1/13. Giant duodenal diverticulum: presentation by blunt trauma.Most duodenal diverticula are asymptomatic, small (i.e., less than 5 cm in greatest dimension), acquired, extraluminal, and false. The only report of a massive or giant duodenal diverticulum (i.e., 10 cm or more), in the current literature, included severe nocturnal diarrhea. The present case report is the incidental finding of a massive duodenal diverticulum in a 34-year-old male trauma victim. The insidious nature of this case and the patient's age suggest a congenital etiology. We believe this is the first report of such a case.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/13. Allergic eosinophilic gastroenteritis in a boy with congenital duodenal obstruction.Eosinophilic gastroenteritis (EG) is a rare allergy-related disease, especially in early childhood. We present the case of a 1 year 4 month old boy with congenital duodenal obstruction who developed EG. That diagnosis of EG was made by a series of imaging studies and was confirmed by upper gastrointestinal (UGI) endoscopic biopsy studies which showed significant tissue eosinophilia in both mucosal and submucosal layers. No evidence of parasite segment or ova was found in the stool and biopsy specimen. Specific IgE antibodies to milk were estimated to be 2 (CAP system). Cow's milk allergy was highly suspected but not confirmed by consecutive elimination and challenge tests since the child was too much suffered to be tested. There was partial response to the 2-week treatment with Alfare (semi-elemental formula) and oral prednisolone 1 mg/kg/day. One month after initial examination, perforation of the stomach occurred and exploratory laparotomy disclosed stenosis of the duodenum. Congenital duodenal obstruction was diagnosed based on operative findings and previous sonographic findings. There has been only one report of EG in an infant with congenital duodenal obstruction. The nature of the relationships among cow's milk allergy as a possible etiologic factor, congenital duodenal obstruction as an predisposing factor and EG involvement at both mucosal and submucosal layers remains unclear.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/13. Successful surgery using recombinant factor viia for recurrent, idiopathic nonulcer duodenal bleeding in a patient with Glanzmann's thrombasthenia.A 68-year-old man with Glanzmann's thrombasthenia suffered from recurrent cryptogenic bleeding originating in the upper duodenal flexure. Extensive endoscopic procedures and medical treatments were unsuccessful and proximal duodenectomy was proposed. In preceding years platelet transfusions had often had a suboptimal result and were complicated by allergic reactions. Surgery was carried out while he was being treated with recombinant factor viia. Neither major blood loss nor other complications occurred. Histological examination of the bleeding site failed to show abnormalities and the nature of this patient's bleeding problem remained unexplained. Glanzmann's thrombasthenia is a rare autosomal recessive disorder of platelet aggregation characterized by a lifelong bleeding tendency due to abnormalities of the glycoprotein IIb-IIIa membrane complex. Common clinical manifestations include purpuric type bleeding, epistaxis, menorrhagia and gingival bleeding. Spontaneous bleeding is uncommon but posttraumatic and postoperative hemorrhage may be particularly serious. There is no specific treatment. Prophylactic and therapeutic platelet transfusions are the cornerstone of supportive treatment. In many patients the efficacy of this approach is diminished by allo-anti-platelet antibodies. We report on a patient with Glanzmann's disease with recurrent nonulcer duodenal bleeding refractory to conservative medical treatment. Despite documented suboptimal effectiveness of platelet transfusions, he underwent successful surgery with administration of recombinant factor viia (rFVIIa).- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/13. Duodenal diverticulum mimicking a cystic pancreatic neoplasm.Duodenal diverticula occur very commonly, with a prevalence as high as 22%. They are most frequently located in the second or third portions of the duodenum, and by nature of their proximity to the head of the pancreas, can be mistaken for cystic pancreatic neoplasms by diagnostic imaging. patients with presumed cystic neoplasms of the pancreas often receive pancreaticoduodenectomies, which at high volume medical centres carry mortality and morbidity rates of 2-4% and 29-44%, respectively. Although most duodenal diverticula are recognized in single or repeat CT scans by the presence of air or contrast medium within the diverticula, we present a case in which serial CTs failed to yield any clue to the diverticulum's true nature and pancreaticoduodenectomy was performed. For presumed cystic lesions adjacent to the duodenum, barium studies, endoscopy, and/or endoscopic ultrasound-guided aspiration should therefore be pursued in addition to all available CT evidence prior to surgery.- - - - - - - - - - ranking = 2keywords = nature (Clic here for more details about this article) |
5/13. Recurrent aortoenteric fistula: case report and review.Aortoenteric fistulas (AEFs) are abnormal communications between the aorta and the bowel most frequently resulting from prosthetic graft erosion. Despite advances in surgery and medical technology, these entities are still associated with significant morbidity and mortality for the patient. Multiple case reports and reviews have attempted to elucidate the nature of AEFs in an effort to better characterize and manage these entities. However, reports of recurrence of this process are extremely rare. In this article, we describe a unique case of recurrence of an AEF that was successfully managed with primary aortic oversew and bowel resection. We will also review the literature on AEFs with a comprehensive overview on background, presentation, diagnosis, and current management options.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/13. Neuromuscolar and vascular hamartoma of the duodenum. A clinical case and review of the literature.BACKGROUND AND AIMS: The NMVH of the intestine is a rare lesion, typical located in the small bowel. After the first 2 cases, reported in 1982, other 12 cases have been described, ten localized in the jejunual or ileal tract, only 1 in the cecum. SUBJECTS AND methods: A case of NMVH of the duodenum, simulating a Crohns disease, is described. The lesion extended about 12 cm. and it caused intestinal stenosis. The microscopic analysis on the operative specimen highlighted the presence of a neuronal hyperplasia at mucous membranae and submucosal levels, associated to muscolaris mucosae hypertrophy and disorganisation. Expanded and ectasic veins, proliferation of nervous fibres and ganglion cells in the submucosal were also observed. RESULTS: NMVH is a non-epithelial hamartomatous, submucosally based proliferation of mature submucosal elements capable of causing small bowel obstruction. In the controversy about the nature of the NMVH, we consider it a separate entity, where the final diagnosis depend on the clinicopathologic setting, as well as on the location and number of the lesions. CONCLUSIONS: The Authors analyse the main characteristics of this rare pathology with regard to clinical, diagnostic and therapeutic aspects.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
7/13. Brunner's gland hyperplasia at the ampulla of vater.Brunner's gland hyperplasia (BGH) is a diagnostic challenge where in the pathophysiology and natural history remain poorly understood. This Case Report describes BGH arising at the ampulla of vater, causing abdominal pain and vomiting in a 46-year-old man. Owing to the inconclusive nature of imaging studies and suspicious intraoperative findings, a Whipple resection was performed without any complications. Histological analysis showed that the obstructing lesion was BGH, with no evidence of malignancy. This is only the second such case of its kind at the ampulla of vater to be reported. In addition, we present the previously unreported endoscopic ultrasound findings. The subsequent literature review focuses on the pathophysiology, clinical presentation, diagnosis and management of BGH.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
8/13. Primary aortoduodenal fistula: manifestation, diagnosis, and treatment.Primary aortoduodenal fistulas are an especially lethal part of the spectrum of arterioenteric fistulas. The lethal nature is due to the subtleties in manifestation, leading to delays in diagnosis and institution of prompt operative repair. A review of the 118 primary aortoduodenal fistulas in the world's literature reveals that pain (32%), palpable abdominal mass (25%), and bleeding (64%) are inconsistently present as initial symptoms and that routine abdominal films, barium studies, and endoscopy have been ineffective as diagnostic aids. attention is called to the importance of recognizing the "herald bleed." Operation is usually undertaken emergently and has been successful in only 21 cases in addition to the case reported here. Repair of the duodenal rent and replacement of the aorta with a Dacron prosthesis, rather than an extra-anatomic bypass, is advised.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
9/13. Management of duodenal diverticula.Duodenal diverticula are not uncommon. Uncomplicated diverticula require no treatment. In the period 1970 to 1980, 104 patients with symptoms presented at the Vancouver General Hospital and the Swedish Hospital in Seattle. Of these, 26% presented with pain and 24% with anemia. Malabsorption and benign tumours were noted infrequently. Fifteen patients were treated surgically for pain, perforation, hemorrhage, tumour, blind loop syndrome and obstruction of the duodenum, biliary tract or pancreatic duct. Two patients died. The second part of the duodenum was involved in 82% and the third part in 10%. Anatomical variations are common in the area of the ampulla; these should be anticipated before operation. Surgical procedures in the area may be technically demanding and associated with high mortality and morbidity. The choice of procedure depends on the urgency and nature of the complication of the diverticulum. Endoscopic retrograde cholangiopancreatography can play a role in evaluating the possible significance of the diverticulum and the anatomy of the area. In some cases endoscopic sphincterotomy may be possible. In some situations diverticulectomy is contraindicated.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
10/13. Primary aortoduodenal fistula: a case report and review of the literature.The case of a 22-year-old female with spontanteous aortoduodenal fistula is presented, and a group of 185 other cases from the world literature are analyzed. Three additional cases were identified which did not appear to have an underlying pathologic process involving the aorta. Successful surgical correction depends upon a high index of suspicion. In the majority of patients the "herald bleed" allows a period for aggressive investigation. The "herald bleed" is usually rapid, painless, of large volume, and may present as hematochezia. Normal barium studies and endoscopy should heighten suspicion in patients with gastrointestinal hemorrhage. Arteriography may define the case of bleeding and may also delineate the nature and extent of the vascular disease. If the aortic wall is of sufficient quality, direct oversewing has the advantage of avoiding the use of a foreign body in a potentially infected field. In the vast majority of patients a vascular prosthesis is required. Consideration should be given to subcutaneous extraanatomic reconstruction.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
| | Next -> |