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PubMed2005

Primary malignant fibrous histiocytoma of the small bowel: a report of an additional case in duodenum.

AIMS: We report herein an additional case of primary malignant fibrous histiocytoma (MFH) in the duodenum and provide a review of the existing literature. METHODS AND RESULTS: A 61-yr-old Chinese man was admitted to our hospital with symptoms of melena, anorexia, and weight loss. An abdominal computed tomography (CT) and gastrointestinal barium meal examination demonstrated a tumor of the duodenum suggestive of primary malignancy. The tumor was successfully treated by pancreaticoduodenectomy. It was histopathologically and immunohistochemically diagnosed to be a storiform-type primary MFH of the duodenum. There have been a total of 40 cases of primary malignant fibrous histiocytoma of the small bowel documented in the literature including our Chinese cases. CONCLUSION: Primary malignant fibrous histiocytoma of the small bowel, especially in the duodenum is extremely rare. The final diagnosis is made only after pathological and immunopathological examination of the tumor. The malignant potential of such tumors is high. The prognosis may be mainly dependent on the invasion and metastasis of tumor, while tumor size is irrelevant. The treatment should be surgery if possible. Early surgical intervention may be the best form of management that may offer the patient good result.

China↗
PubMed2006

A primary follicular lymphoma of the duodenum treated successfully with radiation therapy.

A 48-year-old man was admitted to our hospital because of repeated episodes of epigastralgia. Endoscopy showed multiple whitish granules extending from the 2nd to 3rd portion of the duodenum. Biopsy specimens showed well circumscribed follicles with a monotonous population of predominantly small cleaved cells that were positive for CD20, CD10 and BCL2, but negative for CD5. A full staging study showed no abnormalities. The tumor was finally diagnosed according to the WHO classification as a stage I follicular lymphoma (FL), grade 1, of the duodenum and subsequently received irradiation to the involved area. After 3 years of followup, he is still in complete remission. Because FL arising in the duodenum has recently reported with increasing frequency, patients with multiple granules in the duodenum should be examined carefully.

Duodenal Neoplasms↗
PubMed1994

The influence of restricted feeding on site and extent of digestion and flow of nitrogenous compounds to the duodenum in steers.

The effects of restricted feeding on site and extent of digestion, flow of N-containing compounds to the duodenum, and ruminal metabolism were determined. In Trial 1, corn silage-based diets were fed at one of three intakes to three ruminally and duodenally fistulated steers (420 +/- 4.4 kg BW) in a repeated 3 x 3 Latin square experiment. Feeding levels were 100% of ad libitum intake, 90% of ad libitum intake, and 80% of ad libitum intake. Site of digestion was not affected by restricted feeding; however, extent of DM, NDF, and apparent N digestion were increased (P < .03) 2.8, 4.1, and 6.2 percentage units for each 1-kg restriction in DM intake. Restricted feeding increased (P < .06) ruminal pH and ammonia concentrations, decreased (P < .05) ruminal liquid dilution rate, and had no major effects on bacterial concentrations. In Trial 2, all-concentrate diets based on whole shelled corn were fed at 100, 90, or 80% of ad libitum intake to six ruminally and duodenally fistulated steers (440 +/- 4.1 kg BW) in a replicated 3 x 3 Latin square experiment. Restricted feeding increased (P < .06) apparent ruminal DM digestion; however, true ruminal OM digestibility was not affected. Extent of apparent N digestion increased 3.0 percentage units for each 1-kg restriction in DMI. Ruminal pH was not affected by restricted feeding; however, ruminal ammonia concentrations increased (P < .06) and ruminal liquid dilution rate decreased (P < .04) with restricted feeding. In both Trials, total N flow to the duodenum was approximately 100% of N intake for the 80% of ad libitum intake. Flow of N exceeded N intake in a linear (P < .01) manner as DMI increased. Decreases in duodenal N flow when intake was restricted resulted from decreases (P < .01) in bacterial N flowing to the duodenum, and also in decreases (P < .01) in non-ammonia, non-bacterial N flow when whole shelled corn-based diets were fed. We concluded that restrictions in digestible energy intake are less than the DM restriction when corn silage-based diets are fed but are equal to the DM restriction when whole shelled corn-based diets are fed. Also, restricted feeding strategies reduce the flow of N to the duodenum from both bacterial and feed origins.

Animal Feed↗
PubMed1999

[Pancreatic and colonic simultaneous or successive resections of tumors in both organs, duodenum infiltrating colon carcinoma and pancreas tail carcinoma invading left colon. Report 10 cases].

Two patients with cancer of the right colon fistulized in duodenum underwent simultaneous right hemicolectomies and cephalic duodenopancreatectomies. There were no important post-operative complications and they are both alive eleven and ten years after surgery. In another case a piece of duodenum adherent to colon was resected and the duodenum was transversally sutured, segments IV and V of the liver were also resected because of a infiltration. The patient is well more than three years after surgery. Another similar patient who underwent resection of a part of the duodenum during a right hemicolectomy due to adenocarcinoma, developed the head of the pancreas ten months later which was resected by means of a cephalic duodenopancreatectomy. He survived the second operation for three years and a half and died with carcinomatosis. A fourth female patient who had been referred due to jaundice caused by cephalopancreatic cancer was reoperated two months later with resection of the tumor Seven months after duodenopancreatectomy she underwent another operation for resection of a bleeding cancer of the rectum by means of anterior resection. She survived for four and a half years. Cancers of body and tail of the pancreas sometimes invade the left colon and make necessary resection in the same operation. This happened in four other cases. In two of them it was necessary to resect stomach and the first jejunal loop. Respective survivals were of two years and nine months in two cases, others are 4111 alive more than two years after surgery. But the fourth case, who had an acinar carcinoma, died a month later with en hepatic metastasis which grew rapidly. The opposite happened to the tenth patient because colon cancer invaded pancreas and stomach, that were partially resected. The patient is alive two and a half years later.

Adult↗
PubMed1992

Evaluation of metoclopramide hydrochloride as an aid for passage of a flexible endoscope into the duodenum of dogs.

The purposes of this study were to evaluate the efficacy of metoclopramide to aid passage of a flexible endoscope into the duodenum of dogs, and to determine whether the effect of metoclopramide is dependent on dose. In a randomized, blinded, complete-block design, 6 healthy dogs were anesthetized, then each was given saline solution or 1 of 4 doses of metoclopramide on different days. The ease of passage of a flexible, fiberoptic gastroscope through the pylorus was assessed independently by 3 endoscopists. Administration of metoclopramide hydrochloride at a dosage of 0.4 mg/kg of body weight, iv, made passage of a flexible endoscope into the duodenum significantly (P = 0.009) more difficult than when saline solution was administered; however, dosages of 0.1, 0.2 and 0.8 mg of metoclopramide/kg did not (P = 0.489, 0.842, and 0.092 respectively). It was concluded that metoclopramide did not facilitate, and at one dosage hindered, successful passage of a flexible endoscope into the duodenum of healthy dogs under the conditions of the study. Metoclopramide, therefore, cannot be recommended as an aid for passage of a flexible endoscope into the duodenum of dogs.

Animals↗
PubMed2006

[A case of flat elevated type carcinoma in adenoma of the duodenum with gastric cancer].

Duodenal adenoma is rare, and there have been very few case reports of flat elevated type adenoma. We report a case of flat elevated type carcinoma in adenoma of the duodenum with gastric cancer. A 58-year-old man was referred to our hospital for gastric cancer. Endoscopic examination revealed the gastric cancer and a flat elevated tumor in the descending part of the duodenum, measuring 6 cm in diameter. The biopsy specimen of the duodenal lesion was diagnosed as adenoma. Distal gastrectomy and segmental partial resection of the duodenum were performed with no complication. Histologically, the gastric cancer was poorly differentiated adenocarcinoma with submcosal invasion and without lymph node metastasis, and the duodenal tumor was a well differentiated carcinoma in villous adenoma. The duodenal adenocarcinoma was limited to the mucosal layer and the resected margins were free of tumor. It is difficult to distinguish a carcinoma from a benign elevated lesion in the duodenum. Therefore, a resection of the whole tumor is necessary. Though endoscopic resection is the first choice of therapy, a surgical partial resection is necessary when it is difficult. Then, a segmental resection may be one of the useful procedures of surgery.

Adenocarcinoma↗
PubMed1989

[Ph measurement in the stomach and duodenum through endoscopy].

The pH values were measured by means of a flexible glass-electrode through endoscope in the stomach and duodenum. The measuring instrument and technique are described. The luminal and juxtamucosal pH values were determined. The latter indicates the pH value prevailing on the epithelial surface of the viscid mucous layer. The gradient between the two values expresses the hydrogen-ion neutralizing capacity of the viscid mucus on the surface of the mucosa. Quantitative data on the first protective line of the gastric and duodenal mucous membrane may be obtained by measuring it. The pH values at different points of the stomach and duodenum were determined through endoscope in 24 patients with duodenal ulcer and in 15 controls. No significant difference was found between the two groups concerning the gastric luminal pH values, however the luminal pH of the duodenal bulb was significantly lower in patients with duodenal ulcer than that of the controls. In patients with duodenal ulcer the juxtamucosal pH value was significantly lower at several points in the stomach and in the duodenum too as compared to the controls. This refers to the insufficient neutralizing capacity of the viscid mucous layer. The pH measurement performed through endoscope furnishes in a simple way valuable clinical data, it is furthermore the first quantitative method which can be used routine-like for the examination of the barrier function of the viscid mucous surface in the stomach and duodenum of man.

Adult↗
PubMed1988

Carcinoma of the duodenum.

Primary carcinoma of the duodenum is an uncommon tumor of the gastrointestinal tract. We reviewed the histories of ten patients seen between 1976 and 1986. Some of the patients with tumors in the second part of the duodenum presented with clinically evident jaundice. The symptom complex of all other patients was compatible with many benign diseases and made the diagnosis difficult. At laparotomy, seven patients had resectable disease. Two patients had advanced disease so that no curative resection could be done. In one patient, a resection was technically impossible. A modified Whipple procedure (in which the pylorus is saved) is the method of choice for tumors of the second part of the duodenum. We perform a segmental resection for other tumors. In five patients, there was no involvement of the lymph nodes and these patients are well--two more than 30 months postoperatively and one patient almost ten years postoperatively. In two patients, one or more lymph nodes were involved, but they are still well 30 months postoperatively. As the prognosis of carcinoma of the duodenum, once metastasized, is poor, a greater awareness of the possibility of a duodenal tumor must accompany aggressive diagnostic and surgical procedures. That will be the only way to a higher percentage of cures.

Adenocarcinoma↗
PubMed1976

Alien cancers of the duodenum.

Invasion of the duodenum by contiguous cancer or an isolated metastasis can manifest itself with the signs and symptoms of primary cancer of the duodenum. Fourteen patients were identified with this type of diagnostic confusion. All of their tumors were in the second or third portion of the duodenum. Although the median length of survival after excision of the tumor or palliative bypass operations in these patients was nine months, considerably longer survival times have also been described. Barium enema examinations and excretory urograms should be considered as diagnostic tests for any patient with a tumor of the duodenum to identify the contiguous carcinomas of the colon and kidney subject to long palliation.

Adult↗
PubMed1994

Primary non-Hodgkin's lymphoma of the duodenum.

Primary non-Hodgkin's lymphoma of the duodenum is an uncommon primary tumor of the gastrointestinal (GI) tract. Diffuse, large cell lymphoma of B-cell origin is currently recognized as representing the predominant histologic type of primary extranodal lymphoma arising in a gastrointestinal site. Three patients are presented with primary lymphoma arising in the second (two) and fourth (one) portions of the duodenum. Two patients with Stage I-E disease were treated by pancreaticoduodenectomy followed by postoperative radiotherapy, and remain without recurrence at 8 and 6 years. A third patient with Stage II-E disease of the fourth portion of the duodenum was treated with total resection of all bulky disease followed by chemotherapy without radiotherapy. However, this patient died after 46 months. The literature is reviewed, with emphasis on the use of surgical resection in the treatment of non-Hodgkin's lymphoma of the duodenum.

Adult↗
PubMedDate not supplied

[Intraluminal diverticulum of the duodenum. Report of a case and review of published cases].

The intraluminal diverticulum of the duodenum is very rare; it is an anatomical sac like formation, located in the interior of the duodenum and communicating with it through an orifice situated a the upper pole of the diverticulum where the wall is covered by mucosa on both faces. It has interesting etiopathogenic problems. We present an observation after reviewing the corresponding literature. It was a 32-year old woman suffering from moderate epigastric pains, pyrosis, chronic constipation, markedly nervous. The epigastric pain was unrelated to food or physical efforts. The physical examination showed slight epigastric pain. The gastroduodenal radiological examination showed in the second part of the duodenum a particular image, pear-shaped, homogeneous, impregnated in barium; this image was surrounded by a radiotransparent halo which changed with the patient's position. It has been seen that the diverticulum changes in size and position in agreement with the peristaltism, without ever obstructing the passage through the duodenum. A review is made of the literature and history of intraluminal diverticulum.

Adolescent↗
PubMed2003

Duodenum- and spleen-preserving total pancreatectomy for end-stage chronic pancreatitis.

BACKGROUND: Total pancreatectomy may be warranted in patients with advanced chronic pancreatitis in whom partial resection has failed and in those with end-stage pancreatic function. A new operation, duodenum- and spleen-preserving total pancreatectomy, is described. METHODS: Nineteen consecutive patients with chronic pancreatitis who had duodenum- and spleen-preserving total pancreatectomy were studied. RESULTS: There were 15 men and four women with a median age of 40 (range 29-64) years. The aetiology was alcohol misuse in nine, hereditary pancreatitis in five and idiopathic in five patients. All patients had chronic intractable abdominal pain. Six had undergone pancreatic surgery previously and one had had multiple coeliac plexus blocks. There were ten postoperative complications in five patients, and one hospital death. The median hospital stay was 25 (range 10-84) days. There was a reduction in pain (P < 0.001) and analgesic use (P < 0.001) after surgery, and weight gain was noted at 12 and 24 months (P < 0.001). Nine patients required readmission to hospital, four because of surgical complications: adhesional obstruction in one, biliary stricture in two and duodenal obstruction in one. In the other five patients (four of whom had long-standing pre-existing diabetes mellitus) readmission was for better control of pain (three patients), diabetes mellitus (two), and diabetes-associated diarrhoea (two) or gastropathy (one). CONCLUSION: Duodenum- and spleen-preserving total pancreatectomy has a role in selected patients with medically intractable pain from chronic pancreatitis.

Abdominal Pain↗
PubMed1990

Morphological changes of the myenteric plexus neurons in the bullfrog (Rana catesbeiana) duodenum during metamorphosis.

Myenteric plexus neurons of the duodenum in the bullfrog Rana catesbeiana were examined during metamorphosis by the Gros-Bielschowsky silver impregnation method and electron microscopy. Larval type neurons with slender and curved cell soma were recognized in the duodenum of the premetamorphic tadpole. They degenerate and decrease in number during early metamorphic climax through shrinkage of the cell soma and autolysis of the cytoplasm. These larval type neurons reduce to debris and then disappear. Two new cell types (adult type neurons) subsequently appear. These new neurons develop and increase in number during late climax and after metamorphosis. Those that appear first are large type A neurons each with a prominent axon and they stain darkly with silver. They enlarge during late stages. Subsequently small type B neurons appear which stain weakly with silver. They increase the number of their dendrites, change their shape, but enlarge only slightly during late development. In summary, therefore, it is concluded that during metamorphosis, the larval myenteric plexus neurons in the bullfrog duodenum are replaced by two new populations of adult neurons.

Animals↗
PubMed1988

Intraoperative irradiation in a rat model: histopathological changes in irradiated segments of duodenum.

During intraoperative radiation therapy for carcinoma of the head of the pancreas in humans, a portion of duodenum is often at risk for radiation-induced complications because of its fixed anatomical position within the treatment field. This study was undertaken to determine the feasibility of using the rat as a model to determine the radiotolerance of normal mammalian duodenum. The procedures used to exteriorize and irradiate a selected segment of duodenum are described. Histopathologic changes in 5-cm segments of midduodenum were studied 14 and 28 days after 0, 30, 40, or 50 Gy X-radiation. Complete denudation of the epithelium and thickening of the muscularis and serosal layers occurred in all irradiated segments by day 14. By day 28, even though crypt and villus architectures were atypical, large areas of epithelial regeneration were seen in rats receiving 30 Gy. In contrast, complete denudation of the epithelium were still evident along most of the length of the irradiated segments in rats receiving 40 or 50 Gy. Serosal fibrosis was prominent in all irradiated animals, regardless of dose. These results indicate that radiation doses above 30 Gy carry high risks of complications. The rat is considered a suitable animal model.

Animals↗
PubMed1989

The motor response to ethylenediamine of the rat isolated duodenum: involvement of GABAergic transmission?

We have studied the motor response to ethylenediamine (EDA), a well known releaser of endogenous GABA, on the longitudinal muscle of the rat isolated proximal duodenum in presence of atropine (3 microM) and guanethidine (3 microM). EDA produced a concentration-(0.03-3 microM)-dependent relaxation which was potentiated when the preparations were exposed to GABA during the equilibration period. The GABA-induced potentiation of the response to EDA was prevented by nipecotic acid, an inhibitor of GABA uptake. The response to EDA was partially inhibited by 3-mercaptopropionic acid, a known inhibitor of GABA release. However, contrary to the relaxant response produced by exogenous GABA, the EDA-induced relaxation was picrotoxin-(0.1 microM)-resistant. In preparations pre-exposed to GABA, the response to EDA was partially tetrodotoxin-(1 microM)-sensitive. By contrast, in preparations not exposed to GABA, the EDA-induced relaxation was totally tetrodotoxin resistant. The response to EDA was abolished or largely inhibited in preparations excised from rats in which the proximal duodenum was chemically denervated by exposure (2 weeks before), to benzalkonium chloride (BZK). Likewise, the indirect relaxations produced by electrical field simulation. DMPP, capsaicin or GABA were abolished by BZK pretreatment while noradrenaline was still effective. These findings indicate that the relaxant response to EDA is neurogenic in origin, while being largely tetrodotoxin-resistant. A GABAergic mechanism could be involved but also other inhibitory transmitter(s) should be taken into account. EDA appears a useful tool to study the inhibitory non-adrenergic non-cholinergic innervation of the rat proximal duodenum.

3-Mercaptopropionic Acid↗
PubMed1987

Localization of high-affinity GABA uptake and GABA content in the rat duodenum during development.

The localization of high-affinity uptake sites for 3H gamma-aminobutyric acid (3H-GABA) was investigated in the rat duodenum during ontogenesis and also at the adult stage (from 15.5 days of fetal life up to 105 days post natum) by means of low- and high-resolution autoradiography. At all stages studied, specific endocrine cell types of the epithelium were labelled and an intense uptake was detected in the nervous tissue, especially in glial cells but also in scarce neurones. When the incubation medium was supplemented with beta-alanine (1 mM), a blocker of the glial uptake for GABA, the labelling persisted only in endocrine cells and in few neurones. The intensity and the frequency of the labelling decreased at later periods compared to the earlier developmental stages. The GABA content of the duodenum as measured by a new ion-exchange column chromatography-HPLC-coupled method was higher in the early postnatal period compared to later stages. These observations suggest that GABA, in addition to being a neurotransmitter, may play an important role during development of the duodenum.

Aging↗
PubMed1983

Normal development of cells with somatostatin immunoreactivity in the pancreas and duodenum of the rat fetus and newborn. Effect of hypophysectomy and intrauterine growth retardation.

Immunohistochemistry was employed to study the development of somatostatin-containing cells in the pancreas and duodenum of rat fetuses and of 1-7 day-old newborns. Immunoreactive cells were first detected in the pancreatic islets on day 17 of gestation and in the duodenum on day 18. Somatostatin cells were numerous in the pancreas and gut at term and in early postnatal stages. The development of somatostatin-containing cells in both pancreatic islets and duodenum was not affected by either fetal hypophysectomy on day 16 or intrauterine growth retardation induced by ligature of the main uterine vessels on day 17 of gestation.

Animals↗
PubMed1981

Stereological studies on the small intestinal epithelium of the rat. 1. The absorptive cells of the normal duodenum and jejunum.

Quantitative macroscopic, light-microscopic and electron-microscopic studies were performed on the small intestine of fasted and non-fasted adult, male Sprague-Dawley rats. In non-fasted rats the small intestine was longer than in fasted rats. Due to the presence of villi the surface area in the duodenum and the jejunum was enlarged about six times. The microvilli on the villous crests caused a surface enlargement by 13 times in the duodenum (value corrected for overestimation due to section thickness), and 19 times in the jejunum of the fasted rats. At the base of the villi these values were about 50% lower. It was calculated that, in the fasted rats, the total enlargement of the luminal surface area--due to villi and microvilli--was 63 times in the duodenum and 81 times in the jejunum (corrected for section thickness). Differences between the villous crest epithelium and the villous base epithelium were also found with regard to the mean cell height, and the volume densities of the absorptive cell nuclei, the mitochondria, and the paracellular channels.

Animals↗