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PubMed1994

[Adenocarcinoma of the duodenum. Contribution to the study of a rare pathology].

Primary adenocarcinoma of the duodenum is a rare lesion and represents 0.35% of all tumors of the gastrointestinal tract. 75% of the primary tumors of the duodenum are adenocarcinomas and 33-45% of the adenocarcinomas of the small bowel arise in the duodenum. The incidence of these tumors has been estimated to be 0.03%. The diagnosis is usually made at a very late stage because the symptoms are often non-specific. The mean diagnostic delay between beginning of symptoms and the diagnosis is of 10 months. Oesogastroduodenoscopy is the diagnostic procedure of choice and upper GI series is still of interest since it permits a topographic analysis of the lesion. Pancreatico-duodenectomy is recognized by a majority of authors as the standard curative procedure, in the absence of regional nodes. Survival after pancreaticoduodenectomy in the absence of local lymph node invasion is 68% at 5 years whereas there is no survivor after 3 years when there is regional invasion of the lymph nodes. Survival rates after palliative excisions are generally of 15 months, after bilio-digestive derivation of 6 months. Radical excision is preferable in as much as it is technically feasible.

Adenocarcinoma↗
PubMed1993

Evidence for the participation of the L-arginine-nitric oxide pathway in neurally induced relaxation of the isolated rat duodenum.

1. Electrical field stimulation (EFS) of intrinsic nerves in the rat proximal duodenum induces a frequency-dependent non-adrenergic-non-cholinergic (NANC) relaxation response. 2. The inhibitors of L-arginine-NO synthase L-NG-nitro arginine methyl-ester (L-NAME) and L-NOARG (L-NG-nitro arginine) reduced the NANC relaxations elicited by EFS in a dose- and time-dependent manner; L-NOARG was two times more potent than L-NAME (IC50 = 14.3 vs 25.2 microM) and these effects were partially reverted by the addition of 300-1000 microM L-arginine but not of 300-1000 microMD-arginine. Relaxation caused by vasoactive intestinal peptide (VIP; 0.1 microM) or ATP (20 microM) was not blocked by L-NAME or L-NOARG. 3. The magnitude of the blockade caused by L-NAME and L-NOARG was dependent on the frequency of stimulation. At low frequencies (below 1 Hz) both L-NAME and L-NOARG abolished the relaxations, while at 2 to 8 Hz only partial inhibition was observed (maximal inhibition: 44.6% +/- 5.2 and 63.4% +/- 3.4, respectively) 4. The basal tonus of the duodenum was increased by 10-300 microM L-NAME and 10-300 microM L-NOARG and this effect was blocked by 1 mM L-arginine. 5. Nitric oxide generated from acidified NaNO2 caused a dose-dependent (EC50 = 2.75 microM) relaxation of the duodenum which was not affected by 100 microM L-NAME, 100 microM L-NOARG or 1 microM tetrodotoxin (TTX). 6. NADPH-diaphorase positive neurons and fibers identified by histochemistry were present in the myenteric plexus and along both circular and longitudinal muscle fibers indicating that nitric oxide could be synthetized by these neural structures.

Animals↗
PubMed1993

[Role of Helicobacter pylori infection in gastric metaplasia in the duodenum in the production of duodenal ulcer].

Helicobacter pylori (H. pylori) is frequently detected in not only the antrum but also the gastric juice and the duodenum with gastric metaplasia, which is believed to be a response of duodenal mucosa to injury by hyperacidity, in most of duodenal ulcer patients. Conversely, the normal duodenum is not infected with H. pylori in non-duodenal ulcer patients, even if H. pylori is present in the antrum and/or the gastric juice. All patients with H. pylori in the duodenum has the H. pylori infection in the gastric antrum. Patients with H. pylori in the gastric juice also has H. pylori infection in the antrum. These findings may support the following hypothesis in the formation of duodenal ulcer. A high duodenal acid load leads to the formation of gastric metaplasia in the duodenal bulb, where can be easily infected by gastric H. pylori through the gastric juice. As a result of the duodenal colonization of H. pylori, the duodenal mucosa impaired by ammonia of H. pylori could has the formation of duodenal ulcer.

Duodenal Ulcer↗
PubMed1993

The effect of erythromycin on motility of the duodenum, sphincter of Oddi, and gallbladder in the prairie dog.

BACKGROUND: Interdigestive motility of the stomach, duodenum, sphincter of Oddi, and gallbladder is mediated through the migrating myoelectric complex and the action of motilin. Erythromycin, a motilin agonist, has recently been studied as a gastrointestinal and biliary prokinetic agent. We hypothesized that erythromycin would increase interdigestive duodenal and sphincter of Oddi motility in a dose-dependent manner. METHODS: In 10 anesthetized prairie dogs we determined the motility responses of the duodenum, sphincter of Oddi, and gallbladder to erythromycin infusion during a three-log dosing regimen and correlated activity with serum concentrations of the drug. RESULTS: Erythromycin administered at 0.01 and 0.1 mg/kg had no effect on duodenal or sphincter motility. At 1.0 and 10 mg/kg, duodenal motility index increased by 451% +/- 114% and 1070% +/- 480%, respectively, when compared with baseline values, (p < 0.05). Sphincter of Oddi motility index increased by 122% +/- 38% and 323% +/- 99%, respectively, at these same doses of erythromycin (p < 0.05). Gallbladder pressure did not change significantly during erythromycin infusion. Erythromycin serum concentration at 1.0 mg/kg was 1.0 +/- 0.7 micrograms/ml. CONCLUSIONS: These data suggest that erythromycin stimulates interdigestive motility of the duodenum and sphincter of Oddi in a dose-dependent manner at otherwise subtherapeutic concentrations of the drug.

Animals↗
PubMed1993

Duodenum-preserving pancreatoduodenostomy. A new technique for complete excision of the head of the pancreas with preservation of biliary and alimentary integrity.

A new technique for complete excision of the head of the pancreas with preservation of the biliary and digestive tract is described. A series of 11 patients with chronic pancreatitis, pancreatic divisum, or a low-grade malignancy (mucus-producing pancreatic cancer) who underwent the procedure is reported. Previously described techniques for "duodenum-preserving pancreatic resection" differ from ours in two ways. First, other techniques accomplished only a "partial resection", retaining a rim of pancreas along the duodenum, and second, the pancreatoenteric anastomosis utilized a Roux-en-Y jejunal loop. Our procedure permits complete resection of the pancreatic head, which in turn permits a pancreatoduodenal anastomosis. This preserves the normal physiology of pancreatic digestive function. To assure an adequate blood supply to the duodenum, retroperitoneal vessels must be preserved by avoiding Kocher's maneuver, and the posterior superior pancreatoduodenal artery must also be preserved. This operation was successfully performed in 8 consecutive patients when these provisos were adhered to.

Anastomosis, Surgical↗
PubMed1997

Bezoar formation and malabsorption secondary to persistent dilatation and dysmotility of the duodenum after repair of proximal jejunal atresia.

Bezoar formation is a rare but well-recognised complication of previous gastric surgery and persimmon ingestion. We present a case of bezoar formation in the duodenum of a child with a grossly dilated, dysmotile duodenum following surgery for jejunal atresia. The presenting symptoms were vomiting, diarrhoea, and growth failure, with evidence of malabsorption secondary to bacterial overgrowth in the bezoar. Plication of the duodenum to reduce its size and improve its motility may reduce the likelihood of future bezoar formation.

Bezoars↗
PubMed1997

[Localization and expression of dopamine receptors in stomach and duodenum in rats].

UNLABELLED: Dopamine is an important neurotransmitter which may contribute to the regulation of gastrointestinal function, but its mechanism remains elusive. OBJECTIVE: The existence, localization and expression of dopamine receptor mRNAs in rat stomach and duodenum were examined by in situ hybridization. METHODS: The oligonucleotide probes were selected and synthesized according to the previous work. All the probes were labelled with alpha S35dATP using the terminal deoxynucleotide transferase, then were hybridized with the frozen, fixed preparation of rat stomach and duodenum. The density of silver granules were counted and analyzed by the image analysis computer system. RESULTS: It was found that all five subtypes of dopamine receptor mRNAs existed in the stomach and duodenum with greatly different expression. The distribution of dopamine mRNAs in the stomach were mainly localized in the lamina propria near the lamina muscularis mucosae and parallel to the longitudinal axis of the tract. Whereas, all five MRNAs were spread over the entire layer of the duodenal mucosa. With the image analysis system, abundant expressing levels of D5 and D4 mRNAs were documented unexpectedly. CONCLUSION: All these results suggest that dopamine produced its effect via dopamine receptors especially D5 subtype and D4 receptor might be act as a modulator.

Animals↗
PubMed2004

Pancreatic head excavation: a variation on the theme of duodenum-preserving pancreatic head resection.

HYPOTHESIS: Despite the introduction of new methods for duodenum-preserving pancreatic head resection, such as the Beger and Frey procedures, the management of benign lesions of the proximal pancreas remains controversial. We developed a modification of the duodenum-preserving pancreatic head resection in which the proximal pancreatic duct or central core of the pancreatic head is excised by ultrasonic dissection and examined the feasibility, safety, and outcomes of this new procedure. DESIGN AND SETTING: Prospective cohort study in an academic tertiary care referral center. PATIENTS: From April 1, 2001, to September 8, 2003, 6 patients with either chronic pancreatitis (4) or benign tumors of the pancreatic head (2) underwent ultrasonic excavation of the pancreatic head, with reconstruction by a single longitudinal, Roux-en-Y pancreaticojejunostomy. MAIN OUTCOME MEASURES: Safety and cost were assessed by measures of operative time, blood loss, nasogastric drainage, and length of stay. Any complications and the degree of full functional recovery were noted. RESULTS: The technique of ultrasonic excavation of the central pancreatic head is reviewed in detail. Operative time ranged from 344 to 427 minutes (average, 390 minutes); blood loss ranged from 200 to 1300 mL (average, 475 mL); nasogastric drainage ranged from 3 to 5 days; and length of stay ranged from 6 to 8 days. No major complications occurred. Two patients had transient, probable drug-related ileus after discharge. All patients had full functional recovery. CONCLUSIONS: Our modification of the technique of duodenum-preserving pancreatic head resection using ultrasonic dissection and longitudinal reconstruction appears feasible, safe, and effective for benign disease of the proximal pancreas.

Adult↗
PubMed1985

Anomalous drainage of the common bile duct into the fourth portion of the duodenum. Clinical sequelae.

We report two cases of early-childhood anomalous drainage of the common bile duct (CBD) into the fourth portion of the duodenum, which caused recurrent abdominal pain and hyperamylasemia. In both patients, this anomaly was associated with a long common channel between the CBD and the pancreatic duct. The CBD was obstructed by compression from the first portion of the duodenum, which passed anteriorly. Both children required choledochoenteric anastomosis to achieve permanent resolution of the abdominal pain. Elevation of the first portion of the duodenum does not produce permanent relief from symptoms. We believe that these patients represent the first described to have this unusual malformation.

Abdomen↗
PubMed1977

Primary adenocarcinoma of the duodenum.

Primary adenocarcinoma of the duodenum is rare. An extensive experience with fiberoptic esophagogastro-duodenoscopy in our institution has indicated that duodenal neoplasms may be more frequent than suspected and are readily diagnosed by this modality. With this mind, clinical, pathological, diagnostic and therapeutic aspects of the 71 patients with primary carcinoma of the duodenum reported in the literature in the last 10-year period, 1965-1974, were reviewed. It would appear that fiberoptic endoscopy of the upper gastro-intestinal tract should become the major diagnostic tool for this disease. It enables biopsies, brushings and washings to be taken. A preoperative histological diagnosis ensures that both patient and surgeon can be prepared for major abdominal surgery. It is imperatire that during the endoscopic examination, the entire duodenum be examined. Pancreatico-duodenectomy appears to offer the best chance of long term survival in patients whose lesion is resectable. The role and value of adjuvant chemo- and radiotherapy is still to be determined.

Adenocarcinoma↗
PubMed1984

[Duodenum-sparing pancreas head resection in chronic pancreatitis--results after 10 years' use].

During a ten years period duodenum preserving pancreatic head resection was performed in 56 patients with chronic pancreatitis and related pancreatic head tumor. Immediate lethality was 1.8%, rate of reoperation 3.6%, late lethality after an average follow-up of 24 months (minimum 1, maximum 124 months) 3.6%. At the time of follow-up 87.3% of the patients were back at work, 58% were free of abdominal symptoms, 7.4% complained about occasional to frequent abdominal pains. 72.9% gained weight postoperatively. Duodenum preserving pancreatic head resection constitutes the subtotal resection of the pancreatic head and jejunal interpostition for the parenchymal defect. The procedure is advantageous as compared to Whipple's operation in so far as stomach, duodenum and bile duct remain intact.

Adult↗
PubMed1981

Direct metastatic spread of right colonic adenocarcinoma to duodenum--barium and computed tomographic findings.

Contiguous involvement of the duodenum from primary right-sided colonic neoplasms is relatively uncommon. More rarely, metastatic involvement of the duodenum occurs after resection of a primary carcinoma of the right colon. Until recently, the radiological assessment of this pathologic process has been limited to barium gastrointestinal imaging techniques. Three cases of primary right colonic tumors metastasizing to the duodenum are presented, and barium studies are correlated with CT findings in 2 of these cases.

Adenocarcinoma↗
PubMed1994

Lymphangioma of the duodenum: report of a case.

A case of lymphangioma of the duodenum with a successful preoperative diagnosis is reported herein. A 76-year-old man who complained of tarry stool was found to have a hemorrhagic polypoid tumor in the third portion of the duodenum. The tumor was diagnosed histologically as cavernous lymphangioma by endoscopic biopsy. Since such a tumor is essentially benign, a partial resection of the duodenum including the tumor was performed. Therefore, an endoscopic biopsy seems to be valuable in the diagnosis of duodenal lymphangioma.

Aged↗
PubMed1997

[Duodenum preserving resection of the head of the pancrease in therapy of pancreas divisum].

In 1-6% of the patients who are investigated by endoscopic retrograde cholangio-pancreatography a pancreas divisum can be found. In some patients pancreas divisum can lead to an acute relapsing and finally chronic pancreatitis (CP). Surgical intervention in these cases seems to offer a good chance of recovery. We report our experience with the duodenum-preserving resection of the head of the pancreas in 12 patients with pancreas divisum and CP. In all patients the preoperative evaluation showed clinical, functional or radiological signs of CP. The duodenum-preserving resection of the head of the pancreas was carried out in all patients without perioperative mortality. Ten postoperative versus eight preoperative patients showed a pathological exocrine function of the pancreas. Endocrine function, measured by the oral glucose tolerance test (OGTT), improved postoperatively in two patients. Eleven patients who were investigated after a mean follow-up time of 31 months (3-75 months) were completely pain free. No late mortality occurred. OGTT revealed a diabetic endocrine function in two patients. Disturbed exocrine pancreatic function had to be substituted in nine patients. One patient had to be reoperated by duct incision and renewal of the pancreatico-jejunostomy 10 months after the first operation. In conclusion, the duodenum-preserving resection of the head of the pancreas reduced pain in all patients with pancreas divisum and CP and may lead to an improvement of endocrine pancreatic function. Other, nonresecting procedures or endoscopic interventional therapy should be avoided in these patients.

Adult↗
PubMed2006

Mucinous carcinoma of the duodenum associated with hereditary nonpolyposis colorectal cancer: report of a case.

We herein report a rare case of primary mucinous carcinoma of the duodenum associated with hereditary nonpolyposis colorectal cancer (HNPCC). A 50-year-old man known to have HNPCC based on the Amsterdam criteria I was admitted because of the presence of a duodenal tumor. Duodenoscopy revealed an ulcerated tumor in the posterior wall of the second portion of the duodenum and the malignancy was confirmed by a biopsy. He underwent a pylorus-preserving pancreaticoduodenectomy with a regional lymph node dissection. The histological diagnosis was mucinous carcinoma of the duodenum with lymph node metastasis. High-frequency microsatellite instability (MSI-H) was identified in both the colon and a duodenal specimen based on a microsatellite assay. A germline mutation in the hMSH2 gene was also identified. Even though extracolonic malignancies are associated with HNPCC, duodenal cancer is nevertheless very rare, and only two cases have been reported over the past 20 years. The present case is therefore only the third such case and the patient is herein described with a brief review of the literature.

Adenocarcinoma, Mucinous↗
PubMed2000

Synchronous multiple primary cancers of the stomach and duodenum in aged patients: report of two cases.

We describe herein the cases of two aged patients found to have synchronous multiple primary cancers of the stomach and duodenum. The first patient was an 82-year-old man who was preoperatively diagnosed as having gastric cancer after presenting with signs of pyloric stenosis. At laparotomy, duodenal cancer was incidentally found to have infiltrated the transverse colon. A pancreatoduodenectomy and right hemicolectomy with radical lymph node dissection was performed. Two early well-differentiated adenocarcinomas of the stomach and an advanced poorly differentiated adenocarcinoma of the duodenum were confirmed. This patient is now well without any evidence of recurrence more than 5 years after surgery. The second patient was a 77-year-old man who was also diagnosed as having gastric cancer after presenting with signs of pyloric stenosis. Preoperatively, duodenal cancer was detected by endoscopy. A pancreatoduodenectomy and partial colectomy with radical lymph node dissection was performed because the duodenal cancer was suspected of having infiltrated the transverse colon. An early moderately differentiated adenocarcinoma of the stomach and an advanced moderately differentiated adenocarcinoma of the duodenum were confirmed, but the duodenal cancer was not seen to invade the transverse colon microscopically. This patient died of cancer 7 months after surgery. Because multiple primary cancers commonly develop in elderly patients, a precise preoperative diagnosis must be made and optimal treatment applied.

Adenocarcinoma↗
PubMed1986

Aberrant insulinoma in the duodenum.

A rare case of aberrant insulinoma in the duodenum is described. Hyperinsulinemia with typical hypoglycemic symptoms was induced by prolonged fasting. Selective angiography demonstrated a tumor supplied from the first branch of the jejunal artery, and duodenoscopy revealed a submucosal tumor at the third portion of the duodenum. An increase in venous plasma immunoreactive insulin concentration was evident in the vein draining from the tumor, by sampling through percutaneous transhepatic catheterization. Hypoglycemia was ameliorated after the removal of the submucosal tumor of the duodenum. Histologic and immunocytochemical characterization of the tumor showed an insulinoma, predominantly composed of cells with typical B-cell-like granules. The acid extract of the tumor contained 1.2 U/g of insulin, and this insulin, analyzed by reverse-phase high-pressure liquid chromatography, revealed that it had the same amino acid structure as that of human insulin.

Adenoma, Islet Cell↗
PubMed1986

Recurrent villous adenoma of the duodenum.

A patient is presented who in 1977 had a villous adenoma of the duodenum presenting with a diarrheal syndrome. Surgical removal of the polypoid mass lesion, which was pathologically a benign villous adenoma, resulted in resolution of her diarrhea. She remained asymptomatic until 6.5 yr later when diarrhea recurred. Radiographic and endoscopic examinations revealed a large villous adenoma within the proximal duodenum. After endoscopic polypectomy, her diarrhea promptly ceased. This is the first reported case of diarrhea associated with a villous adenoma of the duodenum.

Adenoma↗