SMA) syndrome, also known as Wilkies syndrome, is a rare condition of duodenal obstruction due to extrinsic compression of the third portion of the duodenum by the superior mesenteric artery and the abdominal aorta.

The role of EUS-guided iodine-125 seed implantation in patients with unresectable ampullary cancer after relief of obstructive jaundice.

Few studies have focused on the management of inoperable ampullary carcinoma (AC), and patients with jaundice suffer from biliary stents replacement frequently. Iodine-125 (125I) brachytherapy has been used in the treatment of malignant tumors owing to its curative effect, minimal surgical trauma, and tolerable complications. The aim of the study was to investigate the role of 125I seed implantation in patients with unresectable ampullary carcinoma after relief of obstructive jaundice. A total of 44 patients with obstructive jaundice resulting from unresectable ampullary carcinoma from January 1, 2010 to October 31, 2020 were enrolled in the study. Eleven patients underwent implantation of 125I seeds under endoscopic ultrasound (EUS) after receiving biliary stent placement via endoscopic retrograde cholangiopancreatography (ERCP) (treatment group), and 33 patients received a stent alone via ERCP (control group). Cox regression model was applied in this single-center retrospective comparison study. The median maximum intervention interval for biliary obstruction was 381 days (interquartile range [IQR]: 204-419 days) in the treatment group and 175 days (IQR: 126-274 days) in the control group (p < 0.05). Stent occlusion rates at 90 and 180 days in the control group were 12.9% and 51.6%, respectively. No stent occlusion occurred in the treatment group. Patients in the treatment group obtained longer survival time (median, 26 vs. 13 months; p < 0.01) and prolonged duodenal obstruction (median, 20.5 vs. 11 months; p < 0.05). No brachytherapy-related grade 3 or 4 adverse events were observed. Longer intervention interval for biliary obstruction and survival as well as better stent patency and prolonged time to duodenal obstruction could be achieved by implanting 125I seeds combined with biliary stent in patients with unresectable ampullary cancer.

Case Presentation of Duodenal Obstruction Caused by Complete Annular Pancreas.

Teaching Point: A complete annular pancreas, a rare congenital anomaly, can lead to duodenal obstruction, causing recurrent symptoms like vomiting and often requiring surgical intervention for relief.

An update on gastroparesis in 2024

Gastroparesis is a pathology associating upper digestive symptoms, such as nausea and vomiting, with impaired gastric emptying in the absence of mechanical gastric or duodenal obstruction. It has a major impact on patients' quality of life, can lead to undernutrition, and -increases overall mortality. Several schools of thought converge on the hypothesis of a clinico--pathological spectrum of gastric neuro-muscular dysfunction encompassing gastroparesis and functional dyspepsia, in particular the subtype known as "postprandial distress syndrome". Its management includes non--pharmacological interventions, such as hygienic--dietary measures, pharmacological interventions using prokinetic, antiemetic or neuromodulatory treatments, and endoscopic interventions.

Duodenal Lipoma Causing Recurrent Duodenal Obstruction: A Rare Case, Managed Surgically

Duodenal Lipoma Causing Recurrent Duodenal Obstruction: A Rare Case, Managed Surgically

Superior mesenteric artery syndrome (Wilkie’s syndrome) in children, as a late complication of neuropsychic diseases

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.

Enhanced recovery after surgery in congenital duodenal obstruction

BackgroundThe present study aims to explore the clinical application of enhanced recovery after surgery (ERAS) in pediatric patients with congenital upper gastrointestinal obstruction (CUGIO).MethodsA total of 82 pediatric patients with CUGIO admitted to the neonatal intensive care unit in Kunming Children’s Hospital between June 2017 and June 2021 were enrolled in the present study and divided into two groups: the ERAS group (n = 46) and the control group (n = 36). The ERAS management mode was adopted in the ERAS group, and the conventional perioperative management mode was adopted in the control group.ResultsIn the ERAS group and the control group, the time to the first postoperative bowel movement was 49.2 ± 16.6 h and 58.4 ± 18.8 h, respectively, and the time to the first postoperative feeding was 79 ± 7.1 h and 125.2 ± 8.3 h, respectively. The differences in the above two indicators between the two groups were statistically significant (P < 0.05). In the ERAS group, the days of parenteral nutrition and the length of hospital stay were 14.5 ± 2.3 d and 18.8 ± 6.4 d, respectively. In the control group, 17.6 ± 2.2 d and 23.1 ± 8.1 d, respectively. The differences in these two indicators between the two groups were statistically significant (P < 0.05).ConclusionThe ERAS management model had a positive effect on early postoperative recovery in pediatric patients with CUGIO.

Invasive Pancreatic Adenocarcinoma with Squamous Differentiation Arising in an IOPN with Novel MDM2 Amplification

Abstract Introduction/Objective Intraductal oncocytic papillary neoplasms (IOPNs) are rare pancreatic tumors that are genetically distinct from intraductal papillary mucinous neoplasms (IPMNs). Morphologic and molecular characterization of invasive adenocarcinomas associated with IOPNs remains limited due to the rarity of this entity. Methods/Case Report We present a 68-year-old female who initially presented with abdominal pain and jaundice. MRI revealed a 2.6 cm mass in the pancreatic head with abutment of the superior mesenteric vein and dilation of the biliary and pancreatic duct. Biopsy revealed adenocarcinoma with mucinous features. The patient was started on gemcitabine and abraxane. Her treatment course was complicated by biliary and duodenal obstruction requiring common bile duct and duodenal stenting. Surgical management with pancreaticoduodenectomy was performed six months following initial diagnosis. Gross examination revealed a 2.5 cm ill-defined tumor surrounding the main pancreatic duct adjacent to the common bile duct. Microscopy revealed an IOPN arising within the pancreatic duct exhibiting a complex papillary growth pattern. There was an associated moderately to poorly differentiated invasive carcinoma with mucinous and squamous differentiation with lymph node metastasis. Molecular testing (FoundationOne®CDx) revealed ARID1A mutation and amplification of MDM2, CDK4, and ERBB3. Patient is alive and without radiologic evidence of disease recurrence at 6 months follow-up. Results (if a Case Study enter NA) NA Conclusion To our knowledge, our case is the first report of an invasive pancreatic adenocarcinoma with squamous differentiation arising in association with an IOPN. In addition, our case showed MDM2 amplification which has not been previously identified in pancreatic adenocarcinoma arising in IOPNs. Although recent literature demonstrated that less than 30% of IOPN showed invasive disease and even fewer cases with lymph node metastasis, our case showed extensive invasion with metastases to 2 lymph nodes. This may suggest that MDM2 amplification may play a role in more aggressive disease since it is implicated with poorer outcome in conventional pancreatic adenocarcinoma. Further molecular studies of IOPN may help to identify prognostic features of this entity.