Symptoms Of Duodenal Obstruction Research Articles

Neonate with Congenital Duodenal Obstruction and Ectopic Hepatic Parenchyma

Background The presence of hepatic parenchyma at ectopic locations is infrequently reported in neonatal age. Case details: A male neonate presented with clinical signs and symptoms of duodenal obstruction. At exploration, an annular pancreas was found as the causative factor and he underwent a Kimura's duodeno-duodenostomy. A pedicled cyst was attached to the stomach's greater curvature, was excised, and histologically was a mesothelial-lined cyst with ectopic liver, complete with bile ducts, in the cyst wall. Conclusion: Ectopic liver tissue may be clinically silent and found within the wall of a mesothelial cyst. Long-term complications of this ectopic tissue are not known.

Annular pancreas causing duodenal obstruction in two consecutive sisters

Congenital duodenal obstruction is a common cause of neonatal intestinal obstructions. The occurrence of duodenal obstructions in family is extremely rare. We operated on two consecutive sisters presented with symptoms of duodenal obstruction. In both of our patients, annular pancreas was identified as a cause of duodenal obstruction. Only less than twenty cases have been published in English literatures. To the author's knowledge, we are the first to report the cases of familial annular pancreas and duodenal stenosis in Malaysia.

Giant Brunner's Gland Hamartoma of the Duodenal Bulb Presenting with Upper Gastrointestinal Bleeding and Obstruction.

Brunner’s gland hamartomas are small benign lesions that are most commonly found in the bulb of the duodenum. They are very uncommon, and most are found incidentally during upper gastrointestinal series or esophagogastroduodenoscopy. The lesions tend to be asymptomatic, but patients may present with symptoms of duodenal obstruction or hemorrhage secondary to ulceration. Histologically, a Brunner's gland hamartoma consists of the components of Brunner's gland cells, as well as glandular, adipose and muscle cells. In this study, we report the case of a 30-year-old man who presented with upper gastrointestinal bleeding and obstructive symptoms due to a giant Brunner's gland hamartoma in the duodenal bulb. The hamartoma was successfully removed by endoscopic resection. No significant complications were observed. Microscopically, the lesion was found to be entirely composed of variable Brunner's glands and adipocytes.

Annular pancreas: A review of its molecular embryology, genetic basis and clinical considerations

The annular pancreas remains an intriguing congenital anomaly. Many theories have sought to explain its embryological basis; however, no consensus has yet been reached regarding the exact mechanism of aberration. More recently, molecular investigations have shed light on some of these theories, confirming the origination of annular tissue from the ventral pancreatic bud. These studies highlight the role of the hedgehog signaling pathway in the development of this anomaly. Overexpression of the ventral-specific gene transmembrane 4 superfamily member 3 (tm4sf3) has also been associated with annular formation. Moreover, isolated case reports of familial annular pancreas have also been documented, suggesting a genetic basis for the development of this anomaly. Annular pancreas can initially present in childhood or adulthood with symptoms of duodenal obstruction and is diagnosed using a variety of imaging modalities. Treatment usually involves surgical correction, with bypass procedures (e.g. duodenoduodenostomy, gastrojejunostomy or duodenojejunostomy) currently favored over annular resection due to complications associated with the latter approach.

十二指腸閉塞を併発した巨大腹部大動脈瘤の１例

十二指腸閉塞を併発した巨大腹部大動脈瘤の１例

Spontaneous duodenal hematoma in a patient with Glanzmann's thrombasthenia

Spontaneous intramural duodenal hematoma is a rare problem, most commonly seen in children who have coagulation disorders. A child who had Glanzmann's thrombasthenia, a disorder of platelet function, presented with signs and symptoms of duodenal obstruction. Nonoperative management of an obstructing duodenal hematoma was successful and potentially life-threatening surgery was avoided.

Surgical Palliation of Unresectable Pancreatic Carcinoma

The decision to perform surgical versus nonoperative palliation for unresectable pancreatic cancer is influenced by a number of factors. In most cases, patient symptoms clearly dictate the management. In patients with symptoms of duodenal obstruction at the time of presentation, surgery is the only option. In patients with obstructive jaundice alone, the options for management must be weighed against factors such as overall health status, projected survival, and procedure-related morbidity and mortality. A prospective multicenter trial recently analyzed factors influencing perioperative morbidity and mortality following both curative and palliative surgery for pancreatic cancer. This analysis demonstrated that preoperative diabetes, low Kanofsky's index, and liver metastases are significant risk factors in predicting perioperative morbidity and mortality in patients undergoing palliative procedures for pancreatic cancer. Another analysis focusing on tumor characteristics suggested that for patients with Stage I and Stage II disease (i.e., with no evidence of systemic metastases), survival and the potential for late duodenal obstruction favor surgical management. In summary, although patient management must be individualized, most patients with pancreatic cancer in good medical health and with no evidence of systemic disease are most appropriately managed with surgical palliation. This option affords patients the best chance of avoiding the late complications of recurrent jaundice, duodenal obstruction, and disabling pain. Surgical palliation can generally be completed with an acceptable perioperative morbidity and mortality and a hospital stay of approximately 2 weeks. Finally, only surgical exploration can offer full opportunity for resection for cure.

Gastroduodenal Crohnʼs Disease

Three new cases of gastroduodenal Crohn's disease are presented, two with obstruction and one with massive gastrointestinal bleeding. Of the 124 cases reported in the literature up to 1972, only four had massive gastrointestinal bleeding. An accurate preoperative diagnosis is difficult. When peptic epigastric distress and retention type of vomiting are associated with diarrhea, the diagnosis of gastroduodenal Crohn's disease should be strongly considered. A surgical bypass procedure or resection is indicated when symptoms of duodenal obstruction do not respond to medical treatment.

Crohn's disease of the duodenum (transmural duodenitis): clinical manifestations. Report of 11 cases.

Data from 11 patients with Crohn's disease of the duodenum (transmural duodenitis), seen from 1965–1970, are reported. For all, duodenal involvement predominated with a) symptoms of duodenal obstruction (6 patients); b) symptoms of duodenal ulceration (3 patients); c) or both (2 patients). Six had previous histories of transmural enteritis or colitis; for 5, duodenal involvement was the first manifestation of transmural enteritis. All subsequently had other involvement by transmural enteritis: 8 ileal, 5 colonic, 3 cutaneous fistulae and 3 perirectal abscesses. Ten had operations for duodenal disease and had bypass procedures; no vagotomy was done. Eight have done well and only 1 required further operations. Transmural duodenitis should be suspected for patients with symptoms of duodenal ulceration or obstruction and known transmural enteritis or colitis; duodenal involvement may be the first manifestation of transmural enteritis.

Current concepts of the obstructing duodenal diaphragm.

Intraluminal duodenal diverticulum and incomplete congenital duodenal diaphragm are unusual and have been considered separate entities. Anatomical variations in 9 children with symptoms of duodenal obstruction or bleeding ranged from a tight transverse diaphragm to a prolapsing diaphragm identical to the intraluminal diverticulum. Congenital duodenal diaphragm and intraluminal duodenal diverticulum are probably different forms of an obstructing congenital duodenal membrane. The clinical and roentgen features of this anomaly are discussed.

Duodenal obstruction due to compression by superior mesenteric root.

The causes and symptoms of duodenal obstruction by compression at the superior mesenteric root are illustrated by four case histories. In two the symptoms were completely relieved by side-to-side duodenojejunostomy. In the other two, it was found that barium readily passed the site of obstruction when the patient was in the prone position, so that medical management sufficed; it consisted in complete bed rest, elevation of the foot of the bed, assumption of the knee-chest position after meals, and the wearing of a well-fitting abdominal support.

The pancreatic factor in intestinal obstruction

In a previous communication some experiments on the pancreas in relation to intestinal obstruction were reported. This presentation includes a duplication of the work with additional data. Twenty-three dogs were used. The experiments were divided into five groups. Average duration of life, 76.6 hours. Observations: A mild toxæmia developed which did not stimulate the toxæmia of duodenal obstruction. Autopsy revealed a slight congestion of the duodenal and colon mucosa. Microscopic examination of the pancreas showed a capillary congestion, nuclei indistinct and the ducts filled with secretion. Note: An accidental traumatic pancreatitis and a partial devitalization of the oral duodenum was responsible for a severe toxæmia in two of these cases. These variables were not included in estimating the mean duration of life. Group II: Duodenal occlusion, partial pancreatic resection (duct bearing portion), number of dogs, 3. Average duration of life, 43.3 hours. Observations: The symptoms of duodenal obstruction were greatly accentuated owing to the associated pancreatitis. Autopsy revealed a congestion of the peritoneum, also a slight congestion of the duodenal and colon mucosa. Fat necrosis was present in each case. Microscopic examination of the pancreas showed a hæmorrhagic infiltration with cells in different degrees of auto-digestion. Average duration of life, 70.3 hours. Observation: The severity of the toxaemia of duodenal obstruction is greatly diminished when the pancreas is excised. Autopsy revealed a slight congestion of the mucosa of the duodenum and terminal colon. Note: A severe toxaemia occurred in two cases; the result of general peritonitis in the one and partial devitalization of the duodenum in the other. These variables were not included in estimating the mean duration of life.