Duodenal Obstruction Research Articles

Clinical presentation, investigation findings, and treatment outcomes of intraluminal small intestinal obstruction by bezoars and other materials in adult cows– a retrospective study of 110 cases

BackgroundSmall intestinal obstruction (SIO) is a blockage of the intestinal lumen by blunt foreign bodies, neoplasms originating from the intestinal wall or thick chyme. This study analysed the medical records (only data) of 110 cattle with SIO and described the clinical findings, treatment and outcome. These findings were compared between surviving and non-surviving cattle, and among the affected regions such as the duodenum, jejunum and ileum.ResultsColic occurred in 42.7% (47/110) of the cattle. Rumen motility was absent in all cattle and intestinal motility was reduced or absent in 82.6% (90/109). Ballottement and/or percussion and simultaneous auscultation were positive on the right side in 63.3% (69/109). Little or no faeces in the rectum occurred in 93.6% (102/109) of the cattle. Dilated loops of small intestines could be palpated transrectally in 46.8% (51/109) and the actual obstruction (palpated as a firm mass in the small intestine) in 5.5% (6/109) of the cattle. The main laboratory changes were hypokalaemia (80.9%, 89/110), hypermagnesaemia (75.3% 58/77), hypocalcaemia (71.8%, 56/78), haemoconcentration (66.4%, 73/110), azotaemia (66.4%, 73/110) and positive base excess (63.3%, 62/98). Abnormal ultrasonographic findings included dilated loops of small intestines (94.3%, 83/88) and subjectively reduced or absent small intestinal motility (85.4%, 70/82). The actual obstruction could be visualised in 3.4% (3/89) of the cattle by ultrasonography. In the 14 non-surviving and the 96 surviving cattle the frequencies of abdominal dilatation (57.1%, 8/14 vs. 22.1%, 21/95) and the presence of blood, mucus and/or fibrin in the rectum (92.9%, 13/14 vs. 63.2%, 60/95) were significantly different. Abomasal reflux syndrome was significantly worse in the cattle with duodenal obstruction (26/110) than in those with jejunal (51/110) or ileal obstruction (33/110). A total of 107 cattle underwent right flank laparotomy, and the obstruction was resolved by massaging the affected area or it was removed via enterotomy. Of the 110 cattle, 14 (12.7%) were euthanized and 96 (87.3%) were discharged 3 to 10 days after surgery.ConclusionsTransrectal and/or ultrasonographic diagnosis is the exception, and in almost all cases laparotomy, was required. The prognosis is good provided that surgical treatment is carried out promptly.

Duodenal Obstruction Caused by an Isolated Spontaneous Celiac Artery Dissection.

Duodenal Obstruction Caused by an Isolated Spontaneous Celiac Artery Dissection.

048. Roux-En-Y Duodenojejunostomy as Surgical Treatment for Congenital Duodenal Obstruction: A Case Report

Background: Congenital duodenal obstruction is an anatomical abnormality in newborn. Various intrinsic and extrinsic etiologies can cause duodenal obstruction. The surgical treatment that commonly performed on duodenal obstruction in neonates is duodenoduodenostomy. However, several etiologies conditions such as preduodenal portal vein (PDPV) and pancreatic annulare cause duodenoduodenostomy is nearly impossible to be performed, so an alternative treatment is necessary. Case: This case describes female neonate with congenital duodenal obstruction which had been suspected since in pregnancy due to polyhydramnios, an OGT was installed with greenish yellow residue after the baby was born. Based on abdominal x-ray examination, a double bubble appearance was seen. The patient then underwent surgery when he was 5 days old. Intraoperatively, there was PDPV and pancreas annulare covering the 3rd-4th part of duodenum, so it was decided to perform Roux-en-y duodenojejunostomy. Conclusion: In patients with congenital duodenal obstruction with special etiology and anatomy such as PDPV and pancreatic annulare, it is possible to perform a roux-en-y duodenojejunostomy. Even though this operation is rarely performed on neonate and more common in adult patients, it can be an alternative in cases of congenital duodenal obstruction.

Primary division of annular pancreas: a surgical technique.

The authors presented a case of duodenal obstruction in a 61-year-old man, resulting from an annular pancreas diagnosed on imaging (computed tomography, magnetic resonance cholangiopancreatography, and endoscopic ultrasound). The patient underwent a diagnostic laparoscopy. Intraoperatively, given a straightforward appearance and anatomy of the annular pancreas overlying the second part of the duodenum, and due to extensive adhesions in the abdomen, a primary division of the annular pancreas was performed, instead of a bypass procedure such as gastrojejunostomy. He had some residual symptoms 1 week postoperatively which was treated with duodenal dilatation endoscopically. On review and follow-up at 1 year, he has remained well with resolution of symptoms, supported by radiological improvement on a computed tomography performed at 4months post-operatively. We believe this approach has resulted in less morbidity and a shorter period of recovery as compared to a bypass procedure and represents a reasonable therapeutic option for annular pancreas.

Factors Associated with Postoperative Complications After Congenital Duodenal Obstruction Surgery: A Retrospective Study.

Background and Objectives: Duodenal atresia and stenosis are common causes of intestinal obstruction. Associated anomalies significantly influence early postoperative mortality, while postoperative complications impact long-term survival. Materials and Methods: Over a 13-year period from January 2010 to August 2023, a total of 74 infants and children with congenital duodenal obstruction were treated at "Grigore Alexandrescu" Children's Emergency Hospital and met the inclusion criteria. All patients diagnosed with duodenal obstruction (both instrinsic and extrinsic causes) were included. Analysed data included congenital anomalies, Apgar scores, birth weights, surgical techniques, and complications. Results: The associated anomalies included cardiac (n = 33), Down syndrome (n = 13), neurological (n = 11), pulmonary (n = 7), renal (n = 4), skeletal (n = 1), and gastrointestinal and hepatobiliopancreatic anomalies (n = 25). In total, 12 patients experienced perioperative ventilation problems. Early postoperative complications (within 30 days) occurred in 21 patients, while 6 had late postoperative complications (after 30 days). Among non-surgical complications, we noted ventilation problems, sepsis (n = 7), and pneumothorax (n = 1). Surgical complications included adhesive bowel obstruction (n = 7), incisional hernia (n = 3), peritonitis (n = 3), dysfunctional duodenoduodenostomy or duodenojejunostomy (n = 3), pneumoperitoneum (n = 5), enteric fistula (n = 3), and volvulus (n = 4). Conclusions: Surprisingly, this retrospective study revealed that an Apgar score below 8, along with neurological and pulmonary abnormalities, is associated with postoperative complications. Conversely, other congenital anomalies, low birth weight, and age at admission do not serve as prognostic factors.

S4795 A Case of Partial Duodenal Obstruction Secondary to Superior Mesenteric Artery Syndrome

S4795 A Case of Partial Duodenal Obstruction Secondary to Superior Mesenteric Artery Syndrome

Chronic duodenal obstruction in isolated malrotation of the duodenum in a 17-year-old girl

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.

A 12-year retrospective analysis of non-operative management for paediatric duodenal hematomas caused by trauma at a single center.

Paediatric traumatic duodenal hematoma is a rare type of blunt abdominal injury for which treatment strategies are controversial. This study aimed to evaluate the application value of nonoperative management of paediatric duodenal hematoma caused by trauma. A retrospective analysis was conducted on patients with duodenal hematoma with a confirmed history of abdominal trauma admitted to our hospital between January 2010 and December 2022. General patient information, including age, sex, cause of injury, clinical manifestations, and treatment outcomes, was recorded. A total of 11 cases were included in this study, with 6 males and 5 females. School-age children (≥6 years) accounted for 72.7% (8/11) of the cases. Bicycle handlebar injuries accounted for 63.6% (7/11) of cases. Among these cases, 5 (45.5%) were classified as American Association for the Surgery of Trauma grade I, while the remaining were classified as grade II. The median history time was 1 day (range: 2 h-12 days). All patients were successfully treated using non-operative methods. The median time to oral feeding after injury was 17 days (range: 9-32 days). Oral feeding was initiated within 2 weeks in 2 patients (18.2%), within 3 weeks in 6 patients (54.5%), and within 4 weeks in 10 patients (90.9%). Paediatric traumatic duodenal hematoma is more common in school-aged children, mainly due to bicycle handlebar injuries. Nonoperative treatment is proven to be safe and effective, with duodenal obstruction symptoms typically resolving within 4 weeks.

Duodenal Bezoar: A Rare Cause of Acute Pancreatitis

Gastrointestinal bezoars often occur as a complication of previous gastric surgery or in patients with altered gastrointestinal motility. Complications associated with gastrointestinal bezoars include perforation, peritonitis, protein-losing enteropathy, and acute appendicitis. Acute pancreatitis secondary to a duodenal bezoar is rare, and few studies have reported this complication. We report a case of acute pancreatitis and subsequent duodenal obstruction caused by a large duodenal phytobezoar.

Multicenter study comparing EUS-guided hepaticogastrostomy and ERCP for malignant biliary obstruction in patients with accessible papillae.

One advantage of endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) is that it is difficult for reflux cholangitis, caused by duodenal pressure increasing due to duodenal obstruction, to occur. In addition, since stent deployment is performed away from the malignant stricture site, longer stent patency than with endoscopic retrograde cholangiopancreatography (ERCP) may be obtained. However, no study has previously compared EUS-HGS and ERCP for patients without duodenal obstruction or surgically altered anatomy. The aim of the present study was to compare clinical outcomes between EUS-HGS and ERCP in normal anatomy patients without duodenal obstruction. In the ERCP group, patients who initially underwent biliary drainage were included. In the EUS-HGS group, patients who underwent EUS-HGS due to failed biliary cannulation were included. Patients with an inaccessible papilla, such as with surgically altered anatomy or duodenal obstruction, were excluded. A total of 314 patients who underwent ERCP and EUS-HGS were enrolled in this study. Of the 314 patients, 289 underwent biliary stenting under ERCP guidance, and 25 patients underwent biliary stenting under EUS-HGS. After propensity score-matching analysis, the adverse event rate tended to be lower in the EUS-HGS group than in the ERCP group. Although overall survival was not significantly different between the EUS-HGS and ERCP groups (p = .228), stent patency was significantly longer in the EUS-HGS group (median 366.0 days) than in the ERCP group (median 76.5 days). EUS-HGS had a lower adverse event rate, shorter procedure time, and longer stent patency than ERCP in cases of normal anatomy without duodenal obstruction.

“Gastrointestinal Quality of Life After Congenital Duodenal Obstruction Repair: A Nationwide Long-term Follow-up Study”

BackgroundCongenital duodenal obstruction (CDO) is one of the most common gastrointestinal congenital anomalies. Still, patient-reported long-term results are limited. The aims of this study were to evaluate the long-term gastrointestinal quality of life (QoL), generic QoL, patient-reported scar appearance, and reinterventions after CDO repair. MethodsPatients who underwent surgery for CDO in Norway from 1995 to 2020 were invited to answer the validated questionnaires PedsQL and PedsQL gastrointestinal symptom scale and a study-specific questionnaire on general health and scar assessment. Parent-proxy reports were used for patients <12 years and patients with cognitive impairment. Scores were compared with an American and Norwegian control group for gastrointestinal and generic QoL, respectively. ResultsOf 186 eligible patients, eight were deceased, 25 had unretrievable contact information, and 79 did not respond. There were no significant differences between included (n = 74) and not included (n = 112) patients regarding baseline data. The mean follow-up time was 13.3 (SD = 6.6) years. Patients with CDO had significantly lower overall gastrointestinal QoL than controls (85.9 versus 90.0, p = 0.010). The most common symptoms were gas/bloating, constipation, food/drink limits, and reflux. Generic QoL was similar between the CDO population and controls (84.4 versus 85.3, p = 0.530). Twenty-one (28 %) patients had some degree of pain and/or concern related to the surgical scar. Nine (12 %) patients had reoperations related to the CDO repair; four due to adhesive small bowel obstruction. ConclusionA notable portion of patients report troublesome gastrointestinal symptoms and cosmetic concerns regarding their surgical scar after CDO repair. Even so, generic QoL was good. Level of evidenceIV.

Recurrence of malignant duodenal obstruction following duodenal stenting: successful management through EUS-guided gastrojejunostomy (with videos)

Recurrence of malignant duodenal obstruction following duodenal stenting: successful management through EUS-guided gastrojejunostomy (with videos)

Prenatal diagnosis of 17q12 copy number variants in fetuses via chromosomal microarray analysis - A retrospective cohort study and literature review

Purpose17q12 copy number variants (CNVs) have variable presentations and incomplete penetrance, challenging prenatal counseling and management. This study aims to investigate the intrauterine phenotype. MethodsWe included 48 fetuses diagnosed with 17q12 microdeletion or microduplication by chromosomal microarray analysis. ResultsFor 17q12 deletion, renal anomalies were found in 35 fetuses (35/37, 94.6 %), with hyperechogenic kidneys (HEK, 28/37, 75.7 %) and multicystic dysplastic kidneys (17/37, 45.9 %) being the most common findings. Duodenal obstruction (DO) was most frequently combined in 17q12 duplication fetuses. In addition, cardiac abnormalities were the first reported prenatal phenotype in 17q12 duplication fetuses. ConclusionOur study shows that HEK and DO are the most predominant presentations of 17q12 deletion and duplication, respectively, and cardiac structural abnormalities may be associated with the latter. Although 17q12 CNVs have incomplete penetrance and variable expressivity and may be mainly involved in neurodevelopmental disorders, their short-term prognosis appears positive.

CONSIDERATION OF MORPHOLOGICAL-FUNCTIONAL CHANGES IN THE COMPONENTS OF CALOT’S TRIANGLE IN ACUTE CHOLECYSTITIS AND THEIR INFLUENCE ON THE SPECIFIC LAPAROSCOPIC CHOLECYSTECTOMY TECHNIQUE IN PATIENTS WITH ACUTE CHOLECYSTITIS

From 2018 to 2023, a study was conducted on 89 (100%) patients operated on for acute cholecystitis in the surgical department of the Storozhynets Multidisciplinary Hospital for Intensive Care.The goal is to study the clinical features of acute cholecystitis based on the results of surgical treatment in the general surgery department of a multidisciplinary district hospital for intensive care.Materials and methods. From 2018 to 2023, 89 patients who underwent surgery for acute cholecystitis were studied in the surgical department of the Storozhynets Multidisciplinary Hospital for Intensive Care. Clinical, laboratory, instrumental examinations, and surgical treatment were performed on 89 patients of various age groups (from 18 to 74 years) with manifestations of acute cholecystitis. The patients were divided into two groups. The diagnosis was confirmed clinically, laboratory, by instrumental methods, intraoperative examination, and histological study of the removed specimens. The state of changes in peripheral blood was assessed: the number of erythrocytes, hemoglobin content, number of leukocytes, leukocyte formula, erythrocyte sedimentation rate, and leukocyte intoxication index according to the Kalf-Kalif formula. Statistical processing of the material was performed using the t-test with the determination of the probability corresponding to the Student's t-criterion. When performing statistical processing, the arithmetic mean (M) and the reliability of differences in study results (p) relative to the indicators of different groups were calculated. The results were considered reliable when the confidence coefficient was less than or equal to 0.05.Results. The results of our laparoscopic cholecystectomies for grade I and II (moderate) severity of acute cholecystitis (according to the International Classification) showed a quantitative advantage in prioritizing the laparoscopic method of surgical intervention. However, in the presence of a purulent-inflammatory process in the hepatobiliary zone, priority is given to performing cholecystectomy by the "open method," involving highly experienced surgeons in the surgical team. This option of cholecystectomy is advisable mainly for severe acute cholecystitis (stage III of the pathological process) with a purulent-necrotic process in the hepatobiliary zone detected at the preoperative stage and in the case of peritonitis. Contraindications for laparoscopic cholecystectomy include chronic duodenal obstruction, gangrenous-perforative cholecystitis, and diffuse peritonitis. Considering the features of surgical tactics for treating acute cholecystitis confirms the need for its differentiated determination based on already developed tactical and therapeutic recommendations, the effectiveness of which is evidenced by the accumulated experience of the international school of surgeons and confirmed by our clinical results.Conclusions. 1. Laparoscopic cholecystectomy is currently performed for both chronic and acute cholecystitis. 2. The most optimal time for performing "laparoscopic cholecystectomy" is the first two days from the onset of the inflammatory process in the gallbladder. 3. Performing laparoscopic cholecystectomy considering anatomical landmarks according to the recommendations for "safe cholecystectomy" by Steven Strasberg (1992, 1995 - SVS) and Gary G. Wind (1999) is an effective component of successful laparoscopic cholecystectomy for chronic cholecystitis and in the early stages of acute inflammatory processes in the gallbladder. 4. For acute destructive cholecystitis, the "elephant trunk" technique is practically preferred.

Laparoscopic Versus Open Ladd Procedure for Midgut Malrotation

IntroductionIntestinal malrotation is an uncommon developmental anomaly that can lead to duodenal obstruction and midgut volvulus. The standard correctional operation, Ladd's operation, is traditionally performed using an open approach, but providers are increasingly performing the procedure laparoscopically. However, there remains concern that the reduced adhesive burden associated with laparoscopy could predispose to recurrent volvulus. MethodsWe queried our institutional database from 2012 to 2022 for patients <18 years who underwent Ladd's operation for malrotation. We analyzed baseline characteristics and outcomes including post-operative volvulus, adhesive small bowel obstruction (SBO), duodenal obstruction, and overall abdominal re-operation. ResultsWe identified 226 patients, of whom 90 (40%) underwent a laparoscopic operation. Those undergoing open surgery were younger and had a higher rate of volvulus compared to laparoscopic patients. There were no differences in surgical history or underlying comorbidities. Laparoscopic patients were less likely to develop a post-operative adhesive SBO [1/90 (1%) vs 14/136 (10.0%); OR 9.4 (1.7–176.4), p = 0.036] with no increased rate of volvulus [1/90 (1%) vs 1/136 (0.7%), p = 0.778]. However, there were four laparoscopic patients that required re-operation for a duodenal stricture or kink, which led the overall rate of abdominal re-operation to not be different [7/90 (8%) vs 16/136 (12%); OR 1.6 (0.6–4.8), p = 0.371]. Median follow up was 2.3 years [IQR 1.0–5.0]. ConclusionLaparoscopic correction of midgut malrotation demonstrates no increased risk of post-operative volvulus and may reduce the rate of adhesive SBO. These benefits must be weighed against the potential increased risk of duodenal stricture or obstruction secondary to an incomplete Ladd's procedure. Level of EvidenceIII.

Duodenal ileus caused by a cage magnet in a Fleckvieh cow.

The present report aims to describe the case of a duodenal obstruction ileus in a dairy cow that was caused by a cage magnet. The 4.7-year-old German Fleckvieh cow was hospitalized because of symptoms of intestinal obstruction such as anorexia, noticeable drop in milk yield, reduced defecation, dehydration and positive percussion and swinging auscultation in a circumscribed area cranial of the right flank over the last 2 ribs. Six months as well as 3 days prior to hospitalization the cow had already been treated for signs of hardware disease, which included administration of a cage magnet.After the initial clinical diagnostic procedure on hospital admission, a diagnostic laparotomy in the right paralumbar fossa was performed to identify the cause of the ileus. The cranial part of the duodenum was markedly dilated, and a solid foreign body was found obstructing the intestine immediately aboral to the duodenal sigmoid flexure. This was identified as a cage magnet, which was massaged in retrograde direction into the pyloric antrum and removed via abomasotomy. The cow recovered from surgical intervention and was discharged from the hospital 6 days later.The present report describes an unusual complication of cage magnet administration, which is a standard veterinary procedure and generally considered a safe treatment option in cows with clinical signs of acute traumatic reticuloperitonitis.

Diagnostics and surgical management children with superior mesenteric artery syndrome

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.

Rare Case of Annular Pancreas

One of the rare disorders noted during birth is Annular pancreas. In this disorder a slender band of pancreatic tissue engulfs the duodenum. This congenital anomaly in children produces symptoms like duodenal obstruction but mostly they produce symptoms in later stages of life. This is one of the rare clinical diagnosis. But once diagnosed immediate treatment can reduce the morbidity risk.

Successful Management of Upper Gastrointestinal Obstruction With Primary Advanced Ovarian Cancer.

Upper gastrointestinal obstruction is an extremely rare complication of primary ovarian cancer. We present a case of primary advanced ovarian cancer with gastroduodenal obstruction successfully managed with neoadjuvant chemotherapy (NAC) and conservative treatment. A 60-year-old woman was referred to our hospital for advanced ovarian cancer with upper gastrointestinal obstruction. Computed tomography and endoscopy revealed severe duodenal obstruction caused by dissemination. NAC was initiated with conservative management using a nasogastric tube and total parenteral nutrition (TPN). She was able to eat and TPN was stopped after three months. Complete resection was achieved with interval debulking surgery (IDS) not involving pancreatoduodenectomy, which would have been necessary for primary debulking surgery. There were no serious postoperative complications. NAC with conservative management can improve upper gastrointestinal obstruction in patients with primary advanced ovarian cancer. Furthermore, IDS is expected to allow complete resection, avoiding highly invasive surgeries.

Saline-Aided Ultrasound as a Primary Investigation Tool in Diagnosis of Duodenal Obstruction in Preterm Infants

Saline-Aided Ultrasound as a Primary Investigation Tool in Diagnosis of Duodenal Obstruction in Preterm Infants