Duodenal Wall Research Articles

Duodenal Adenocarcinoma Arising from Brunner’s Glands, A Rare Case Report

Abstract Introduction/Objective Malignancies arising from the Brunner’s glands in duodenum are exceedingly rare with very few cases reported in the literature. Here, we reported a case of duodenal adenocarcinoma of Brunner’s gland origin that obstructed duodenum and extended to involve the pancreatic head. Methods/Case Report A 48-year-old woman came to the Emergency Department of our hospital with epigastric and right upper quadrant abdominal pain. CT imaging demonstrated a heterogeneously enhancing 8.4 x 5.4 x 6 cm mass involving the duodenal lumen, wall, and pancreatic head. An endoscopic ultrasound showed a large fungating, infiltrative, and ulcerative mass in the second portion of the duodenum distal to the ampulla but not involving it. The pancreatic and common bile ducts were uninvolved. Her endoscopic ultrasound biopsy was positive for adenocarcinoma. CA19-9 levels were normal. The patient received chemotherapy with subsequent Whipple procedure. Gross examination revealed an exophytic, tan-white mass with the epicenter in the duodenal wall obstructing the duodenal lumen and extending to involve the pancreatic head inferiorly. The mass was predominantly solid with a few small mucus cysts. Light microscopy demonstrated moderately differentiated adenocarcinoma with prominent necrosis and inflammation. There are intestinal-type, gastric-type and indeterminate types of epithelia in the carcinoma. There are areas in the duodenal wall where a continuous transition from benign Brunner’s glands to dysplastic glands and then to adenocarcinoma is present. Neither adenoma in the overlying duodenal mucosa nor abnormalities in the pancreatic parenchyma is observed. Immunohistochemical stains showed that the neoplastic cells are positive for CAM 5.2, AE1/AE3, and CK7, while only patchy positivity with CK20 and CDX2. Taken together, a diagnosis of duodenal adenocarcinoma arising from Brunner’s glands was rendered. Results (if a Case Study enter NA) N/A Conclusion More cases are needed in order to establish standard treatment guidelines and determine prognostic factors.

Efficacy and safety of apraglutide in short bowel syndrome with intestinal failure and colon–in–continuity: A multicenter, open-label, metabolic balance study

BackgroundApraglutide is a novel long-acting GLP-2 analog in development for short bowel syndrome with intestinal failure (SBS-IF). This multicenter, open-label, phase 2 study in SBS-IF and colon-in-continuity (CiC) investigates the safety and efficacy of apraglutide. MethodsThis was a 52-week phase 2 metabolic balance study (MBS) in 9 adult patients with SBS-IF-CiC receiving once-weekly subcutaneous apraglutide injections. Safety was the primary endpoint. Secondary endpoints included changes in absorption parameters (MBS at baseline, after 4 weeks with stable parenteral support (PS), and 48 weeks), PS needs (48-week PS adjustment period based on monthly 48-hour fluid balances) and intestinal morphology and motility (static and cine MRI at baseline and 4, 24 and 48 weeks). ResultsPS volume decreased by -4702mL/week (-52%; p<0.001) at week 52. Seven patients (78%) achieved ≥1 day off PS at week 52. At 4 weeks, fecal output was reduced by 253 g/day (p=0.013). At 48 weeks, increases in wet weight absorption by 316 g/day (p=0.039), energy absorption by 1134 kJ/day (p=0.041) and carbohydrate absorption by 56.1 g/day (p= 0.024) were observed. Moreover, small bowel length increased from 29.7 to 40.7 cm (p=0.012), duodenal wall thickness increased by 0.8 mm (p=0.02) and motility in the proximal colon was reduced (p=0.031). A total of 127 adverse events was reported, which were mostly mild to moderate. ConclusionApraglutide had an acceptable safety profile and was associated with significant reductions in PS needs and days off PS, improvements in intestinal absorption, and structural and functional intestinal changes in patients with SBS-IF-CiC.ClinicalTrials.gov, Number NCT04964986

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.

Peri-Ampullary Tumour; An Unusual Cause of Upper Gastrointestinal Bleeding

Periampullary tumors are cancers that arise in the region of the around the ampulla of Vater, where the bile duct and pancreatic duct converge and empty into the small intestine. This region is very critical for digestive enzyme and bile secretions. This may be associated with slow disease progression, age related changes delayed onset of symptoms and lack of screening and diagnostic facilities. These tumours can be challenging to diagnose and manage due to their proximity to several vital structures. Upper gastrointestinal bleeding may be a rare clinical presentation following tumoral ulceration, erosion into blood vessels or nearby structures or secondary complications like pancreatitis or portal hypertension. Identifying the anatomical origin of these malignancies is usually a herculean task. This will require prompt oesophagogastroduodenoscopy and imaging to determine the source and appropriate management. This is especially true given the region's transitional character, closeness to various structures, and overlapping features among them. We present periampullary tumour an unusual cause of upper gastrointestinal bleeding in a resource limited setting. A52 year old Nigerian male was admitted at the Usmanu Danfodiyo University Teaching Hospital, Sokoto for evaluation following a 3 months history of progressive weight loss, generalized body weakness and a burning and occasionally colicky, persistent, non-radiating epigastric pain, loss of appetite, easy fatiguability, occasional dizziness and recurrent non-projectile post-prandial non-billous vomiting. Though he had no hematemesis, he had history of passage of malaena. The patient was fully conscious on admission, pale, wasted with a markedly tender epigstric region. He was tachycardic with a minimal elevation in blood pressure level of 138/94mmHg. He had an international normalized ratio (INR) of 1.0. Oesophagogastroduodenoscopy was performed which showed a polypoid fungating mass at the1st extending to the 2nd part of the duodenum. A Computerized Tomogram scan of the abdomen showed a diffuse circumferential duodenal wall thickening of 1st and 2nd parts (more in 2nd part) with reduction in luminal calibre of duodenum and mildly dilated pancreatic, common bile, common hepatic ducts. Multiple biopsies were taken for histology which showed moderately differentiated aadenocarcinoma. Surface epithelium composed of columnar epithelial cells which can be seen in the top right of the image below with an invasive tumour, seen infiltrating the lamina propria in the lower left. He went on to have an exploratory laparotomy with triple bypass involving a side to side gastrojejunal anastomosis and cholecystojejunostomy and entero-enterotomy folowing which he went on to receive chemotherapy. As of the time of this write up the patient has recuperated well following his treatment.

Groove pancreatitis – an unusual case of pancreatitis, case report

Groove pancreatitis is a rare form of chronic pancreatitis affecting the pancreaticoduodenal groove, leading to ductal stenosis and symptoms like abdominal pain, vomiting, and jaundice. It often coexists with cystic dystrophy of the duodenal wall (CDDW), marked by duodenal wall thickening and cyst formation. We report a case of a 36-year-old male with persistent abdominal pain and a history of acute pancreatitis, diagnosed with CDDW via MRI. Despite multiple endoscopic interventions, ductal access was challenging due to inflammation and conservative management with proton pump inhibitors and pancreatic enzymes provided symptom relief. Diagnostic tools include MRI, endoscopy, and EUS were administered. Management of groove pancreatitis still remains a challenge consisting of treatment ranging from conservative methods to surgical intervention for refractory cases, emphasizing a cautious, stepwise approach and lifestyle changes.

Cerebral arterial air embolism after esophageal stenting for recurrence of gastroesophageal junction cancer: a case report.

Cerebral arterial air embolism (CAE) is a rare complication after esophageal stenting, but it can be life-threatening. It is especially a concern for those with a history of previous gastrointestinal cancer therapies. We report a case of CAE after esophageal stenting in a patient with recurrent gastroesophageal junction cancer and a history of multiple cancer treatments. A 71year-old man with a history of a proximal gastrectomy, resection of the lower esophagus, chemotherapy, and radiation presented to our hospital 2weeks after stenting with epigastric and back pain. Mediastinitis was suspected and conservative treatment was begun. The patient suddenly developed altered mental status, left hemiplegia, and anisocoria after drinking water. A brain computed tomography (CT) revealed right-sided predominance of multifocal CAE. Chest and abdominal CT showed a hematoma in the gastric and duodenal wall and an intraluminal hematoma from the esophagus, around the stent, to the upper ileum. CAE was thought to be due to rupture of the recurrent tumor. Unfortunately, despite intensive care, the patient died about 5h after the onset of neurological symptoms. It has been reported that prior treatments, such as chemotherapy and radiotherapy, increase the risk of life-threatening adverse events, including CAE after esophageal stenting. Clinicians should keep in mind the possibility of CAE after esophageal stenting in patients with a history of multiple cancer treatments.

Morphological changes in the biliary mucosa in pediatric patients with congenital biliary dilatation are more influenced by the duration of amylase exposure than by amylase levels in the gallbladder.

We investigated the relationship between bile amylase (AMY) levels and biliary epithelial changes in pancreaticobiliary maljunction (PBM), a congenital anomaly characterized by pancreaticobiliary reflux due to duct fusion outside the duodenal wall. We enrolled 43 children with congenital biliary dilatation (CBD) of Todani types Ia, Ic, and IVa who underwent surgery at the Hokkaido Medical Center for Child Health and Rehabilitation between November 2007 and June 2023. We defined total AMY exposure in bile as bile AMY levels multiplied by the patient's age (months), representing amount of estimated AMY exposure until surgery. We retrospectively investigated the relationships between bile AMY levels and clinicopathological findings. All patients exhibited hyperplasia in the gallbladder and bile duct epithelium, with dysplasia observed in 13 cases, but no carcinoma. Exposure to bile AMY ≥ 662,400IU/L × months was an independent risk factor for dysplasia. The amount of estimated AMY exposure in bile rather than AMY levels in the bile is an independent risk factor for dysplasia in the biliary mucosa.

Intra-ampullary and Periampullary Carcinoma: Clinicopathological Comparison and Survival Outcomes.

Introduction The ampulla of Vater is a structure in the duodenal wall in which the biliary and pancreatic ducts open. Malignant epithelial tumors arising at this site are commonly referred to as ampullary adenocarcinomas. In this study, we compared the clinicopathological features of intra-ampullary and periampullary carcinomas, including survival outcomes. Methods This retrospective cross-sectional study was conducted at the Department of Pathology, Liaquat National Hospital. All radiologically suspected cases or biopsy-proven (endoscopic biopsy) cases of intra-ampullary/periampullary carcinoma were included in the study. All patients underwent surgical resection (Whipple's procedure/pancreatoduodenectomy). The classification of intra-ampullary and periampullary carcinomas was performed according to the College of American Pathologists (CAP) guidelines. Results Among the 188 case studies, most (61.7%, n = 116) were males, with a median age of 55 years. Most tumors were ofthe pancreatobiliary subtype (57.4%, n = 108). Similarly, intra-ampullary carcinoma was more common than periampullary carcinoma (61.7% vs. 38.3%). Intra-ampullary carcinoma showed a higher extent of involvement of adjacent structures, a higher frequency of perineural invasion, and a higher nodal stage than periampullary carcinoma. Similarly, the median disease-specific survival of intra-ampullary carcinoma was significantly lower (46 months) than that of periampullary carcinoma (53.5 months). Conclusion We found a higher incidence of intra-ampullary carcinoma in our study. In addition, intra-ampullary carcinoma had a worse survival rate and was associated with poorer pathological parameters, such as perineural invasion and higher nodal and tumor stages than periampullary carcinoma.

Groove pancreatitis: From enigma to future directions-A comprehensive review.

Groove pancreatitis (GP) is a rare and clinically distinct form of chronic pancreatitis affecting the pancreaticoduodenal groove comprising the head of the pancreas, duodenum, and the common bile duct. It is more prevalent in individuals in their 4-5th decade of life and disproportionately affects men compared with women. Excessive alcohol consumption, tobacco smoking, pancreatic ductal stones, pancreatic divisum, annular pancreas, ectopic pancreas, duodenal wall thickening, and peptic ulcers are significant risk factors implicated in the development of GP. The usual presenting symptoms include severe abdominal pain, nausea, vomiting, diarrhea, weight loss, and jaundice. Establishing a diagnosis of GP is often challenging due to significant clinical and radiological overlap with numerous benign and malignant conditions affecting the same anatomical location. This can lead to a delay in initiation of treatment leading to increasing morbidity, mortality, and complication rates. Promising research in artificial intelligence (AI) has garnered immense interest in recent years. Due to its widespread application in diagnostic imaging with a high degree of sensitivity and specificity, AI has the potential of becoming a vital tool in differentiating GP from pancreatic malignancies, thereby preventing a missed or delayed diagnosis. In this article, we provide a comprehensive review of GP, covering the etiology, pathogenesis, clinical presentation, radiological and endoscopic evaluation, management strategies, and future directions. This article also aims to increase awareness about this lesser known and often-misdiagnosed clinical entity amongst clinicians to ultimately improve patient outcomes.

Morphometric features of the duodenal wall in piglets during different periods of postnatal and neonatal ontogenesis under the influence of the ‘Globigen Jump Start’ feed additive

The morphological parameters of the small intestinal mucosa, such as villi size and crypts, play a key role in the formation of the intestinal tube’s absorption surface. The number of goblet and enterochromaffin cells indicates the epithelium’s functional condition in terms of mucus secretion and production of catecholamines and hormones (serotonin, dopamine). That is why it is important to study and determine certain morphometric parameters of the duodenal wall in piglets during different periods of neonatal and postnatal development, especially during stress situations, namely weaning and transition to protein feeding. The article presents the resulting effect studies of ‘Globigen Jump Start’ feed additive on the histo-morphological parameters of the piglets’ duodenal mucosa on day 7, 14 and 28 of life. A positive effect on mitigating weaning stress was manifested by a decrease in the quantitative and linear indicators of histoarchitectonics of intestinal wall’s individual morphological components. A significant increase in goblet cells, especially in the experimental group, had a positive impact on the mucopolysaccharide synthesis. The piglets’ gastrointestinal tract physiology involves a complex interaction between the central nervous system, metasympathetic nervous system, APUD system, and endocrine system. Due to these systems, the information is transmitted according to the direct and reverse communication mechanisms in the regulation of the gastrointestinal tract function. An increase in the number of enterochromaffin cells and their nuclei diameter in the experimental group of piglets indicated an increased synthesis of catecholamines and hormones. It has an extremely positive effect on the immune and physiological status of piglets, thus emphasizing the crucial role of serotonin in neuronal metabolism and the formation of stress resistance. The increase in the thickness of the duodenal wall muscle layer, in our opinion, occured due to the active peristalsis, which was enhanced by the action of some catecholamines, which were synthesized in a slightly larger amount under the influence of nutrients making up the ‘Globigen Jump Start’ feed additive.

Utility of Contrast-Enhanced Harmonic Endoscopic Ultrasonography to Diagnose Pancreaticobiliary Maljunction.

Detection of a common channel outside the duodenal wall is important in diagnosing pancreaticobiliary maljunction (PBM). The present study evaluated the utility of contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS) in diagnosing PBM. This single-center retrospective study enrolled 45 patients who were diagnosed with PBM or high confluence of pancreatobiliary ducts (HCPBD) between January 2007 and December 2021. The diagnostic sensitivities of contrast-enhanced computed tomography (CE-CT), magnetic resonance imaging (MRI), and CH-EUS for diagnosing PBM were analyzed. Imaging findings were evaluated by two reviewers blinded to the clinicopathological results. Based on diagnostic criteria, 33 patients were diagnosed with PBM and 12 with HCPBD. Compared with the patients with HCPBD, those with PBM had significantly longer common channel (12.5mm vs. 8.1mm, P = 0.018) and common bile duct (13.0mm vs. 8.6mm, P = 0.049) lengths. The κ-coefficients for differentiating PBM and HCPBD were 0.871 between CE-CT and MRI, 0.330 between CE-CT and CH-EUS, and 0.611 between MRI and CH-EUS. The diagnostic sensitivity of CH-EUS (95.2%) was higher than that of CE-CT (83.3%) and MRI (82.8%), although the differences were not statistically significant. CH-EUS may be useful for the diagnosis of PBM.

Endoscopic Closure of Duodenal Perforation using Intracavitary Endoscopic Negative Pressure Therapy

Regardless of the cause of a duodenal perforation, operative treatment remains a fundamental therapeutic choice. The endoscopic closure of leaks is helpful only for fresh defects without an accompanying infection and is limited by the size of the defect. However, the operative treatment of duodenal perforations in the population of older and multimorbid patients is associated with a high morbidity, as well as mortality. Here, we describe a successful case of an endoscopic closure of a duodenal perforation in the bulbus using intracavitary endoscopic negative pressure therapy in a 68-year-old patient initially operated because of an acute cholecystitis with focal gallbladder perforation involving the duodenal wall. Over the course of time a secondary perforation of the duodenum was diagnosed, and a reoperation with a suturing of the duodenum did not lead to complete closure of the defect. Three weeks of intracavitary endoscopic negative pressure therapy led to the successful closure of the duodenal defect. This type of therapy can be an excellent alternative to surgery, for treating duodenal perforations in selected patients.

ТРУДНОСТИ ДИАГНОСТИКИ ОСЛОЖНЕНИЙ ДИВЕРТИКУЛЯРНОЙ БОЛЕЗНИ ДВЕНАДЦАТИПЕРСТНОЙ КИШКИ

Abstract. Introduction. Duodenal diverticulum is a hernia‒like protrusion of the duodenal wall. In terms of prevalence, this disease ranks second among all diverticula of the gastrointestinal tract after colonic diverticula. Aim. To substantiate the difficulty of diagnosing duodenal diverticulum perforation, based on a clinical case. Materials and Methods. A clinical case dated December 2021 of successful diagnostics and treatment of duodenal diverticulum perforation in female patient A. aged 68 is presented, based on the practice of the surgeons of the Surgery Unit in the Clinic of Hospital Surgery of Samara State Medical University. A set of laboratory investigations was performed, such as clinical blood analysis, biochemical blood analysis, coagulation profile, clinical urine analysis, and blood tests for HIV, viral hepatitis, and syphilis. Instrumental diagnostic methods were used, such as ultrasound (Aloka SSD 1700 (Japan)), CT (Revolution EVO (Russia)) of abdominal organs, review radiography, and Napalkov test. Results and Discussion. Laboratory and instrumental diagnostics, such as ultrasound and survey radiography, and primary laparotomy turned out to be insufficient for correct diagnosis and reasonable treatment. Napalkov test was performed, which revealed the contrast agent flow into retroperitoneum. The patient underwent relaparotomy, during which the duodenal diverticulum perforation by a foreign body (a fragment of a laurel leaf) was found. Conclusions. The case presented is an example of timely diagnosis of duodenal diverticulum perforation. The surgeons’ experience allowed them to suspect perforation in a short time, which helped avoid serious complications and contributed to the patient’s recovery. With timely diagnosis of such a rare and grave complication as duodenal diverticulum perforation, its clinical cure is justified.

Aetiological Spectrum of Pancreaticobiliary Diseases in Adult Nigerians on Magnetic Resonance Cholangiopancreatography.

Imaging is vital for assessing pancreaticobiliary diseases. The aim of the study was to investigate the spectrum and pattern of pancreaticobiliary diseases in adult Nigerians using magnetic resonance cholangiopancreatography (MRCP). This was a retrospective, descriptive cross-sectional study. The electronic radiological records of 110 adult Nigerians who had undergone MRCP were reviewed. The MRCP images were evaluated for bile duct dilatation, intraluminal filling defects, strictures, calculi, and other abnormalities. There were 45 males (40.9%) and 65 females (59.1%) aged 18-83 years, with a mean age of 51.93 ± 15.22 years. Jaundice (59.1%) and right hypochondrial pain (31.8%) were the most common presenting complaints. Gallstones (32.7%), common bile duct strictures (15.5%), choledocholithiasis (11.8%), pancreatic head carcinoma (10.9%), and gallbladder carcinoma (2.7%) were the most frequent abnormalities. There was biliary obstruction in 56.4% of participants, mostly at the distal and proximal common bile duct. Other findings include hepatomegaly (23.6%), hepatic cysts (6.4%), hepatic steatosis (0.9%), duodenal wall thickening (1.8%), and ascites (5.5%). MRCP was normal in 25 (22.7%) participants. Gallstones were the predominant pathology of the various pancreaticobiliary diseases, while Pancreatic head and gallbladder carcinoma were the most common malignant diseases.

Theory of the Leaky Intestine: Sex Differences in Intestinal Parasitic Infections, Cytoskeletal Wall Dysfunctions, and Hypertension

BACKGROUND: Intestinal parasitic infections (IPIs) impact approximately 3.5 billion individuals globally. Protozoan IPIs may influence the intestinal microbiome. This research investigates IPI effects on intestinal wall thickness and their potential links to sex-specific hypertension. It also explores the impact of alterations in intestinal wall permeability on sodium and blood glucose levels. METHODS: The study enrolled 108 subjects, including 83 consecutive patients with confirmed symptomatic IPIs (48 males, 35 females) and 25 healthy volunteers used as controls (9 males, 16 females). B-mode ultrasound grayscale images of the duodenum and colon were taken with and without water contrast. RESULTS: Patients with parasites exhibited a higher BMI (mean = 28.9 ± 7.4) compared to controls (mean = 24.68 ± 7.2), F (1, 96) = 5.78, _p _&lt; 0.05. IPI patients showed a tendency towards increased duodenal wall thickness (DUOTHICK = 0.88 ± 0.7 cm) versus controls (0.6 ± 0.1 cm), _p = _0.05. Additionally, IPI patients had significantly greater thickness in the ascending colon (ASCTHICK = 1.1 ± 0.3 cm) and descending colon (DSCTHICK = 1.2 ± 0.4 cm) compared to controls (ASCTHICK = 0.6 ± 0.2 cm, DSCTHICK = 0.6 ± 0.1 cm), _p _&lt; 0.05. Men over 50 years exhibited greater DSCTHICK (1.25 ± 0.434 cm) than postmenopausal women (0.986 ± 0.389 cm), _p _&lt; 0.05. DSCTHICK significantly predicted diastolic blood pressure (β = −0.295, _p _&lt; 0.05) and blood sodium level (β = −0.300, _p _&lt; 0.05). DUOTHICK in diabetic IPI patients exceeded that in nondiabetic patients. Effective antiparasitic and antidiabetic treatments induced changes in the echoanatomy of the intestinal wall, suggesting the sealing of ‘the leak’. CONCLUSIONS: IPIs disrupted the intestinal cytoskeleton, leading to “leaky gut syndrome” development.

A case of retained surgical mop in abdomen with partial intragastric migration: a case report

Though not uncommon, to retain a foreign body in the abdomen is a preventable error that makes the life of a patient miserable. One of the commonest retained foreign bodies is surgical mop or sponge. Retained mop may cause either an early septic reaction or a late fibrotic reaction. They often cause sinus or fistula and even can transmigrate in to the lumen of viscera. In case of upper abdominal retained mops, they usually erode the thin duodenal wall and rarely stomach. In this case, a mop was retained in the deep subhepatic space 2.5 months ago following open cholecystectomy. It caused an aseptic fibrotic reaction resulting in encapsulation of the mop. It then eroded the antral part of stomach through the lesser curvature and caused luminal obstruction. The patient presented with vomiting after each meal. Upper gastrointestinal tract (GIT) endoscopy revealed a woven fabric object that was impacted and occluded the lumen. The retained mop was removed after laparotomy and the antral wall was repaired well. This case is noteworthy due to its less symptom and penetration into the stomach.

Duodenal tuberculosis with gastric outlet obstruction: a case report of successful diagnosis and treatment, with review of literature

BackgroundDuodenal tuberculosis (TB) is extremely rare, and its diagnosis is challenging owing to the lack of specific symptoms and radiological or endoscopic findings. When it leads to gastric outlet obstruction (GOO), diagnosing it accurately and providing appropriate treatment is crucial. However, this is often overlooked.Case presentationA 35-year-old man presented with abdominal pain, fullness, vomiting, and weight loss. Upper gastrointestinal endoscopy and radiography revealed nearly pinpoint stenosis with edematous and reddish mucosa in the D1/D2 portion of the duodenum. Computed tomography (CT) showed the duodenal wall thickening, luminal narrowing, multiple enlarged abdominal lymph nodes, and portal vein stenosis. Conventional mucosal biopsy during endoscopy revealed ulcer scars. We initially suspected stenosis due to peptic ulcers; however, chest CT revealed cavitary lesions in both lung apices, suggesting tuberculosis. Due to the suspicion of duodenal TB and the need to obtain deeper tissue samples, endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) was performed. The tissue sample showed caseating granulomas with multinucleated giant cells, and acid-fast bacilli were positive by Ziehl–Neelsen staining. The patient was diagnosed with duodenal TB and subsequent GOO. Because the patient had difficulty eating, surgical intervention was prioritized over antitubercular drugs, and laparoscopic gastrojejunostomy was performed. The patient started an oral diet on the 3rd postoperative day and began antitubercular treatment immediately after discharge on the 11th day. During the 6th month of treatment, endoscopic examination revealed residual duodenal stenosis; however, the bypass route functioned well, and the patient remained asymptomatic.ConclusionsAn aggressive biopsy should be performed to diagnose duodenal TB. EUS-FNA has proven to be a useful tool in this regard. Both nutritional improvement and antitubercular treatment were achieved early and reliably by performing laparoscopic gastrojejunostomy for duodenal TB with GOO.

Histopathologic and genomic profile characteristics of biliary cancers related to pancreaticobiliary maljunction.

527 Background: Pancreaticobiliary maljunction (PBM) is a congenital malformation in which the pancreatic duct and bile duct anatomically merge outside the duodenal wall, and is associated with a high rate of biliary cancer. It has been reported that TP53 and KRAS mutations are found not only in the cancerous area but also in the noncancerous area. However, there is no report of precise mapping of genetic mutations throughout the gallbladder and bile ducts. Methods: Ninety-seven patients (including 31 patients with biliary cancer) who underwent cholecystectomy and cholangiectomy for PBM between 1990 and 2023 at our hospital and affiliated hospitals were included in the study, and consent forms were obtained from 36 patients. The panel targeting 60 genes frequently identified in biliary tract cancer was created in-house and deep sequenced to compare with clinicopathological features. To date, we have analyzed 4 patients with biliary tract cancer and 5 patients without it (with prophylactic resection). The same analysis was also performed on cancerous and noncancerous parts of patients of gallbladder cancer and cholangiocarcinoma without confluence abnormalities for comparison. Results: A total of 33 Samples (7 cancerous parts and 26 noncancerous parts) were examined for biliary tract cancer. We found a variety of functional gene abnormalities, including driver mutations such as TP53, ARID2, and BRCA2, in 9 non-cancerous areas including hyperplasia and normal bile duct mucosa. Some of these mutations were not shared with cancerous areas. On the other hand, in 46 samples from 5 patients who did not develop gallbladder cancer (prophylactic resection), Driver mutations were found in only 3 sites. Pathological findings of dysplasia/hyperplasia in these prophylactic resections were observed in 28 of the 46 sections. In addition, Driver mutations were rarely observed in noncancerous areas in patients with normal gallbladder or cholangiocarcinoma. Conclusions: Unlike conventional biliary tract cancers, the patients with PBM showed a great variety of genetic abnormalities in both cancerous and noncancerous areas. On the other hand, in patients of prophylactic resection without cancer, driver mutations were almost completely absent despite the presence of mucosal changes. We believe that these findings can develop better strategy for biliary cancers with PBM.

Theory of the Leaky Intestine: Gender Differences in Intestinal Parasitic Infections, Cytoskeletal Wall Dysfunctions, and Hypertension

BACKGROUND: Intestinal parasitic infections (IPIs) impact approximately 3.5 billion individuals globally. Protozoan IPIs may influence the intestinal microbiome. This research investigates IPI effects on intestinal wall thickness and their potential links to gender-specific hypertension. It also explores the impact of alterations in intestinal wall permeability on sodium and blood glucose levels. METHODS: The study enrolled 108 subjects, including 83 consecutive patients with confirmed symptomatic IPIs (48 males, 35 females) and 25 healthy controls (9 males, 16 females). B-mode ultrasound grayscale images of the duodenum and colon were taken with and without water contrast. RESULTS: Patients with parasites exhibited a higher BMI (mean = 28.98 ± 7.43) compared to controls (mean = 24.68 ± 7.2), F (1, 96) = 5.78, _p _&lt; 0.05. IPI patients showed a tendency towards increased duodenal wall thickness (DUOTHICK = 0.88 ± 0.73 cm) versus controls (0.6 ± 0.1 cm), _p = _0.056. Additionally, IPI patients had significantly greater thickness in the ascending colon (ASCTHICK = 1.1 ± 0.3 cm) and descending colon (DSCTHICK = 1.2 ± 0.4 cm) compared to controls (ASCTHICK = 0.6 ± 0.2 cm, DSCTHICK = 0.6 ± 0.1 cm), _p _&lt; 0.05. Men over 50 years exhibited greater DSCTHICK (1.25 ± 0.434 cm) than postmenopausal women (0.986 ± 0.389 cm), _p _&lt; 0.05. DSCTHICK significantly predicted diastolic blood pressure (β = −0.295, _p _&lt; 0.05) and blood sodium level (β = −0.300, _p _&lt; 0.05). DUOTHICK in diabetic IPI patients exceeded that in nondiabetic patients. Effective antiparasitic and antidiabetic treatments induced changes in the echoanatomy of the intestinal wall, suggesting the sealing of ‘the leak’. CONCLUSIONS: IPIs disrupted the intestinal cytoskeleton, leading to “leaky gut syndrome” development.

Minimally invasive interventions for complications associated with intra-abdominal calculi after laparoscopic cholecystectomy

To study the possibilities of minimally invasive methods for removing intra-abdominal calculi after laparoscopic cholecystectomy. There were 5 patients with abdominal abscesses associated with infected calculi after previous laparoscopic cholecystectomy at the Sklifosovsky Research Institute for Emergency Care between 2020 and 2023. Mean age of patients was 55±12 years. There were 3 (60%) women and 2 (40%) men. All patients underwent minimally invasive treatment. Four patients (80%) underwent percutaneous drainage of abscess with subsequent replacement by larger drains and removal of calculi with endoscopic assistance. Event-free period after cholecystectomy was 44±32 months. One patient developed subhepatic abscess in 72 months after laparoscopic cholecystectomy. This patient underwent transluminal removal of calculus through the duodenal wall. There was 1 calculus in 3 (60%) patients, 2 calculi in 1 (20%) patient and 3 calculi in 1 (20%) patient. The above-mentioned cases demonstrate successful minimally invasive interventions for symptomatic abdominal calculi after laparoscopic cholecystectomy. Minimally invasive treatment can reduce surgical aggression and accelerate rehabilitation.