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PubMed2005

Carcinoid tumors of the duodenum.

BACKGROUND: Carcinoid tumors of the duodenum are rare, and their natural history has not been defined. Consequently, there is no consensus on the optimal extent of surgical treatment. METHODS: The authors reviewed the records of all patients with primary carcinoid tumors of the duodenum treated at their institution from 1969 through 2004. Patients with primary periampullary tumors and gastrinomas were excluded. RESULTS: Twenty-four patients had a pathologic diagnosis of duodenal carcinoid tumor. The majority (89%) of tumors measured less than 2 cm in diameter, and most (85%) were limited to the mucosa or submucosa. Lymph node metastases were identified in the surgical specimen in 7 (54%) of 13 patients in whom lymph nodes were examined, including 2 patients with tumors smaller than 1 cm and limited to the submucosa. At a mean follow-up of 46 months, the disease-specific survival rate was 100%, and only 2 patients have had recurrences in regional lymph nodes. No patient has had distant metastases or the carcinoid syndrome. CONCLUSIONS: Carcinoid tumors of the duodenum are indolent. The presence of regional lymph node metastases cannot be predicted reliably on the basis of tumor size or depth of invasion, and their impact on survival is uncertain.

Adult↗

PubMed1976

[Cyst of the duodenum with termination of the bile and pancreatic ducts (author's transl)].

The radiological findings in a 27-year old female Turkish patient with a cyst in the wall of the duodenum are described. It caused a sharply demarkated, smooth thumb-print in the duodenum shown by barium meal. An intravenous and intra-operative cholangiogram caused filling of the cyst with contrast through the bile duct. The bile and pancreatic ducts terminated on the medial side of the cyst through the papilla of Vater. The size of the cyst varied, depending on its degree of filling with bile and pancreatic juice. Its position and morphology has been confirmed at operation. Histology showed an external cover of small bowel mucosa and an inner lining of small bowel mucosa interspersed with islands of gastric mucosa. The development of this cyst is explained as a developmental anomaly during recalisation of the embryonic duodenum.

Adult↗

PubMed1981

Intramural hematoma of the duodenum in a patient with chronic pancreatitis.

Intramural hematoma of the duodenum is usually caused by blunt abdominal injury. Sometimes this lesion occurs in patients with coagulation disturbances or pancreatic disease such as chronic pancreatitis. There also appears to be a link with alcohol abuse. We describe the case-history of a 45-year-old male with chronic pancreatitis who presented with abdominal pain. The diagnosis of a space-occupying process of the duodenum was made and subsequently a pancreatico-duodenectomy was performed. The duodenum revealed an intramural hematoma, the pancreas showed signs of mild chronic pancreatitis.

Chronic Disease↗

PubMed1980

Crohn's disease of the stomach and duodenum: A clinical study with emphasis on the value of endoscopy and endoscopic biopsies.

The aim of this study was to correlate endoscopic, radiological and pathological observations in 30 patients with Crohn's disease, with involvement of the stomach and/or duodenum. The incidence of gastroduodenal involvement in our patients with Crohn's disease is about 3%. 22 of the 30 patients had intrinsic lesions of the stomach and/or duodenum; in 8 patients the lesions seemed to be produced by involvement from contiguous diseased bowel. Radiological studies and endoscopy of the gastroduodenal region are complementary. Endoscopy allows better visualisation of mucosal defects. Other features, for example a diminished expansion and the presence of contiguity lesions, are better demonstrated by barium meal. The mucosal lesions found at endoscopy are heterogenous, but irregularly-shaped ulcers and erosions in a disrupted mucosal pattern are typical for gastroduodenal Crohn's disease. Pathological examination of endoscopic "forceps"-biopsies permitted a conclusive diagnosis based on the presence of granulomas, in 15/22 (68%) of the cases with intrinsic gastroduodenal disease. This observation indicates that simple forceps biopsy is a very useful diagnostic tool. Involvement of the first part of the duodenum in Crohn's disease was complicated by a biliary fistula in two patients.

Adolescent↗

PubMed1990

Gastrinomas in the duodenums of patients with multiple endocrine neoplasia type 1 and the Zollinger-Ellison syndrome.

In patients with multiple endocrine neoplasia type 1 (MEN-1), gastrinomas are common and thought to occur predominantly in the pancreas. We describe eight patients with MEN-1 and hypergastrinemia (seven with the Zollinger-Ellison syndrome) in whom we searched for neuroendocrine tumors in the pancreas and duodenum. Tumors were found in the proximal duodenum in all eight patients: solitary tumors (diameter, 6 to 20 mm) in three patients and multiple microtumors (diameter, 2 to 6 mm) in the other five. Paraduodenal lymph-node metastases were detected in four patients. Immunocytochemical analysis revealed the presence of gastrin in all the duodenal tumors and in their lymph-node metastases. In contrast, no immunoreactivity for gastrin was present in the endocrine tumors found in the seven pancreatic specimens available for study, except for one tumor with scattered gastrin-positive cells. In four of the six patients whose duodenal gastrinomas were removed, serum gastrin levels returned to normal; in the other two patients gastrin concentrations decreased toward normal. We conclude that in patients with MEN-1 and the Zollinger-Ellison syndrome, gastrinomas occur in the duodenum, but the tumors may be so small that they escape detection.

Adult↗

PubMed1997

Hepatocellular carcinoma with gastrointestinal hemorrhage caused by direct tumor invasion to the duodenum.

Gastrointestinal hemorrhage from hepatocellular carcinoma invading the duodenum is very rare. A 60-year-old man with multiple hepatocellular carcinoma was admitted to our hospital because of massive melena and hematemesis. We succeeded in hemostasis of an esophageal variceal rupture by endoscopic varicial ligation. The duodenum could not be observed endoscopically due to extramural compression to the stomach from the liver tumor. Massive gastrointestinal hemorrhage occurred again and the patient died of hepatic failure. The postmortem examination revealed that the liver tumor had invaded the second portion of the duodenum and perforated into the lumen.

Carcinoma, Hepatocellular↗

PubMed1999

Surgical intervention and understanding of diseases of the stomach and duodenum.

The stomach and duodenum are organs of complex physiology and cell biology. Neoplastic disease of these organs represents a difficult surgical challenge, and gastric and duodenal cancer mortality rates remain high despite advances in surgical technique, perioperative care, and adjuvant therapy. True "cures" elude the surgeon all too often. Fortunately, our understanding of the genetics and molecular biology of upper gastrointestinal neoplasms is increasing and is now significantly affecting the clinical management of these tumors as surgical therapies continue to improve. The care of benign disease of the stomach and duodenum is also evolving as medical therapy and surgical technology improve to lessen the morbidity associated with peptic ulcer disease and other benign conditions. The event that may have the greatest effect on surgical intervention in peptic ulcer disease is the Centers for Disease Control and Prevention launching of an educational campaign to promote treatment of Helicobacter pylori. This article reviews the most significant advances published in the past year on surgical intervention of the stomach and duodenum.

Journal Article↗

PubMed2003

Extraluminal gastrointestinal stromal tumour in the second portion of the duodenum.

The preoperative diagnosis of extraluminal gastrointestinal stromal tumours in the duodenum is difficult to establish due to their rare occurrence and the lack of pathognomonic signs. This report describes the case of a 61-year-old woman who suffered from an immunohistologically confirmed gastrointestinal stromal tumour in the second portion of the duodenum. Preoperative, abdominal, multislice computed tomography showed an extraluminal but intramural tumour located between the head of the pancreas and the duodenum. Rapid postprocessing analysis by three-dimensional, volume-rendered images revealed a strong arterial blood supply and an early draining vessel into the superior mesenteric vein during the portal-venous phase. The combination of endoscopic ultrasonography and non-invasive multislice computed tomography provided an early suggestion of gastrointestinal stromal tumour.

Duodenal Neoplasms↗

PubMed1977

Morphological study of the Paneth cell. Paneth cells in intestinal metaplasia of the stomach and duodenum of man.

The Peneth cells in intestinal metaplasia of stomach and the duodenum in human subjects were studied ultrastructurally, and the fine structures of these cells were compared. Paneth cells showed the ultrastructure of serozymogenic cells and secreted their secretory granules by merocrine process. The rod or tubular dense bodies were observed in the apical region of some Paneth cells. The structures may have some relation to the secretion of the secretory granules. The secretory granules with less dense layer in the periphery, which had never been described in the Paneth cell of man, were also observed. Morphologically intermediate cells between Paneth cell and goblet cell were found. Some of the Paneth cells might be phagocytized by undifferentiated crypt cells. The Paneth cells in intestinal metaplasia were fundamentally the same as those in duodenum at least in morphology. Difference between them was that Paneth cells with many phagolysosomes in the lower cytoplasm were observed more frequently in the duodenum than in intestinal metaplasia of the stomach. The physiological functions of the Paneth cell have been discussed.

Duodenal Diseases↗

PubMed1990

Villous adenomas of the duodenum and an unusual variant.

We report two cases of villous adenoma of the duodenum, one arising from the main papilla and the other from the accessory papilla. Both were managed by local resection. In one case endoscopic biopsies and intraoperative frozen sections were negative for carcinoma but histology of the locally resected specimen revealed a focus of invasive adenocarcinoma. Villous adenomas of the duodenum have a high risk of malignant change and foci of carcinoma can be missed on endoscopic biopsy. The literature is reviewed and the clinical, diagnostic, pathological and therapeutic aspects of villous adenomas of the duodenum are discussed.

Adenocarcinoma↗

PubMed1998

A case of pedunculated tubulovillous adenoma of the duodenum.

Tubulovillous adenoma of the duodenum is a rare tumor. Almost all of the lesions have been reported endoscopically and are recognized as small, sessile, polypoid lesions. This article discusses an unusual case of pedunculated tubulovillous adenoma of the duodenum in a 48-yr-old woman. The lesion was discovered on the upper part of the descending duodenum during a gastric mass survey. The polyp was removed using an electrocautery snare and was histologically diagnosed as tubulovillous adenoma.

Adenoma, Villous↗

PubMed1977

Crohn's disease of the duodenum.

Crohn's disease of the duodenum is uncommon, occurring in approximately 2% of patients with Crohn's disease. Approximately 165 cases have been reported in small series in the literature. Our report includes 36 patients, most of whom had symptoms of duodenal disease coincident with or after obvious disease elsewhere in the gastrointestinal tract, although occasionally duodenal disease developed first and rarely disease was confined to the duodenum. Upper abdominal pain and symptoms of gastroduodenal obstruction are the commonest patterns of presentation. Significant weight loss is common, and occasionally major upper gastrointestinal bleeding occurs. The commonest pattern of involvement was contiguous disease of the proximal duodenum and distal stomach. Endoscopically, diffuse granularity, nodularity, and ulceration are seen accompanied by lack of distensibility of the involved area. Granulomas are rarely found in endoscopic biopsies. A bypass procedure was carried out on 18 patients, 15 of whom continue to be free of symptoms with an average follow-up of 6-6 years. When symptoms of obstruction dictate, operative bypass is accompanied by favourable long-term results in the large majority of patients.

Adolescent↗

PubMed1995

Ultrasonographic examination of the small intestine of cows with ileus of the duodenum, jejunum or ileum.

The small intestine of 35 heifers and cows with an ileus of the duodenum, jejunum or ileum was examined ultrasonographically. After a clinical examination, the animals were examined from the right flank and thorax with a 3.5 MHz linear transducer, and the findings were verified by a right flank laparotomy or post mortem. Dilated loops of small intestine with a diameter of more than 3.5 cm were visible in at least one location in all the animals; they were seen predominantly in cross-section or longitudinally. The number of loops of dilated intestine visible from the flank or intercostal spaces was markedly influenced by the site of the ileus. In animals with an ileus of the duodenum, only one intestinal loop was usually visible from the flank or from the 12th, 11th or 10th intercostal spaces. In contrast, more than five dilated loops of intestine were usually visible in animals with an ileus of the jejunum or ileum. The largest diameter of intestine measured from the 12th intercostal space was between 6.5 and 9.9 cm in animals with an ileus of the duodenum, between 3.5 and 9.8 cm in animals with an ileus of the jejunum, and between 4.4 and 5.5 cm in animals with an ileus of the ileum. In the majority of the cows, the contents of the intestines were predominantly echogenic, but in the others they were anechoic. The cause of the ileus could be identified by ultrasonography in only a few cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed2001

Malignant obstruction of gastric outlet and duodenum: palliation with flexible covered metallic stents.

PURPOSE: To assess the usefulness of flexible covered metallic stents in the palliation of malignant obstruction of the gastric outlet and duodenum. MATERIALS AND METHODS: Twenty-four consecutive patients with malignant obstruction of the gastric outlet (n = 22) or duodenum (n = 2) underwent palliative treatment with self-expandable flexible covered metallic stents. Fourteen patients had advanced gastric carcinoma at the antrum and/or pylorus, and eight had obstruction at the anastomosis site of previous gastrojejunostomy. Complications and clinical status were investigated during the study period. RESULTS: The technical success rate was 75% (18 of 24 patients). Twenty-one stents were placed in 18 patients by using an introducer 6 (n = 7) or 8 mm (n = 14) in diameter. The mean follow-up period was 3.4 months (range, 1 week to 9 months). Symptoms improved in 12 (67%) patients after the procedure. There was no change in symptoms in five and a decrease in one. Twelve patients died during the follow-up period (mean survival, 4.3 months). The complication rate was 25% (six of 24 patients), including stent migration (n = 5) and fracture (n = 3). CONCLUSION: Flexible covered metallic stent placement can be useful for palliation in patients with malignant obstruction of the gastric outlet or duodenum.

Adult↗

PubMed1999

Polypoid hamartoma of Brunner's gland of the duodenum.

BACKGROUND/AIMS: Brunner's gland adenoma is an extremely rare but important entity. Controversy exists over its etiology and pathogenesis, but the present view is that it is a duodenal hamartoma with a predominance of Brunner's gland elements. METHODS: A case of a 76-year-old woman with a reddish pedunculated polyp prolapsing between the bulb and the second part of the duodenum seen at endoscopy and removed surgically through a longitudinal duodenotomy is presented. RESULTS: The cut surface of the tumor had a grayish color, revealing multiple cystic spaces which on microscopic examination proved to be enlarged Brunner's glands. The hyperplastic glands formed lobules which were surrounded by bundles of fibromuscular and connective tissue. In the adjacent duodenum, large numbers of lobules of well-differentiated Brunner's glands with mucus-secreting epithelial cells were seen. CONCLUSION: The reported case supports the theory that Brunner's gland adenomas are duodenal hamartomas with a predominance of Brunner's gland elements and further shows that a continuity exists in Brunner's glands of the tumor and those of the adjacent duodenum.

Aged↗

PubMed2004

Primary small-cell neuroendocrine carcinoma of the duodenum - a case report and review of literature.

BACKGROUND: Small-cell neuroendocrine carcinoma in the duodenum is an extremely rare neoplasm with poor prognosis. CASE PRESENTATION: A 57-year-old man presented with sudden onset gastrointestinal bleeding and fainting attacks. Duodenoscopy and hypotonic duodenography revealed a 3 x 3 cm protruding tumor with ulcerations situated opposite the ampulla of Vater in the second part of the duodenum. Local excision of the tumor was performed, followed by adjuvant chemotherapy with 5-fluoro uracil and leucovorin. Examination of the tumor by immunohistochemistry and electron microscopy indicated it to be neuroendocrine in nature, expressing synaptophysin and AE1/AE3, and containing dense core granules. The patient showed no sign of recurrence and has been disease-free for more than 48 months after surgery. CONCLUSIONS: Most cases of small-cell neuroendocrine carcinoma in the duodenum show rapid progression of the disease, and even radical surgery with or without chemotherapy do not prevent death. We report a rare subtype of small-cell neuroendocrine carcinoma. This subtype appears to have a much better prognosis, and may be amenable to local excision, if the lesion is away from the ampulla of Vater.

Journal Article↗

PubMed2002

Virtual gastroduodenoscopy: a new look at the bypassed stomach and duodenum after laparoscopic Roux-en-Y gastric bypass for morbid obesity.

BACKGROUND: After open or laparoscopic Roux-en-Y gastric bypass (RYGBP) for morbid obesity, the bypassed stomach and duodenum are not readily available for radiological and endoscopic evaluation. Furthermore, little is known about the long-term physiologic and histologic changes that occur in the bypassed GI segments following these procedures. Many alternative radiological and endoscopic techniques have been described to access the distal gastric pouch and the duodenum after RYGBP. Apart from percutaneous gastrografin studies, all these techniques require the insertion of a gastrostomy tube in the distal stomach. METHODS: A new diagnostic method to access the bypassed segments by virtual CT gastroscopy (VG) was used in 5 morbidly obese patients who underwent laparoscopic RYGBP (LRYGBP). RESULTS: All patients tolerated the procedure well, which appears safe and suitable for an outpatient setting. The virtual images offered an excellent intraluminal view of the stomach and duodenum. CONCLUSIONS: VG holds promise as the method of choice in the follow-up of LRYGB patients, having the potential to detect inflammatory changes and cancer in the excluded segments early.

Adult↗

PubMed1992

Effects of supplemental protein source and alkaline hydrogen peroxide treatment of wheat straw on site of nutrient digestion and flow of nitrogenous compounds to the duodenum of steers.

The objective of this study was to determine the effects of soybean meal (SBM) or spray-dried blood meal (BM) supplementation of diets based on untreated (UNT-WS) or alkaline hydrogen peroxide-treated wheat straw (AHP-WS). A 4 x 4 Latin square design with a 2 x 2 factorial arrangement of treatments was used. Variables included nutrient digestion and flow to the duodenum. Four Simmental steers (average weight 477 kg) fitted with ruminal and duodenal cannulas were fed 65% UNT-WS or AHP-WS based diets in 12 equal portions daily. Diets were formulated to contain 10% CP. Chromic oxide was used as the digesta flow marker and purines were used as the microbial marker. There were no straw type x protein source interactions. Total tract and ruminal OM digestibility were approximately 25% greater (P < .04) when AHP-WS was fed than when UNT-WS was fed. Source of protein did not affect (P > .10) OM or fiber digestion in the rumen or total tract. Ruminal digestion of NDF and ADF was increased (P < .01) by 51 and 40%, respectively, when AHP-WS was fed than when UNT-WS was fed. Main effect means (P > .10) for N flow to the duodenum as a percentage of N intake were 128.2, 142.5, 133.4, and 137.6 for UNT-WS, AHP-WS, SBM, and BM treatments, respectively. Despite increased (P < .01) ruminal OM digestion for AHP-WS, microbial N flow to the duodenum was greater (P < .01) when UNT-WS was fed than when APH-WS was fed.(ABSTRACT TRUNCATED AT 250 WORDS)

Amino Acids↗