Duodenal Obstruction Research Articles

Prenatal detection of chromosomal abnormalities and copy number variants in fetuses with congenital gastrointestinal obstruction

BackgroundCongenital gastrointestinal obstruction (CGIO) mainly refers to the stenosis or atresia of any part from the esophagus to the anus and is one of the most common surgical causes in the neonatal period. The concept of genetic factors as an etiology of CGIO has been accepted, but investigations about CGIO have mainly focused on aneuploidy, and the focus has been on duodenal obstruction. The objective of this study was to evaluate the risk of chromosome aberrations (including numeric and structural aberrations) in different types of CGIO. A second objective was to assess the risk of abnormal CNVs detected by copy number variation sequencing (CNV-seq) in fetuses with different types of CGIO.MethodsData from pregnancies referred for invasive testing and CNV-seq due to sonographic diagnosis of fetal CGIO from 2015 to 2020 were obtained retrospectively from the computerized database. The rates of chromosome aberrations and abnormal CNV-seq findings for isolated CGIOs and complicated CGIOs and different types of CGIOs were calculated.ResultsOf the 240 fetuses with CGIO that underwent karyotyping, the detection rate of karyotype abnormalities in complicated CGIO was significantly higher than that of the isolated group (33.8% vs. 10.8%, p < 0.01). Ninety-three cases with normal karyotypes further underwent CNV-seq, and CNV-seq revealed an incremental diagnostic value of 9.7% over conventional karyotyping. In addition, the incremental diagnostic yield of CNV-seq analysis in complicated CGIOs (20%) was higher than that in isolated CGIOs (4.8%), and the highest prevalence of pathogenic CNVs/likely pathogenic CNVs was found in the duodenal stenosis/atresia group (17.5%), followed by the anorectal malformation group (15.4%). The 13q deletion, 10q26 deletion, 4q24 deletion, and 2p24 might be additional genetic etiologies of duodenal stenosis/atresia.ConclusionsThe risk of pathogenic chromosomal abnormalities and CNVs increased in the complicated CGIO group compared to that in the isolated CGIO group, especially when fetuses presented duodenal obstruction (DO) and anorectal malformation. CNV-seq was recommended to detect submicroscopic chromosomal aberrations for DO and anorectal malformation when the karyotype was normal. The relationship between genotypes and phenotypes needs to be explored in the future to facilitate prenatal diagnosis of fetal CGIO and yield new clues into their etiologies.

Laparoscopic Hand-Sewn Duodenojejunostomy for Superior Mesenteric Artery Syndrome Using 3D-4K Image - A Case Study

Background: Superior mesenteric artery (SMA) syndrome, also known as wilkie’s syndrome, is a rare condition characterized by vascular compression of third part of the duodenum that leads to duodenal obstruction. Traditionally, open or laparoscopic stapled duodenojejunostomy is recommended when conservative management failed. We report a 3D-4K image hand-sewn duodenojejunostomy (DJ) for the treatment of SMA syndrome. Materials and Methods: A 13 years old patient presented with anorexia, post prandial vomiting, dull abdominal pain &amp; weight loss for 6 years. Upper GI endoscopy revealed duodenal stenosis and Barium follow through demonstrated obstruction to the third part of the duodenum. Ultrasound examination revealed gastric &amp; duodenal dilatation. With these clinical and radiological findings, the diagnosis of SMA syndrome was suspected. He was identified as a candidate for a duodenojejunostomy. 3D-4K image system was used for superior image quality and binocular depth perception and a laparoscopic hand-sewn duodenojejunostomy performed on september 20, 2020 Results: Diagnostic laparoscopy detected SMA syndrome. Laparoscopic hand-sewn duodenojejunostomy took 120 minutes time. There were no intraoperative complications. The blood loss was minimum. The postoperative course was uneventful with resolution of duodenal obstruction. The patient discharged on 6th postoperative day. He gained 10 kg weight 6weeks after surgery. Conclusion: 3D-4K image laparoscopic hand-sewn duodenojejunostomy as a surgical option for the treatment of SMA syndrome is safe, cost effective, feasible, and valid alternative to open and laparoscopic stapled technique with added benefits of a minimally invasive approach. Additionally hand-sewn anastomosis ensures good tissue approximation. Of course it is time consuming and needs expertise in intracorporeal suturing. 3D-4K image technology makes this difficult procedure easier. J Bangladesh Coll Phys Surg 2022; 40: 68-71

Role of Palliative Duodenojejunostomy in Advanced Pancreatic CarcinomaA Case Series

Pancreatic cancer is a common gastrointestinal malignancies associated with poor prognosis. Most of the patients present only in late stage with metastasis or locally advanced disease during the time of diagnosis, requiring palliative surgery. At the time of diagnosis, patients usually have a few months of survival. The surgical palliation for such patients is a less explored area; so, here authors present a series of three patients, who presented with symptoms suggestive of Gastric Outlet Obstruction (GOO) or duodenal obstruction. On further work-up, they found to have pancreatic growth infiltrating the duodenum or Duodenojejunal Flexure (DJF). All three patients underwent palliative duodenojejunal bypass with relief of symptoms and improvement in quality of life in postoperative period. Hence, duodenojejunal bypass is an effective surgical procedure for palliation of obstructive symptom for advanced pancreatic cancer involving duodenum to improve the quality of life of the patient.

Imaging Findings of an Intraluminal Duodenal Diverticulum Associated with Adult Duodeno-Duodenal Intussusception and Recurrent Pancreatitis: A Case Report

Intraluminal duodenal diverticulum (IDD) is a rare congenital abnormality, consisting of a sac-like mucosal lesion in the duodenum. Cases of IDD can present with gastrointestinal bleeding, duodenal obstruction, or pancreatitis. Here, we report a rare case of a 25-year-old female presenting with IDD complicated by duodeno-duodenal intussusception and recurrent pancreatitis. The diagnosis was based on findings from radiologic examinations (CT and MRI), upper gastrointestinal series (barium swallow), and gastroduodenofiberscopy. Laparoscopic excision of the presumed duodenal duplication was performed. The subsequent histopathologic evaluation of the excised sac revealed normal mucosa on both sides, but the absence of a proper muscle layer confirmed the diagnosis of IDD. Radiologic detection of a saccular structure in the second portion of the duodenum can indicate IDD with duodeno-duodenal intussusception as the lead point.

Estenose hipertrófica de piloro em recém-nascido prematuro com manifestação atípica: relato de caso e breve revisão

Hypertrofic pyloric stenosis is one of the main causes of non-biliary vomiting in newborn and is typically found between 3 and 4 weeks old babies. It is rarely found in early neonatal period, especially in prematures. The case here reported is a male, premature born with 34 gestational weeks, with 3,180 grams of weight admitted to the neonatal ICU due to respiratory discomfort and prematurity. With 3 days old presented non-biliary vomiting, abdominal distention and difficulty to feed. Radiography demonstrated hyperdistended stomach. Remained symptomatic for the next 48 hours and a contrast study demonstrated slow gastric emptying and pyloric and duodenal narrowing. As the findings suggested duodenal obstruction exploratory laparotomy was indicated. During surgery hypertrofic pyloric stenosis was found with no signs of malrotation or duodenal obstruction. Pyloromiotomy was performed and 12 hours after surgery oral feeding was restarted. Patient presented good outcome, is now with 9 months old, good development and adequate weight gain. As demonstrated, even though it is an unusual cause, hypertrofic pyloric stenosis must be considered as an important differential diagnosis when facing a digestive obstruction in newborn.

Endoscopic Double Stenting for Palliative Management of Duodenal Perforation Secondary to Advanced Pancreatic Cancer

Introduction: Duodenal perforation secondary to advanced pancreatic cancer entails a challenging management. Endoscopic stenting can be used to treat duodenal obstruction; however, there are no previous reports on its use to treat malignant duodenal perforation.

Eosinophilic gastroenteritis: A case series of a rare disease from an apex Tertiary Care Center in South India.

Eosinophilic gastroenteritis (EGE) is a rare disease with a myriad of presentations. In this case series of four patients from South India, we describe three classical manifestations of the disease (mucosal, muscular, and serosal). Two of them had obstructive jaundice as a presenting complaint due to duodenal obstruction, whereas one had massive upper gastrointestinal bleed. There are very few case series regarding this disease from India. Its presentation as hemetemesis and obstructive jaundice is also very rare,with only few such case reports reported till now.

Intraluminal duodenal “windsock” diverticulum

Intraluminal duodenal diverticulum (IDD) is a rare developmental anomaly usually found in the second portion of the duodenum. The cause appears to be a failure of recanalization of the occluded foregut lumen of the human embryo, resulting in a fenestrated mucosal membrane [1]. A small aperture in this diaphragm will gradually cause it to elongate caudally in response to duodenal peristalsis to form the so called “wind-sock” configuration. Symptoms are nonspecific and generally depend on the degree of duodenal obstruction; 25% of cases are associated with GI bleeding. In most documented cases, IDD was diagnosed radiologically, but the value of endoscopy for diagnosis and treatment has been amply demonstrated

Intraluminal duodenal “windsock” diverticulum; Case Report and discussion

Intraluminal duodenal diverticulum (IDD) is a rare developmental anomaly usually found in the second portion of the duodenum. The cause appears to be a failure of recanalization of the occluded foregut lumen of the human embryo, resulting in a fenestrated mucosal membrane [1]. A small aperture in this diaphragm will gradually cause it to elongate caudally in response to duodenal peristalsis to form the so called “wind-sock” configuration. Symptoms are nonspecific and generally depend on the degree of duodenal obstruction; 25% of cases are associated with GI bleeding. In most documented cases, IDD was diagnosed radiologically, but the value of endoscopy for diagnosis and treatment has been amply demonstrated.

Depressive syndrome in gastroenterology

Depression has recently expanded beyond psychiatry to become a general medical problem. Psycho-emotional stress is the main factor that provokes anxiety-depressive disorders. There is a two-way connection between the psyche and the somatics: mental disorders affect somatic functions, and somatic diseases, in turn, affect the state of the psyche.&#x0D; In this article, the author pays attention to the most common gastroenterological diseases associated with mental disorders. They include: peptic ulcer, functional (gastroduodenal) dyspepsia syndrome, irritable bowel syndrome, functional forms of chronic duodenal obstruction syndrome, chronic cholecystitis and associated extrahepatic biliary dyskinesia.&#x0D; As for the digestive system, psychosomatic disorders are manifested by nausea and vomiting, belching, flatulence, abdominal pain, rumbling and splashing in the intestines, constipation or diarrhea, dry mouth. Anxiety-depressive syndrome in patients is characterized by dyssomnia, chronic anxiety, bodily discomfort, hypothymia, synestopathy, somatoform disorders, frustration, alexithymia, etc.&#x0D; The main criteria and diagnostic tools for depression are described (international classifications, self-assessment scales, diagnostic tests).&#x0D; In addition to the basic individualized therapy for somatic diseases, patients usually need additional prescription of psychotropic drugs and psychological support. The main technique of treatment is psychotherapy (less often — hypnotherapy). Only upon the ineffectiveness of psychotherapy, doctors should resort to the appointment of psychotropic drugs of four different groups: anxiolytics, antidepressants, “small” antipsychotics, nootropics.

Delayed small-bowel perforation after EUS-guided gastroenterostomy

A 69-year-old man with a history of severe chronic pancreatitis presented with weight loss, vomiting, and abdominal pain. CT demonstrated gastric distention from duodenal obstruction consistent with gastric outlet obstruction (A). The patient was not a surgical candidate because of significant adhesive disease from prior necrotizing pancreatitis episodes and malnutrition; therefore, EUS-guided gastroenterostomy (EUS-GE) was successfully performed with a 15-mm diameter lumen-apposing metal stent (LAMS) (B). At a clinic visit 3 months later, the patient was tolerating a regular diet with weight gain and pain resolution. Two weeks after his clinic visit, he presented with acute-onset excruciating abdominal pain, and CT showed pneumoperitoneum with fluid and small-bowel thickening near the LAMS (C). During exploratory laparotomy, small-bowel perforation was identified on the wall opposite the LAMS (D). Owing to difficulties in bowel mobilization from severe adhesive disease that precluded visualization of the stomach and friable small-bowel tissue, the defect was repaired and the LAMS was left in place. The patient did well postoperatively. We speculate that adhesions created a fixed segment of small bowel prone to ulceration from pressure and gastric acid exposure. We believe this is the first described case of delayed perforation on the contralateral small-bowel wall from a properly positioned LAMS placed during EUS-GE. Reporting of adverse events encountered with EUS-GE is essential to optimize future outcomes.

Endoscopic ultrasound-guided biliary drainage-current status and future perspectives.

Endoscopic retrograde cholangiopancreatography (ERCP) with stenting is the treatment modality of choice for patients with benign and malignant bile duct obstruction. ERCP could fail in cases of duodenal obstruction, duodenal diverticulum, ampullary neoplastic infiltration or surgically altered anatomy. In these cases percutaneous biliary drainage (PTBD) is traditionally used as a rescue procedure but is related to high morbidity and mortality and lower quality of life. Endoscopic ultrasound-guided biliary drainage (EUS-BD) is a relatively new interventional procedure that arose due to the development of curvilinear echoendoscope and the various endoscopic devices. A large amount of data is already collected that proves its efficacy, safety and ability to replace PTBD in cases of ERCP failure. It is also possible that EUS-BD could be chosen as a first-line treatment option in some clinical scenarios in the near future. Several EUS-BD techniques are developed EUS-guided transmural stenting, antegrade stenting and rendezvous technique and can be personalized depending on the individual anatomy. EUS-BD is normally performed in the same session from the same endoscopist in case of ERCP failure. The lack of training, absence of enough dedicated devices and lack of standardization still makes EUS-BD a difficult and not very popular procedure, which is related to life-threatening adverse events. Developing training models, dedicated devices and guidelines hopefully will make EUS-BD easier, safer and well accepted in the future. This paper focuses on the technical aspects of the different EUS-BD procedures, available literature data, advantages, negative aspects and the future perspectives of these modalities.

Role of Transanastomotic Feeding Tube versus Early Gastric Feeding in Postoperative Duodenal Surgery

Background: Postoperative enteral feeding in congenital duodenal obstruction is usually delayed due to dilated atonic duodenum. The trans-anastomotic tube feeding (TAT) has been proposed to be more effective than early gastric feeding in the role of supporting &ldquo;Enhanced recovery after surgery concept&rdquo;. Objective: Comparing time to feeding among patients using TAT, early gastric feeding, and traditional delayed gastric feeding. Materials and Methods: Comparing postoperative enteric feeding via TAT (group A: n=7) and gastric feeding (group B: n=6) &mdash; prospective data collected from 2015 to 2020 &mdash; to traditional gastric feeding (group C: n=17) that is retrospective data from 2008 to 2015, in neonates with congenital duodenal obstruction. Results: TAT and early gastric (OG) feedings had provided earlier enteral feeding compared to traditional practice (p&lt;0.001). The early gastric feeding was faster full fed than TAT on the earlier postoperative date with median (IQR) = 11 (10, 11) and 16 (13, 23) respectively. However, all 3 groups had the same timing of gastric full feeding (median (IQR): A=8 (5, 11); B=7 (4, 7); C=9 (5, 10)), p=0.772. Even not significant, the early gastric feeding group provided the shorter time of hospital stay and TPN administration. Conclusion: The early OG feeding is feasible for early postoperative feeding comparable to TAT feeding and applicable in cases beware of TAT-related complications. Postoperative gastric function recovery is not related to the pre- or post-anastomotic feeding. Keywords: Duodenal atresia; Duodenal stenosis; Neonatal duodenal obstruction; Trans-anastomotic feeding tube; Enteral feeding; ERAS

Is postoperative transanastomotic feeding beneficial in neonates with congenital duodenal obstruction?

PurposeWe aimed to evaluate possible positive and negative effects of postoperative use of transanastomotic feeding tube (TAFT) in neonates operated for congenital duodenal obstruction (CDO).MethodsThis is a retrospective study reviewing medical records of neonates operated for CDO during 2003–2020 and comparing postoperative feeding outcomes and complications in patients with and without TAFT. Approval from the hospital’s data protection officer was obtained.ResultsOne hundred patients, 59% girls, were included, and 37% received TAFT. Mean birth weight and gestational age were 2628 (675.1) grams and 36.6 (2.4) weeks, respectively. Furthermore, 45% had no other malformations, and 36% had Down syndrome. Patient demographics were similar for TAFT and not-TAFT patients, except that not-TAFT neonates weighed median 335 g less (p = 0.013). The TAFT group got parenteral nutrition 2 days shorter (p < 0.001) and started enteral feeds 1.5 days earlier (p < 0.001) than the not-TAFT group. Fewer neonates with TAFT got a central venous catheter [65 vs 89%, (p = 0.008)]. In the TAFT group, 67% were breast fed at discharge compared to 49% in the not-TAFT group (p = 0.096).ConclusionNeonates with TAFT had earlier first enteral feed, fewer days with parenteral nutrition and fewer placements of central venous catheters.

“Triple duodenal obstruction” complicated with intestinal malrotation and several cardiovascular malformations

Triple duodenal obstruction is an extremely rare disorder—apparently only two cases were reported in the English literature. We present a third case complicated with some cardiovascular anomalies (interrupted inferior vena cava, left-sided inferior vena cava, preduodenal portal vein, and ventricular septal defect) and intestinal malrotation. Operative procedure to reconstruct continuity of the duodenal lumen was a combination of longitudinal incision, partial web resection, and transverse closure at the first obstruction site together with diamond-shaped duodeno-duodenostomy between the oral side of the second obstruction and the anal side of the third obstruction.

Postoperative superior mesenteric artery syndrome following appendicectomy: A case report.

IntroductionSuperior mesenteric artery syndrome is a rare cause of proximal intestinal obstruction. It is caused by a narrow aortomesenteric angle resulting in external compression of the duodenum as it traverses between the abdominal aorta and the superior mesenteric artery. Presenting symptoms tend to be non-specific and aetiological risk factors for this syndrome remain subjects to debate. The lack of awareness for this phenomenon often results in a delayed diagnosis, yet it can predispose to potentially life-threatening complications.Case presentationWe describe an acquired case of SMA syndrome, in an 88-year old male who underwent an open appendicectomy 20 years prior. The patient presented with an 18-month history of progressive anorexia, weight loss, and intractable vomiting. After inconclusive initial investigations, an exploratory laparotomy demonstrated extensive postoperative adhesions, placing traction on the SMA through its ileocolic branch, resulting in acute angulation of the SMA and subsequent external duodenal compression.DiscussionThis case illustrates the acute evolving presentation of gastric and duodenal obstruction associated with SMA syndrome, and the need to raise the index of suspicion for its diagnosis. In this case, it is postulated that SMA syndrome presented as a late complication of an open appendicectomy - A rare presentation for a rare disease.ConclusionSMA syndrome is an uncommon, but important differential for upper gastrointestinal obstruction. This case illustrates the challenges in the diagnosis of this rare clinical entity. Further study is warranted to understand the varied aetiology and optimal management for patients presenting with SMA syndrome.

Hilaiditi syndrome as a cause of chronic duodenal obstruction in children operated on for omphalocele

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.

A CASE REPORT : A CASE OF SUPERIOR MESENTERIC ARTERY SYNDROME

Superior mesenteric artery (SMA) syndrome is an uncommon but well recognized clinical entity characterized by compression of the third, or transverse, portion of the duodenum between the aorta and the superior mesenteric artery. This results in chronic, intermittent, or acute complete or partial duodenal obstruction. Superior mesenteric artery syndrome was rst described in 1861 by Von Rokitansky, who proposed that its cause was obstruction of the third part of the duodenum as a result of arterio-mesenteric compression. Some studies report the incidence of superior mesenteric artery syndrome to be 0.1- 0.3%.

Subtotal Gastrectomy vs Gastroenterostomy in Duodenal Obstruction Secondary to Peptic Ulcer Disease: Results of a Retrospective Nationwide Study

Quiroga, Andrea C. MD; Serrano-Pastrana, Juan P. MD; Quintero, Orlando Navas MD; Gómez Ochoa, Sergio A. MD Author Information

Single session endoscopic ultrasound-guided double bypass (hepaticogastrostomy and gastrojejunostomy) for concomitant duodenal and biliary obstruction: A case series.

Concomitant malignant biliary and gastric outlet obstruction can be difficult to manage endoscopically with traditional endoscopic retrograde cholangiopancreatography (ERCP) and luminal stenting. Endoscopic ultrasound (EUS)-guided hepaticogastrostomy (HG) and gastrojejunostomy (GJ) are novel techniques that can relieve both obstructions in a single session. This study aims to describe the outcomes of combined, single session EUS-HG and EUS-GJ. This is a two-center retrospective study of consecutive patients who underwent same session EUS-HG and EUS-GJ. The primary outcome was technical success. Secondary outcomes included adverse events (AE), reduction in total serum bilirubin, length of hospital stay (LOS), and re-intervention rates. A total of 23 patients underwent EUS-HG and EUS-GJ (12 males, mean age 66.4years). Twenty-one were performed for malignant obstruction. Technical success was 100% and 95.6% for HG and GJ, respectively. All patients subsequently tolerated a soft diet and 72.7% (16/22) of patients had a 50% reduction in bilirubin post-procedure. The median LOS for the 17 patients who were not discharged home immediately following the procedure was 2 (range 1-20) days. There were five AEs (2 mild, 3 moderate). Only three patients required reintervention (interventional radiology-guided biliary drainage, stent exchange for a benign biliary stricture, and placement of a second stent through an occluded distal common bile duct stent) over a median follow-up of 78days. One patient with pancreatic cancer underwent successful tumor resection. Single session EUS-guided double bypass (HG and GJ) is technically feasible and safe when conducted by experienced endosonographers. Larger, comparative studies are needed.