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PubMed1995

Segmental resection of the duodenum for treating leiomyosarcoma associated with von Recklinghausen's disease: a case report.

We report a case of leiomyosarcoma originating from the second portion of the duodenum and associated with von Recklinghausen's disease. A 62-year-old man was admitted to our hospital complaining of abdominal pain and melena. A 5 cm tumor in the descending part of the duodenum was detected by hypotonic duodenography, CT, ultrasonography and endoscopy. Angiography revealed the tumor to be supplied by the mesenteric artery of the transverse colon. A segmental resection of the distal part of the duodenum was performed, preserving the head of the pancreas. Histologically, the tumor was a leiomyosarcoma, and the surgical margin was free of tumor cells. This surgery is safer than pancreatoduodenectomy, and is appropriate for treating non-epithelial tumors in the distal part of the duodenum in the absence of invasion of the head of the pancreas and regional lymph node metastasis. When carrying out the procedure, it is essential to ligate the branch of the pancreaticoduodenal vessels as close as possible to the duodenal side in order to preserve the blood supply to the pancreatic head.

Duodenal Neoplasms↗
PubMed1995

Octreotide versus pyloric exclusion in reducing gastrointestinal secretions entering the duodenum in a canine model.

Pyloric exclusion is advocated in the treatment of duodenal injury. The beneficial effect is thought to be due to diversion of gastric secretions and resultant reduction of biliary and pancreatic secretions. The long-acting somatostatin analog, Octreotide, makes the inhibitory actions of somatostatin on gastric, biliary, and pancreatic secretions a potential alternative to pyloric exclusion. We compared the effect of pyloric exclusion to the effect of Octreotide on the volume of gastrointestinal secretions entering the duodenum by creating a duodenal fistula using a canine model. Five animals had modified Thomas cannulas placed in the duodenum. Two animals had staple closure of the pylorus with a gastrojejunostomy in addition to the cannula. Gastrointestinal secretions were measured in 2- or 3-hour collection periods performed every third or fourth day. Animals were administered saline or Octreotide (100 micrograms/hour) intravenously during each collection. Up to 9 hours of collections under both saline and Octreotide (18 hours total) were done on each dog. Octreotide alone reduces gastrointestinal secretions entering the duodenum more than pyloric exclusion alone. Pyloric exclusion and Octreotide together offered no additional reduction in gastrointestinal secretions entering the duodenum over Octreotide alone.

Animals↗
PubMed1993

[Surgical treatment of open and closed injuries of the duodenum].

The article discusses a complex of methods for the diagnosis of injuries to the duodenum in 18 patients. Laboratory and X-ray findings and laparocentesis with introduction of a "feeling" catheter into the abdominal cavity with lavage of the cavity facilitated the discovery of blood and intestinal contents and allowed the correct diagnosis to be established before the operation. In inspection of the duodenum mobilization after Kocher is insufficient, in rupture of the posterior wall in the region of the inferior horizontal part the duodenum must be mobilized for its whole length. It is advisable that the defect in the duodenum is closed with a double-row suture applied with an atraumatic needle (the first inner row of interrupted sutures). The methods for applying hemostatic sutures suggested by the authors by means of created devices provide reliable hemostasis in combined injuries to the parenchymatous organs. The operation was completed by leaving glove-tube drains. The postoperative mortality was 16.6%.

Adult↗
PubMed1977

[New acquisitions on the arterial vascularization of the 3d and 4th portions of the duodenum. Surgical applications].

The authors studied the blood supply of the 3rd and 4th parts of the duodenum in 15 adult subjects. Although the duodeno-pancreatic arches are constantly found, the branches to the duodenum have a variable lay-out. On the right, the superior mesenteric artery, the distribution of which is always regular on both sides of the 3rd part of the duodenum. On the other hand, on the left, the superior mesenteric artery, there is sometimes a vascular hiatus which may extend to the duodeno-jejunal angle. Although in 60 p. cent of cases this part of the duodenum is well supplied with blood on both surfaces, in 40 p. cent of cases on the other hand, there exists an avascular area on both sides. This lay-out is not favourable for division and anastomsis of this segment of the digestive tract.

Duodenum↗
PubMed1976

Mucosal iron retention and plasma iron absorption in the duodenum and jejunum of dogs.

Two groups of non-anemic dogs, one with normal tissue iron stores and one with decreased tissue iron stores, underwent a surgical construction of two equal segments of duodenum and jejunum. A solution of 0.1 mg ferrous sulfate and 1 mg ascorbic acid was injected into the lumen of each segment. The solution for the duodenal segment contained 30 muc of iron59, for the jejunum segment 60 muc of iron55. The solutions were left in the segments for 2 1/2 hours before washout. On the 14th postoperative day, iron59 and iron55 radioactivity per ml/RBC was measured, and iron uptake by segments determined in two ways. Bone marrow, liver, and spleen were histologically assessed of iron stores. In dogs with normal iron stores, percent iron retained was slightly higher in jejunum that duodenum. In dogs with decreased iron stores percent retention was always higher in duodenum; in this group iron retained was about four times higher than in dogs with normal iron stores. This indicates that mucosal uptake of iron from lumen and mucosal transfer of iron from plasma vary inversely with body iron stores, but compared to mucosal uptake, mucosal transfer is more restricted to duodenum, more affected by body iron stores, more limited, and more crucial to regulation of iron absorption.

Animals↗
PubMed1997

Experiences with duodenum preserving pancreatectomy.

According to the principle of surgery for chronic pancreatitis the preservation of pylorus, duodenum or distal part of common bile duct gives the benefit of more physiological intervention. 2 patients with duodenum preserving pancreatectomy are presented. The operation was carried out for chronic pancreatitis. Both patients had jaundice and needed T drainage. Both patients suffered from very severe malnutrition with cachectic condition adding severe pain. None of them proved to be malignant by the frozen section. Previous diabetes, severe chronic inflammation of the whole pancreas, destruction of the pancreatic ductal system and cysts helped the decision-making for ablation of pancreas with preservation of duodenum which seems organ saving procedure. In comparison with the Whipple operation the duodenum-preserving pancreatectomy spares the patient a gastrectomy, a duodenectomy and a resection of distal common bile duct.

Cachexia↗
PubMed1979

Biochemical and energetic gradients in the mucosa of stomach and duodenum of patients with antral ulcer.

Separation and measurement of adenine-adenosine, adenosine monophosphate (AMP), adenosine diphosphate (ADP), adenosine triphosphate (ATP), lipid phosphates, RNA and DNA, further, separation and measurement of Mg2+-dependent, total (Mg2+-dependent plus Na+--K+-dependent, Mg2+-Na+-K-dependent) and Na+-K+-dependent ATPases were carried out in the mucosa and muscles of the corpus, antrum and duodenum of 68 patients with antral ulcer. It was found that (1) the substrate levels of adenosine nucleotides, lipid phosphates and RNA were significantly higher in the corpus mucosa than those in the mucosa of the antrum and duodenum (calculated for 1.0 mg DNA content); (2) the amounts of adenosine nucleotides and the sum of ATP + ADP + AMP did not alter significantly in the muscles of the corpus, antrum and duodenum; (3) the levels of adenosine nucleotides, sum of ATP + ADP + AMP, lipid phosphates and RNA, further the activities of Mg2+-dependent , total (Mg2/-dependent plus Na+-K+-dependent) and Na+-K+-dependent ATPases were significantly higher in the corpus mucosa than those in the corpus muscles. It was concluded that (1) energetic and biochemical gradients are present between the substrate levels in the mucosa of the corpus, antrum and duodenum; (2) the neural and/or humoral regulatory mechanisms differ in the mucosa and muscles of the corpus, in order to their biochemistry.

Adenine Nucleotides↗
PubMed2003

Adenocarcinoma of the third and fourth portions of the duodenum: results of surgical treatment.

HYPOTHESIS: To verify the adequacy of duodenal segmentectomy after intestinal derotation in the treatment of primary adenocarcinoma of the third and fourth portions of the duodenum. DESIGN: A retrospective review of the surgical management of patients who underwent derotation of the third and fourth portions of the duodenum was undertaken to determine long-term outcome. SETTING: Departments of surgery in 3 university hospitals. PATIENTS: Between January 1, 1980, and December 31, 2000, 47 patients with primary adenocarcinoma of the third and fourth portions of the duodenum were surgically treated at 3 different institutions. MAIN OUTCOME MEASURES: Details of primary surgery were abstracted from clinical records of the original hospital referral. Postoperative clinical course and long-term outcome were evaluated by a review of the hospital records and follow-up. RESULTS: The results of a barium swallow test series was positive in 38 cases (80.8%) and esophagogastroduodenoscopy was primarily diagnostic in 30 patients (63.8%). In all cases duodenal segmentectomy was attempted. Twenty-two patients underwent palliative gastrojejunal bypass and in 9 patients pancreaticoduodenectomy was performed. In 16 cases duodenal segmentectomy was performed after intestinal derotation. Anastomoses were performed manually in all cases. Fifteen of the resected patients died of recurrent disease. A median (SD) disease-free survival of 36 (23.6) months (range, 6-85 months) was observed. The median (SD) overall survival was 37.5 (23.9) months (range, 11-85 months), the overall 5-year survival rate was 23% (11 patients), and the actuarial 5-year survival rate was 51% (24 patients). CONCLUSIONS: Duodenal segmentectomy associated with intestinal derotation was shown to be a straightforward, safe procedure for the treatment of the primary adenocarcinoma of the third and fourth portions of the duodenum. This surgical procedure should be preferred to pancreaticoduodenectomy because it is associated with negligible rates of morbidity and mortality, while allowing for satisfactory margin clearance and adequate lymphadenectomy.

Adenocarcinoma↗
PubMed1984

Primary adenocarcinoma of the duodenum. Report of two cases.

Between 1969 and 1982, two patients were treated for malignant primary tumors of the duodenum in the Central Institute for Tumors and Allied Diseases in Zagreb. Adenocarcinoma of the posterior wall of the third part of the duodenum was histologically confirmed in the first patient. Today, 11 years after surgery and radiotherapy, there are no signs of the disease. Invasive papillary adenocarcinoma of the third part of the duodenum was histologically confirmed in the second patient. This patient died in cachexia 2 years after the diagnosis. The autopsy confirmed the initial diagnosis, and metastasis in the liver and periduodenal lymph nodes. When establishing the differential diagnosis of undefined pathologic processes in this region, one should consider a primary tumor of the duodenum. Palliative surgery can also be valuable in the overall outcome of treatment.

Adenocarcinoma↗
PubMed1995

Villous adenoma of the duodenum in a patient with familial adenomatosis coli.

A case of familial adenomatosis coli with villous adenoma of the third portion of the duodenum, which falls in the category of a Gardner's syndrome, is described. The patient, who had complained of an abdominal mass which had been diagnosed as a desmoid tumor after surgical resection, had numerous adenomatous polyps throughout the colon confirmed by colonoscopy with biopsy. Endoscopic examination of the upper gastrointestinal tract revealed fundic gland polyposis in the stomach and numerous small adenomas in the duodenum. In addition, there was a pedunculated polyp in the third portion of his duodenum, measuring 30 mm in diameter, the surface of which had a cauliflowerlike appearance. The polyp was removed with the electrocautery snare and was histologically diagnosed as villous adenoma. Our case report supports the concept that villous adenoma, which possesses a high malignant potential, may occur in the upper gastrointestinal tract in patients with familial adenomatosis coli, and careful examination of the upper gastrointestinal tract including the distal duodenum seems to be necessary in the follow-up patients with this disease.

Adenoma, Villous↗
PubMed1996

Solitary cavernous hemangioma of the duodenum: report of a case.

Vascular lesions of the duodenum, including hemangioma, are rare causes of gastrointestinal bleeding. We herein describe a 52-year-old woman with a solitary cavernous hemangioma of the duodenum that caused chronic gastrointestinal bleeding. Repeated upper gastrointestinal endoscopy and a barium meal study revealed a solitary vascular tumor in the fourth portion of the duodenum, although the initial investigations including selective angiography were unsuccessful. A wedge resection of the duodenum was performed and microscopical examination showed a cavernous hemangioma. Vascular lesions should therefore also be considered in the differential diagnosis of patients with gastrointestinal bleeding of unknown origin.

Diagnosis, Differential↗
PubMed1999

Laparoscopic resection for ectopic gastric mucosa of the duodenum: report of a case.

We report herein the case of a 53-year-old man in whom ectopic gastric mucosa was successfully resected laparoscopically. Radiography and endoscopy showed a well-demarcated and sessile polypoid lesion measuring 2.0 cm in diameter in the second part of the duodenum. Under the diagnosis of a submucosal tumor of the duodenum, a wedge resection of the duodenum was performed laparoscopically. Subsequent histological examination revealed that the tumor was ectopic gastric mucosa of the duodenum.

Choristoma↗
PubMed1997

[Duodenum-preserving pancreatic head resection--a standard method in chronic pancreatitis].

In patients with chronic pancreatitis the inflammatory process in the pancreatic head is frequently the pacemaker of the disease. In these cases an inflammatory tumor develops which leads to local complications in half of the patients. Duodenum-preserving pancreatic head resection, contrary to procedures used in the past, offers the possibility to preserve stomach, duodenum, biliary tree, and the insulin secretory capacity. Duodenum-preserving pancreatic head resection is a subtotal resection of the pancreatic head. In a series of 380 patients the hospital mortality rate was 0.8%, the frequency of reoperation 5.3%, and the median hospitalisation time 13.9 days. The early postoperative glucose metabolism was deteriorated in 2% and improved in 9% of cases. After a median follow-up time of 6 years, 88% of the patients were completely painfree or suffered pain rarely. Sixty-three percent were gainfully employed; the late mortality was 8.9%. Only 10% of the patients had further bouts of pancreatitis. The decisive advantage of duodenum-preserving pancreatic head resection over Kausch-Whipple resection is preservation of the endocrine pancreatic function and of neighbouring organs.

Blood Glucose↗
PubMed1998

[Duodenum-preserving resection of the pancreas head in treatment of benign tumors of the pancreas head].

Benign tumors of the pancreatic head are normally treated by a partial duodenopancreatectomy. This operation has been developed for the treatment of malignant alterations in the pancreatic head and includes resection of the gastric bowel, duodenum and common bile duct. The aim of this study was to evaluate whether the less radical duodenum-preserving pancreatic head resection is a suitable surgical procedure in the treatment of benign pancreatic head tumors. From May 1982 to December 1996, seven patients underwent surgical treatment for benign pancreatic head tumors. Two patients suffered from gastrinoma of the pancreatic head, four exhibited a serous or mucinous cystadenoma, and one patient suffered from an intraductal papillary-mucinous tumor in this region. All patients were treated by duodenum-preserving pancreatic head resection. The operation was easily performed with little blood loss and a low rate of complications. None of the patients had to be reoperated upon due to postoperative surgical complications. After a follow-up period of a median 3 years, six of seven patients were had no recurrence of the disease and were symptom-free. One patient who had initially been operated on for gastrinoma still exhibited high gastrin values postoperatively. The endocrine and exocrine pancreatic function was not impaired in the early and late postoperative phase as compared to the preoperative assessment. From our results, it is concluded that duodenum-preserving pancreatic head resection is an adequately radical, yet organ-preserving procedure for the treatment of benign tumors of the pancreatic head without compromising endocrine and exocrine function.

Cystadenoma, Mucinous↗
PubMed1994

Preoperative chemoradiation for adenocarcinoma of the pancreas and duodenum.

PURPOSE: This study was designed to evaluate the effects of preoperative chemoradiation on resectability, response, local control, and survival in patients with local or local-regional involvement from carcinoma of the pancreas or cancer of the duodenum and to assess the associated toxicity of such treatment. METHODS AND MATERIALS: This prospective pilot study of preoperative chemoradiation was initiated in 1986 for patients with clinical evidence of adenocarcinoma of the pancreas or duodenum without evidence of distant metastases. Radiation was given at 1.8 Gy per day to a total dose of 50.4 Gy. Two cycles of chemotherapy were given concurrent with radiation. On days 2-5 and 29-32, 5-fluorouracil (1 gm/m2/24 h x 4 days) was given, while mitomycin-C (10 mg/m2) was given on day 2 only. Surgical resection was 4-6 weeks following completion of chemoradiation. Thirty-one patients (17 male and 14 female) were entered on the protocol with a median potential follow-up of 4.5 years (range 6 months to 7.5 years). The median age was 64 years (range 32-73 years). Twenty-seven patients had pancreatic cancer (25 head, two body), while four patients had carcinoma arising from the duodenum. Twenty-one patients were initially judged to be unresectable and ten potentially resectable prior to chemoradiation. RESULTS: Twenty-nine of 31 patients completed the entire course of radiation and both cycles of chemotherapy. Acute toxicity from chemoradiation consisted of nausea, vomiting, diarrhea, stomatitis, or hematologic suppression which was moderate to severe (Grade 3 or 4) in seven patients (23%). One patient died of sepsis following the first week of therapy. Seventeen patients (55%) underwent curative resection with subtotal or total pancreatectomy or Whipple resection (four duodenum, 13 pancreas) and two (2/17) had pathologic nodal involvement, while (0/17) none had involved margins. A complete pathologic response was seen in all four (4/4) patients with duodenal cancer and in none (0/13) with pancreatic cancer who underwent resection. The median postoperative hospitalization stay was 22 days (range 4-144 days). Of 17 patients who underwent curative resection, there were two postoperative mortalities (12%). Late complications have included abscess, one; and nonmalignant ascites, five. Ten of the 31 patients are alive. For patients with pancreatic cancer the median survival is 9 months, while survival at 1 year and 3 years are 36% and 19% overall and 60% and 43% at 1 and 3 years for those undergoing resection. Six of the 27 patients (22%) with pancreatic cancer are alive without recurrence. All four patients with duodenal cancer are alive without recurrence (12 months, 23 months, 35 months, 90 months). CONCLUSION: Preoperative chemoradiation for cancer of the pancreas and duodenal region was relatively well-tolerated and enhanced resectability and downstaging of nodal metastases were suggested. The 3-year survival, particularly in patients who underwent resection, was high. For these reasons the applicability of this treatment regimen for pancreatic cancer is presently being studied in a group-wide multi-institutional Phase II trial. Chemoradiation for duodenal cancer has produced a complete pathologic response in all patients and survival has been excellent, suggesting efficacy of this regimen for duodenal cancer.

Adenocarcinoma↗
PubMed1995

Randomized trial of duodenum-preserving pancreatic head resection versus pylorus-preserving Whipple in chronic pancreatitis.

BACKGROUND: In about 30% of patients, chronic pancreatitis leads to an inflammatory enlargement of the pancreatic head with subsequent obstruction of the pancreatic duct, common bile duct, and duodenum. METHODS: In a prospective, randomized controlled trial, we compared duodenum-preserving pancreatic head resection (DPPHR) with pylorus-preserving Whipple (PPW) operation to define the advantages of each operation with regard to (1) postoperative complications, (2) glucose tolerance and induction of diabetes mellitus, and (3) postoperative pain and quality of life up to 6 months after operation for chronic pancreatitis. RESULTS: The two study groups of 20 patients were both well balanced with regard to sex, age, history of chronic pancreatitis, and indication for surgery. Postoperative mortality was zero. After duodenum-preserving and pylorus-preserving resection, morbidity was 15% and 20%, respectively. After 6 months, patients who underwent the duodenum-preserving resection had less pain, greater weight gain, a better glucose tolerance, and a higher insulin secretion capacity. CONCLUSION: The DPPHR compares favorably with the standard PPW operation and should be considered as an alternative procedure in the treatment of chronic pancreatitis.

Adult↗
PubMed1976

[The manifestations of regional enteritis (Crohn's disease) in the stomach and duodenum (author's transl)].

Involvement of the stomach and duodenum is relatively rare, but produces distrinct radiological changes. In the stomach the antrum and pyloric portion are affected most frequently. Simultaneous involvement of the duodenum is common. Typical radiological changes consist of funnelshaped narrowing of the antrum, decreased motility of the wall of the stomach, cobblestone mucosa with flat ulcers, deformity of the pylorus and first part of the duodenum and stenosing lesions of the duodenum. If the gastro-duodenal changes occur together with the typical appearances in the jejunum, ileum and colon, then the diagnosis can be made by radiology alone.

Adolescent↗
PubMed2000

Increased incidence of follicular lymphoma in the duodenum.

The incidence of indolent lymphomas in the lymph nodes and extranodal regions is quite different. Follicular lymphoma (FL) is most common in the nodes, and it seems to be least common in the gastrointestinal (GI) tract, where mucosa-associated lymphoid tissue lymphoma arises most frequently. The authors report that the incidence of FL is unexpectedly high in the duodenum compared with other portions of the GI tract. FL was detected in only eight of 222 cases of GI lymphoma (3.6%). However, five cases of FL arose in the duodenum, which accounted for 38.5% of 13 duodenal lymphomas. Only in two patients did FL arise in either the stomach or the colorectum, and in the remaining patients FL was widespread with lymphomatous polyposis. Duodenal FL was composed of neoplastic follicles with small cleaved cells in dominance, and the immunophenotype of the lymphoma cells was CD10+, BCL-2+, CD20+, CD75+, CD79+, CD3-, CD5-, cyclin D1-, CD23-, and CD45RO-. All the patients were women age 37 to 66 years (average age, 52.4 yrs). In all patients the lymphoma was present around the ampulla of Vater, and four of five patients showed multiple small-size polyps. Although lymphoma cell infiltration was confined to the submucosa in the four patients examined, the regional lymph nodes were involved partially in two patients without distant metastasis. All patients are alive at 2 to 50 months of follow up (average, 27 mos), which is comparable with the prognosis for indolent nodal lymphomas. These results suggest that the duodenum has a distinct background of histogenesis of the lymphomas and that biopsy specimens from the duodenum with multiple polyps should be examined carefully.

Adult↗