Rare Cause Of Duodenal Obstruction Research Articles

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.

Incidental Preduodenal Portal Vein Causing Partial Duodenal Obstruction and Hypertrophied Pre-Pyloric Gastric Polyp.

Preduodenal portal vein (PDPV) is a rare congenital anomaly in which the portal vein lies anterior to the duodenum rather than its normal posterior position. It is a known rare cause of duodenal obstruction and can be associated with other anomalies such as malrotation with or without jejunal atresia. Presented is an incidentally found PDPV causing partial duodenal obstruction during exploration for the resection of a gastric mass and placement of open gastrostomy tube for feeding. This was managed with duodenoduodenostomy, re-creating normal anatomy with portal.

Rare cause of duodenal obstruction in a young-age female: a case report

BackgroundGastrointestinal tract can be compressed by many vascular structures in the abdomen; such compressions may be incidentally found or may result in compression symptoms like abdominal pain and vomiting.Case presentationWe illustrate an uncommon cause of extrinsic compression of the third part of the duodenum by jejunal branches of the superior mesenteric artery in an 18-year-old female, presented with dull-aching epigastric pain and vomiting. Contrast Enhanced Computerized Tomography (CECT) showed atypical origin of the jejunal branches of superior mesenteric artery with relative space narrowing between it and the aorta, causing significant compression on the third part of the duodenum. Barium follow-through confirmed indentation of the duodenal lumen at the same level of the aberrant vessel. Conservative treatment failed to control her symptoms, and the patient referred to the surgery.ConclusionHigh index of suspicion is required for diagnosis of atypical causes of upper abdominal pain and vomiting. CECT guided by a well-descriptive comment of the treating doctor is very helpful diagnostic tool for detecting such rare condition. Barium studies still have a valuable role for determining the level of obstruction and confirming the diagnosis of such rare cases.

Wilkie’s Syndrome: Case Report

Superior Mesenteric Artery or Wilkie Syndrome is a rare cause of duodenal obstruction and results from compression of the third portion of the duodenum by the superior mesenteric artery and the aortic artery.

Iatrogenic Duodenal Obstruction due to Acupuncture Therapy Trauma

There are many possible causes of duodenal obstruction, such as congenital anomalies and various acquired conditions associated with space-occupying lesions. However, hemorrhage or retroperitoneal hematoma is a rare cause of duodenal obstruction. Here, we report the case of a 55-year-old man who developed duodenal obstruction due to a large retroperitoneal hematoma after acupuncture therapy. The patient experienced abdominal discomfort along with vomiting and nausea. Considering the size of the hematoma, emergency surgery could have been performed, but conservative treatment was continued because the patient’s vital signs were stable. With spontaneous resolution of the hematoma, the symptoms of duodenal obstruction improved. The patient was eventually discharged without any complications associated with the hematoma. Our findings suggest that even when a hematoma is large, a conservative approach can be maintained until improvement of the symptoms of duodenal obstruction if the vital signs of the patient remain stable. Keywords: Acupuncture; Duodenal obstruction; Hematoma

S2819 Evaluating All Angles: Wilkie's Syndrome—A Rare Cause of Intestinal Obstruction

INTRODUCTION: Superior mesenteric artery (SMA) syndrome is a rare cause of duodenal obstruction. The prevalence of SMA syndrome is estimated at less than 0.3%. Normally, the angle between the SMA and aorta is 38-65 degrees maintained by mesenteric fat padding. The mechanism of intestinal obstruction is due to exaggerated acute angularity of the SMA caused by excessive fat loss, leading to compression of the third part of the duodenum as it travels between the SMA and aorta. There are multiple predisposing factors that can increase the angularity, such as anorexia nervosa, kyphoscoliosis, and bariatric surgery. However, there are limited reports of SMA syndrome secondary weight loss exacerbated by chemotherapy. CASE DESCRIPTION/METHODS: We present a 22-year old female with a history of aplastic anemia, post allogenic bone-marrow transplant with cyclophosphamide/fludarabine/anti-thymocyte globulin conditioning therapy, who presented with nausea and vomiting for 4 days and a 9 kg loss in weight since conditioning therapy. Physical examination revealed a severely dehydrated patient with peri-umbilical tenderness. The patient had presented with similar symptoms 1 month prior, with a normal EGD, and resolution of symptoms with supportive care. On readmission CT-Abdomen revealed a massively distended stomach, first, and second portions of the duodenum, and complete collapse of the duodenum at the level of the SMA. CT-Angiography revealed acute angulation of the SMA-aortic takeoff at 20 degrees, establishing the diagnosis of SMA syndrome. The patient underwent nasogastric decompression and laparoscopic duodenojejunostomy resulting in a successful bypass. DISCUSSION: Physicians should be wary of this rare etiology of duodenal obstruction and its clinical presentation. A high index of suspicion should be employed for young patients presenting with signs and symptoms of intestinal obstruction with a history of weight loss. Delayed diagnosis can lead to significant morbidity, due to electrolyte abnormalities or perforation. CT-Angiography is the imaging modality of choice to establish the diagnosis. However, the diagnosis may be overlooked, as radiological findings do not always correlate with clinical findings. Additionally, some patients may experience intermittent symptomatic compression of the duodenum, leading to a delay in diagnosis, as illustrated with our patient. Depending on initial management, it is recommended that once symptom free and patency of the duodenum is achieved, patients begin a dietary regimen.Figure 1.: 3D Reconstructed CT-Angiography revealing severely distended stomach, first, and second portion of the duodenum.Figure 2.: CT Angiography revealing severe acute angularity of the SMA-aortic takeoff. Black arrow—Celiac artery, Maroon arrow—Aorta, Blue arrow—Superior Mesenteric Artery.

Superior mesenteric artery syndrome: a case report and a novel surgical approach

Background: Superior mesenteric artery syndrome (SMAS) is a rare cause of duodenal obstruction that has non-specific and insidious symptoms. An initial treatment is conservative, and surgery is reserved for patients who continuously present with symptoms or complications. The aim of this study is to describe a combination of two surgical techniques: duodenojejunostomy and Strong\'s procedure (the release of the Treitz ligament) through a laparoscopic approach. This combination of both techniques has already been described, however, with a lack of technical detail. Case Presentation: This report presents the case of a 19-year-old male diagnosed with SMAS, confirmed through computed tomography and angiographic magnetic resonance imaging of the abdomen. He underwent a laparoscopic duodenojejunostomy and release of the Treitz\'s ligament. The patient recovered well with no complications and was discharged 5 days postoperatively. Conclusion: Due to the rarity of the disease, there is a lack of literature comparing the benefits of either of these two techniques, and also, there are no established protocols favoring the use of one procedure over the other. In this case, we combined both techniques to reduce the rate of recurrence, increase the anastomotic safety, and reduce long-term complications. However, a larger study would be necessary to establish the combined use of these two techniques.

Superior Mesenteric Artery Syndrome: Need for an Awareness

Superior Mesenteric Artery (SMA) syndrome is an upper gastrointestinal disorder caused by the compression of the third part of the duodenum between Aorta and Superior mesenteric artery. SMA syndrome is a rare pathology with an incidence that ranges between 0.013 and 0.3%. It’s a rare cause of duodenal obstruction which may be complete or partial but is a life-threatening disorder as it poses a diagnostic dilemma. Apatient was admitted in the emergency with complaints of subacute intestinal obstruction along with peritonitis. He underwent exploratory laparotomy along with surgical resection of gangrenous segment.Histopathological examination showed gangrenous bowel, however, no specific cause could be identified. CT findings were reviewed for a possible compression/ obstruction aetiology. It revealed features suggestive of superior mesenteric artery syndrome.

Superior Mesenteric Artery Syndrome: a Prospective Study in a Single Institution

BackgroundSuperior mesenteric artery syndrome (SMAS) is a rare cause of duodenal obstruction, resulting from the compression of the duodenum between superior mesenteric artery and aorta. This prospective registry aims to describe demographic, clinical, and outcome features of patients suffering from SMAS and to point out the indications for surgery. MethodsBetween 2008 and 2016, patients with chronic gastrointestinal symptoms and diagnosis of SMAS were included. Demographics, clinical presentation, diagnosis, and surgical outcome were recorded. Symptoms were investigated with a standardized questionnaire. The diagnosis was achieved through barium swallow, CT/MR angiography (aortomesenteric angle ≤ 22°, distance ≤ 8 mm), endoscopy. All patients underwent duodenojejunostomy ± distal duodenum resection. At follow-up, symptom score and barium swallow were re-evaluated. ResultsThirty-nine patients (11 M/28 F, median age 38 years, median BMI 17.8 kg/m2) were included. Barium swallow showed a gastroduodenal dilation in 57% of patients, and a delayed gastroduodenal emptying in 38%. Median aortomesenteric angle was 11° and distance was 5 mm. All patients underwent duodenojejunostomy, and in 32 patients, a distal duodenum resection was also performed. At a median follow-up of 47 months, the overall symptom score significantly dropped (10 vs. 32, p < 0.0001) and BMI increased (19.5 vs. 17.8, p < 0.0001). Barium swallow at 2 months postoperatively showed an improvement in terms of gastroduodenal dilation and emptying in 38% of patients with preoperative pathological findings. ConclusionsSMAS is a rare condition that should be suspected in cases of chronic, refractory upper digestive symptoms, particularly in females with low BMIs. Surgical treatment may improve symptoms and quality of life, although it is not curative in all cases.ClinicalTrials.gov Identifier: NCT03416647

Increase body weight to treat superior mesenteric artery syndrome

IntroductionSuperior mesenteric artery (SMA) syndrome is a rare cause of duodenal obstruction resulting from vascular compression of the third part of the duodenum in the angle between the abdominal aorta...

Superior mesenteric artery syndrome - A clinicoradiologic case report

Superior mesenteric artery (SMA) syndrome is a rare cause of duodenal obstruction due to compression of the third part of duodenum between SMA and aorta. Clinical suspicion and radiological findings are playing important role in the diagnosis of SMA syndrome. We report here the clinicoradiologic findings in a case of 66-year-old Indian male. In our case, abdominal aortic tortuosity in an elderly patient was the cause for SMA syndrome.

Superior Mesenteric Artery Syndrome; A rare cause of duodenal obstruction: Report of two cases

Aim To report two cases of Superior Mesenteric Artery Syndrome (SMAS) with some abnormal anatomical findings.

A rare cause of duodenal obstruction: Superior mesenteric artery syndrome

A rare cause of duodenal obstruction: Superior mesenteric artery syndrome

Congenital Membrane Causing Duodenal Obstruction and Malpositioning of the Descending Colon

A congenital membrane without intestinal malrotation is a rare cause of duodenal obstruction. Here we present an 11-year-old girl who had suffered from intermittent abdominal cramping pain and vomiting for more than 5 years. The image studies, including a plain abdomen roentgenogram and sonogram, showed no definite diagnosis. The upper gastrointestinal series and small bowel series showed the contrast was static over the third portion of the duodenum and the descending colon pulled up toward the epigastric area. Laparoscopic exploration revealed a congenital membrane extending from the right-side paraduodenal peritoneum through the third portion of the duodenum to the descending colon, which had caused obstruction of the third portion of the duodenum and malpositioning of the descending colon. To the best of our knowledge, this is the first case report in the literature where a congenital membrane caused both duodenal obstruction and malpositioning of the descending colon.

Robotic Management of Superior Mesenteric Artery Syndrome

Robotic surgery is an advanced minimally invasive approach that has become popular over the last decade for its precision and innovative technology. The superior mesenteric artery syndrome is a known but rare cause of duodenal obstruction because of its compression between the superior mesenteric artery and the abdominal aorta. This paper reports and discusses the management of 2 patients who presented with this syndrome and were treated using the robot.

A rare cause of duodenal obstruction

A 35-year-old woman presented with bloating and vomiting. She had a 2 month history of occasional abdominal pain and had been vomiting for …

Patient with both Wilkie syndrome and nutcracker syndrome

Wilkie syndrome or superior mesenteric artery syndrome is a rare cause of duodenal obstruction in pediatric and adult age groups. Its manifestations are due to compression of the third portion of the duodenum between the aorta and the superior mesenteric artery. We present one case of a 29-year-old female with a recent history of epigastric pain and severe weight loss due to duodenal obstruction from superior mesenteric syndrome. She was treated conservatively with jejunostomy tube feeding to regain loss of weight. Our case is unique in that the patient has also nutcracker syndrome.

Superior mesenteric artery syndrome as a rare cause of duodenal obstruction

Superior mesenteric artery syndrome is a rare cause of duodenal obstruction. The syndrome can present as acute small bowel obstruction or intermittent compression symptoms such as postprandial epigastric pain, fullness or vomiting. The obstruction is caused by compression of the third part of the duodenum against the posterior structures by the narrow‐angled superior mesenteric artery. The diagnosis is easily confused with gastric outlet obstruction or proximal small bowel obstruction. A high index of clinical suspicion is crucial for diagnosis and computed tomography provides confirmatory evidence. We report two cases of superior mesenteric artery syndrome and a review of the literature for this condition.

Superior mesenteric artery syndrome ? case report and review of the literature

Acute vascular compression of the duodenum is a rare cause of duodenal obstruction in children. An 11-year-old girl presented with acute symptoms of upper gastrointestinal obstruction with no antecedent cause. Radiological investigations revealed it to be complete duodenal obstruction. At laparotomy the obstruction was found to be due to extrinsic compression of the third part of the duodenum by the superior mesenteric artery. A duodenoiejunostomy was performed, which resulted in relief of the obstructive symptoms; the patient showed satisfactory weight gain in the postoperative period.