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PubMed1997

Endoscopic diagnosis of hookworm disease of the duodenum.

Hookworm is one of the most common parasites in the world, but can be missed on stool examination. We report a 31-year-old man who was complaining of epigastric discomfort, with laboratory findings of iron-deficiency anemia and eosinophilia. He was found to be infected with hookworm (Ancylostoma duodenale), which was directly detected and retrieved from the duodenum with biopsy forceps during upper gastrointestinal endoscopy. We eliminated his infection successfully by the Damaso de Rivas-Kihara modified method and oral administration of pyrantel pamoate. This report indicates that it is important to check carefully even in the distal duodenum at routine upper gastrointestinal endoscopy whenever parasitic disease is suspected but is hard to diagnose because of a limited number of eggs in feces.

Adult↗
PubMed2003

Management and outcome of patients with sporadic gastrinoma arising in the duodenum.

BACKGROUND: Primary duodenal gastrinomas are now recognized as a common etiology for patients with sporadic Zollinger Ellison Syndrome (ZES); however, the clinical and pathologic features of this condition and long-term outcome after operation are not well characterized. METHODS: Between November 1982 and September 2000, 63 patients diagnosed with sporadic ZES underwent resection of a primary duodenal gastrinoma and regional nodal metastases with curative intent. Data from a prospectively maintained database were reviewed for clinical and pathologic parameters relating to primary tumor size, location, frequency of lymph node metastases, and disease-specific and disease-free survival. RESULTS: There were 41 males and 22 females (mean age, 48.6 years). The majority of duodenal gastrinomas were in the first or second portions of the duodenum (83%). Tumor size ranged from 0.2 to 2.0 cm with 62% measuring less than 1.0 cm. Sixty percent of individuals had regional lymph node metastases identified primarily in proximity to the primary tumor. At a median 10-year follow-up, the overall disease-specific and disease-free survivals were 100% and 60%, respectively. Actuarial 10-year disease-free survival was significantly higher for patients without lymph node metastases versus those with lymph node metastases (78% versus 48%, P = 0.0137). CONCLUSIONS: Duodenal gastrinomas in patients with sporadic ZES are frequently small, most commonly located in the proximal duodenum, and associated with regional lymph node metastases in 60%. Disease-free survival is lower for patients with regional lymph node metastases suggesting that a more systematic lymphadenectomy to extirpate occult disease may be indicated in this group.

Adolescent↗
PubMed2004

Obstructing Crohn's disease of the duodenum: is surgery always mandatory?

Crohn's disease may involve any part of the alimentary tract. But, Crohn's disease of the duodenum is a very rare condition. Systemic steroid therapy had been shown to be effective in patients with Crohn's disease, and the most common indication for surgical intervention is duodenal obstruction. We report a case with Crohn's disease of the duodenum presenting with duodenal obstruction. Medical treatment option was successful as a first line of therapy because of young age and new diagnosis. The patient was administered mesalazine as a treatment, and the obstruction was resolved. The patient is still in remission for the last 2 years.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1978

Villoglandular adenoma of the duodenum.

Two cases of villoglandular adenoma of the duodenum presenting with features of peptic ulcer are reported. At surgery both patients had intussusception of the duodenum. One of them had carcinoma in situ. The literature is briefly reviewed, and the importance of keeping in mind this rather rare condition, even in areas where duodenal ulcer is widely prevalent, is emphasized.

Adenoma↗
PubMed1997

Multiple forms of alkaline phosphatase in horse bone, liver, kidney, duodenum, caecum and serum separated by agarose gel electrophoresis with and without neuraminidase pretreatment.

Horse bone, liver, duodenum, caecum and kidney alkaline phosphatases were separated by a commercial agarose gel electrophoresis method with and without neuraminidase pretreatment, following the manufacturer's directions. Tissue extracts were obtained in saline solution and ALP extracted from cell membranes by the butanol method. Electrophoresis was performed using a TRIS/barbital/sodium barbital buffer with detergent, pH 8.6 to 9.0, at 250 V for 30 minutes. Bone, liver and kidney untreated extracts showed two ALP bands each, but with different relative migration (compared to albumin migration). When they were preincubated with neuraminidase, the two bone bands showed a marked decrease in their migration, followed by the kidney ALP bands and the most anodic band of liver Both intestinal untreated extracts showed three bands but with different mobilities. After preincubation with neuraminidase, the three bands of caecum mucosa decreased in their migration, and the most anodic duodenum band disappeared, overlapping the second one. When tissue extracts were incubated with wheat germ-lectin (WGL), 74.5% of bone extract ALP and 67.2% of caecum extract ALP precipitated, which demonstrated that the ALP band of both tissues have similar groups in the carbohydrate side chains. Horse serum showed two electrophoretic bands, which increased to three bands when treated with neuraminidase. ALP from hepatocytes was the dominant isoform, followed by a caecum band. Because the electrophoretic mobilities of some of the tissue bands studied were identical, the neuraminidase agarose electrophoretic method appeared to be a satisfactory alternative to separate them.

Journal Article↗
PubMed1997

Peptic duodenitis--does it exist in the second part of the duodenum?

AIM: To re-evaluate all patients diagnosed histologically as having peptic duodenitis who had known endomysial antibody (EMA) test results to find out whether they would still be classified as peptic duodenitis on histological analysis and to review their subsequent clinical course. METHODS: All mucosal biopsy specimens of the second part of the duodenum which were reported as showing features of peptic duodenitis and on which a serum EMA test had been done between January 1990 and January 1995 were reviewed. The number of intraepithelial lymphocytes (IELs) per 500 epithelial cells was also counted. The cases were re-assigned to one of three clinical categories: normal, coeliac disease or peptic duodenitis. Clinical details were reviewed for any cases where the re-assigned diagnosis and the EMA test result did not correlate. RESULTS: Of the 24 cases, 21 showed a correlation between morphology and immunology-that is, if the biopsy specimen was characteristic of coeliac disease, the EMA was positive and if the biopsy specimen was normal or characteristic of peptic duodenitis, the EMA was negative. Three cases had a negative correlation: two had a positive EMA test but a biopsy diagnosis of peptic duodenitis and one had a normal duodenal biopsy specimen with a positive EMA test. On review of their clinical details, two of the three patients were diagnosed with coeliac disease and the other with silent coeliac disease. EMA test results and IEL counts correlated with the final diagnosis in all cases. CONCLUSIONS: The diagnosis of peptic duodenitis on biopsy specimens of the second part of the duodenum was not substantiated in 92% of cases. On review of 24 cases, a histological diagnosis of peptic duodenitis was reached in four. In difficult cases, the histological appearances should be correlated with the EMA test result and the IEL count. Correlation of this kind should leave no cases of coeliac disease undiagnosed.

Adult↗
PubMed1979

Leiomyoma of the duodenum presenting as a pyogenic liver abscess.

Leiomyoma of the duodenum is a rare condition which is most often diagnosed only as an incidental finding at post-mortem. It may present clinically with pain or haemorrhage. A case is described of degeneration of a leiomyoma of the fourth part of the duodenum giving rise to pyogenic liver abscess. There is no previous report of this association in the literature.

Duodenal Neoplasms↗
PubMed1979

Leiomyoma of the duodenum--an unusual presentation of a rare tumour.

A case of leiomyoma of the duodenum presenting with sub-acute intestinal obstruction and a palpable abdominal mass is described. Both the siting of the lesion in the duodenum and a presentation other than gastro-intestinal bleeding are unusual for this type of tumour.

Duodenal Neoplasms↗
PubMed1994

Adenocarcinoma of the duodenum with a duodeno-colic fistula occurring after childhood Wilms' cancer.

A case of a 44 year old man with a duodeno-colic fistula secondary to an adenocarcinoma of the second part of the duodenum is described. An asymptomatic leiomyoma of the second part of the duodenum was also present. The patient had been treated successfully for a right Wilms' cancer in childhood with surgery and radiotherapy. There are no previous reports of a duodenal carcinoma arising following a Wilms' tumour and cases of gastrointestinal adenocarcinoma arising as second malignancies following Wilms' tumours are reviewed. The aetiology of duodeno-colic fistulas is reviewed. Duodenal carcinoma is a unusual cause of duodeno-colic fistulas and this case may be unique in that respect.

Adenocarcinoma↗
PubMed1989

Reflux of bile acids from the duodenum into the rumen of cows with a reduced intestinal passage.

The purpose of this study was to find out whether the concentration of bile acids in the rumen of healthy cows differs from that of cows with a reduced gastrointestinal passage. The investigations were performed on 277 heifers and cows of the Swiss Braunvieh, Simmental and Swiss Holstein breeds. Forty of these had traumatic reticuloperitonitis, 30 had right or left abomasal displacement, 14 had an ileus of the duodenum, 36 had an ileus of the jejunum and 54 had a caecal dilatation. The other 103 animals had disorders which did not affect the digestive system and were used as controls. The mean (+/- se) bile acid concentration in the rumen fluid of the control animals was 1.0 +/- 0.30 mumol/litre. The bile acid concentrations in the rumen fluid of the cows with a duodenal or jejunal ileus were significantly higher than those of the other groups, demonstrating that bile acids may reflux from the duodenum into the rumen of cows with an ileus in the small intestine.

Animals↗
PubMed1996

Benign and malignant stenoses of the stomach and duodenum: treatment with self-expanding metallic endoprostheses.

PURPOSE: To assess palliation of inoperable stenoses of the stomach and the duodenum with self-expanding metallic endoprostheses. MATERIALS AND METHODS: Under combined endoscopic and fluoroscopic guidance, 13 Wallstents were placed in nine consecutive patients, two with benign and seven with malignant obstruction. RESULTS: Technical success was achieved in eight patients (89%). One failure was due to stent dislocation during implantation. No major complications occurred; in two patients (22%), additional stents were implanted to improve patency. During the follow-up, which was 1-52 weeks (mean, 17 weeks) or until death there were no signs of stent obstruction. In seven patients (78%), quality of life improved substantially with restoration of oral food intake and relief of vomiting. CONCLUSION: The placement of Wallstents offers good palliation of inoperable outlet stenoses of the stomach and the duodenum. With a combined radiologic and endoscopic approach, it is an easy and rapid procedure that can be performed without general anesthesia.

Deglutition Disorders↗
PubMed2000

Surgical treatment of leiomyosarcoma of the distal duodenum.

Malignant tumors of the small intestine are rare. An uncommon finding of leiomyosarcoma located in the fourth part of the duodenum was diagnosed by gastrointestinal contrast studies, CT and angiography. Although malignant lesions of the small bowel are usually diagnosed late and thus are far advanced, curative resection was possible in our case. The location and histology of the tumor permitted a 'pancreas-preserving segmental duodenectomy'. The operative approach and exposure using the Cattell maneuver is described. It is emphasized that the more extensive pancreatoduodenectomy should be reserved for adenocarcinomas or lesions situated in the proximal part of the duodenum. Thirteen years following the operation, the patient is asymptomatic while CT and gastrointestinal contrast studies reveal no evidence of disease.

Adult↗
PubMed2004

A solitary Peutz-Jeghers-type hamartomatous polyp in the duodenum. A case report including results of mutation analysis.

BACKGROUND/AIMS: We report a case of solitary Peutz-Jeghers-type hamartomatous polyp of the duodenum in a 22-year-old Japanese woman along with the results of genomic analysis. METHODS/RESULTS: The patient was almost asymptomatic, though endoscopic examination revealed a solitary lobular polypoid lesion measuring 3 cm in diameter in the first portion of the duodenum. The lesion was resected endoscopically. Histopathological examination showed hyperplasia with a tree branch-like extension of the lamina propria derived from the muscularis mucosae, consistent with histological features of polyps of Peutz-Jeghers syndrome (PJS). No mucocutaneous pigmentation of the skin was evident and family history was negative. Analysis of the loss of heterozygosity at the locus of 19p 13.3 and mutation analysis of the STK11/LKB1 gene, which has recently been recognized as a susceptible gene in PJS, were performed. However, no evidence of genomic abnormality was found. CONCLUSION: The clinical and investigative findings in our case suggest that the solitary Peutz- Jeghers-type hamartomatous polyp can be regarded as a clinical entity separate from PJS.

Adult↗
PubMed2004

Glomus tumor of the duodenum: a case report.

We describe a rare case of glomus tumor of the duodenum. The tumor was detected in a 46-year-old man being investigated for episodes of gastrointestinal bleeding. The excised specimen showed a 2.3 x 1.5 x 1.5 cm gray-tan tumor involving the mucosa and the submucosa. The overlying mucosa was focally ulcerated. Histologically, the tumor had a solid pattern of sharply demarcated, round glomus cells with prominent pericytoma-like vessels of varying sizes. The neoplastic cells stained for vimentin, smooth muscle actin, and focally for synaptophysin. These histologic and immunohistochemical features are consistent with a diagnosis of glomus tumor of the duodenum.

Actins↗
PubMed1986

Augmentation of cysteamine and mepirizole-induced lesions in the rat duodenum and stomach by histamine or indomethacin.

Repeated administration of histamine X 2HCl (40 mg/kg X 4) significantly augmented mepirizole (200 mg/kg) or cysteamine (300 mg/kg)-induced duodenal and gastric lesions in rats within 6 hr. Most of the duodenal lesions were penetrating ulcers and were located over the entire duodenum. Gastric lesions were mainly located in the antrum adjacent to the duodenum. Indomethacin pretreatment did not significantly augment the duodenal lesions induced by mepirizole or cysteamine, but did augment the gastric lesions induced by these compounds.

Animals↗
PubMedDate not supplied

[Acute pancreatitis due to intramural hematoma of the duodenum by the use of anticoagulants].

BACKGROUND: Spontaneous intramural hemorrhage of the duodenum due to anticoagulant therapy is rare and the treatment is controversial. OBJECTIVE: To present the acquired knowledge with the treatment of these disease. CASE REPORT: A 71-year-old women receiving for a 3 month period an anticoagulant therapy presented cervical bleeding of soft tissues and symptoms of acute pancreatitis and high small bowel obstruction. Early noninvasive diagnosis by computed tomographic scan was possible and conservative therapy proved successful in complete resolution of the pancreatitis and obstructive symptoms, with resumption of oral intake in the fourth day of treatment. The frequency of bleeding in high risk patients during warfarin therapy is reduced by less intense therapy, achieving a prothrombin time with an International Normalized Ratio of 2.0 to 3.0. RESULTS: The use of conservative treatment was helpful and the patient was discharged asymptomatic, 10 days after admission. CONCLUSION: It is suggested conservative treatment for intramural hematoma of the duodenum and recommended laparotomy only when complications occur.

Acute Disease↗
PubMedDate not supplied

[Adenocarcinoma of the duodenum].

PURPOSE: To revise literature data about adenocarcinoma of the duodenum comparing to our results. METHODS: Six patients with this kind of cancer, excluding periampullary lesions, were treated from 1991 to 1999 in the Department of Surgery, Santa Casa of São Paulo Medical School. Five of them were males in theirs fifties. The commonest signs and symptoms were those of gastrointestinal obstruction and weight loss. All patients were evaluated by duodenoscopy. Ultrasonography and CT scans played an important role with regard to preoperative staging. Three patients underwent a segmental resection and the others were submitted to a palliative duodenal bypass. RESULTS: Post-operative hospitalization varied from 5 to 9 days (7,3 days average). The operative mortality was 16.6% (one patient). Patients were not submitted to chemo or radiotherapy. Follow-up has been done. Patients with curative resection were free from recurrence. Two patients submitted to palliative operations were lost to follow-up. CONCLUSION: Rarity of duodenum carcinomas and few patients in the literature did not permit conclusions.

Adenocarcinoma↗
PubMed1980

Papillary adenoma of the duodenum; report of a case and review of the literature in Japan.

A papillary (villous) adenoma of the duodenum was found in a 67-year-old male. Radiographic barium studies of the upper gastrointestinal tract revealed a tumor in the second portion of the duodenum. Biopsied specimens taken through a duodenofiberscope showed papillary adenoma. A partial duodenectomy with duodenojejunostomy was performed. The specimen was a pedunculated tumor measuring 3 X 2 X 1.5 cm. Histologically, the tumor was composed of villous and tubular arrangements of mucus-secreting columnar epithelial cells. A moderate number of entero-endocrine cells and a few Paneth cells were also noted. Forty-two other cases reported in Japan are briefly reviewed.

Aged↗