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PubMed1995

Villous tumors of the duodenum: a retrospective study of 47 cases by the French Associations for Surgical Research.

BACKGROUND: We evaluated villous tumors of the duodenum in regard to preoperative diagnosis of malignancy and the choice of treatment. STUDY DESIGN: From January 1974 to October 1992, forty-seven patients with a benign or malignant tumor arising from the duodenal mucosa were studied. Forty-two patients underwent a macroscopically complete resection of the tumor. Nineteen tumors were malignant. RESULTS: Preoperative endoscopic biopsy results had a 52 percent sensitivity and 100 percent specificity for the diagnosis of malignancy. For the 42 patients who underwent complete resection, jaundice was predictive of malignancy (p < 0.01), whereas tumor size was not (p < 0.2). The five-year survival rate of this group was 69.5 percent (confidence interval: 50 to 84). The recurrence rate was higher (p < 0.01) and the survival rate shorter (p < 0.001) for patients who underwent ampullectomy (n = 8) compared with patients treated by limited resection (n = 20) or pancreatoduodenectomy (n = 14). CONCLUSIONS: Preoperative diagnosis of malignancy is difficult for villous tumors of the duodenum. For tumors located near the papilla, it seems that pancreatoduodenectomy is the best treatment.

Actuarial Analysis↗
PubMed1995

[Treatment of complications in adjacent organs in chronic pancreatitis by duodenum saving resection of the head of the pancreas].

Chronic pancreatitis frequently generates complications through involvement of adjacent organs. Distal common bile duct stenosis or segmental duodenal stenosis, the most frequent complications, are usually treated by resective or by-passing procedures. This study presents the experience with an organ and functionality sparing procedure in the treatment of chronic pancreatitis with predominant involvement of the pancreatic head and coexisting organ complications. Sixty-eight patients with severe chronic pancreatitis underwent duodenum preserving resection of the head of the pancreas. Fourty-one of these patients presented with organ complications: fourty with distal common bile duct stenosis, eight with duodenal stenosis, thirteen with segmental portal hypertension, and one patient suffered from a pancreatico-pleural fistula. All patients were prospectively documented. Mean follow-up was 4.1 years. 93% of the organ complications were permanently eradicated. Three patients (7%) exhibited transitory cholestasis. 88% of the patients reported complete relief of all symptoms. Duodenum preserving resection of the head of the pancreas is effective to treat severe chronic pancreatitis with predominant involvement of the pancreatic head. It also provides definitive management of associated organ complications.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1995

[The status of duodenum-preserving resection of the head of the pancreas in therapy of chronic pancreatitis].

AIM OF THE STUDY: To evaluate the efficacy of duodenum-preserving resections of the head of the pancreas in the treatment of chronic pancreatitis this study was devised. So far studies on the natural course and the different therapeutic approaches have primarily focused on pain measurement in rough categories and hard data as mortality and morbidity. In this study the improvement of the quality of life was assessed to determine the therapeutic success of both procedures. PATIENTS AND METHODS: In a prospective randomized study 24 patients underwent either Beger's (n = 11) or Frey's procedure (n = 13) so far. 15 patients suffered from distal common bile duct stenosis, 2 from segmental duodenal stenosis, 4 from segmental portal hypertension, and one from pancreato-pleural fistula. The quality of life questionnaire of the European Organization for Research and Treatment of Cancer was assessed before surgery and during follow-up. The multidimensional questionnaire incorporates functional scales (physical, cognitive, emotional, and social), symptom scales (fatigue, pain, dyspnea, loss of appetite, sleep disturbance, obstipation, diarrhea, nausea, and vomiting), and a global quality of life scale. Follow-up was 12 months in all patients. RESULTS: There was no postoperative mortality in neither group. Postoperative morbidity was 17% (n = 2 in either group). This included one transitory common bile duct stenosis, one bronchopneumonia, and two postoperative bleedings which were treated conservatively. The pain index was reduced by 94% in the Beger- and 90% in the Frey group. The physical status, working ability, emotional and social functioning, and global quality of life score had significantly improved by 46%, 50%, 69%, 60%, and 67% in the Beger group and by 38%, 50%, 64%, 80%, and 67% in the Frey group. CONCLUSION: The duodenum-preserving resections of the head of the pancreas according to Beger and Frey are equivalently safe and effective. Both techniques result in a significant improvement of the patients' quality of life.

Adult↗
PubMed1995

Leiomyosarcoma of the duodenum.

Leiomyosarcoma of the duodenum is a rare tumor. These tumors manifest with unexplained melena, anemia and sometimes partial duodenal obstruction. Diagnosis is difficult on account of inaccessibility for biopsy. Treatment involves excision of the duodenum with reconstruction, a difficult task with high morbidity and mortality. However, if the tumor is successfully treated, its prognosis is usually good because of its non-aggressive nature.

Duodenal Neoplasms↗
PubMed1993

Somatostatin-containing carcinoid tumor of the duodenum in neurofibromatosis: report of a case.

We report a case of von-Recklinghausen's disease presenting with obstructive jaundice and found to have a somatostatin-containing carcinoid tumor in the papilla of Vater and a small neurofibroma in the duodenum. A 42-year-old woman with von-Recklinghausen's disease presented with intermittent jaundice, pruritus, and mild steatorrhea of a two-year duration. Abdominal ultrasonography and computed tomography showed dilated intrahepatic ducts, common bile duct and pancreatic ducts. Duodenoscopy showed a tumor at the papilla of Vater, but a preoperative biopsy failed to provide a definite diagnosis. Laparotomy revealed a yellowish tumor at the papilla of Vater and another nodule on the mesenteric side of the second section of the duodenum. Microscopically, the tumor at the papilla of Vater was found to be a somatostatin-containing carcinoid tumor. The small nodule on the mesenteric side was a neurofibroma. The jaundice, pruritus and steatorrhea disappeared after surgery.

Adult↗
PubMed1994

Perforated colonic carcinoma mimicking perforated peptic ulcer: an argument for full exploration of the stomach and duodenum.

Perforated peptic ulcer is one of the commonest types of hollow-viscus perforation. Because many of these ulcers are found at laparotomy to be sealed off, some authors believe it is unnecessary to dissect the surrounding tissue from the presumed site of perforation. A patient with a long history of peptic ulcer disease experienced the sudden onset of signs and symptoms of perforated peptic ulcer. On exploration, the omentum appeared to be densely adherent to the pylorus and duodenum. However, no perforation was found when the omentum was dissected free from the stomach and duodenum. Further exploration revealed a walled-off, perforated carcinoma of the transverse colon adjacent to the mesenteric border. As a result of this experience, the authors emphasize that when the findings at operation do not fit the clinical presentation in a patient with a presumed perforated peptic ulcer, a thorough exploration of the abdominal viscera is mandatory to identify the pathologic process.

Adenocarcinoma↗
PubMed1994

[Tumors of the duodenum (excluding the major duodenal papilla)].

Of the 2704 patients operated on for duodenal ulcer disease within the 10-year period, a benign tumour of the duodenum was revealed in 8 (polyp--in 6, myoma--in 1, fibroma--in 1), and a malignant one--in 3. Endoscopic polypectomy was performed in 6 patients. For malignant tumours, pancreaticoduodenal resection was performed in 1 patient, resection of 2/3 of the stomach with removal of the suprapapillary duodenal portion--in 1, resection of the distal duodenum--in 1. The result of operation is good.

Adenocarcinoma↗
PubMed1993

Effect of preanesthetic medication on ease of endoscopic intubation of the duodenum in anesthetized dogs.

The effects of preanesthetic medication on ease of duodenal endoscopic intubation in dogs was evaluated. One of 12 combinations of preanesthetic medications (using atropine, glycopyrrolate, morphine, meperidine, acepromazine, and 0.9% NaCl solution) was administered IM to each of 12 dogs in a trial. Twelve endoscopic trials were performed so that each dog received each treatment combination once. Anesthesia was induced with thiamylal administered IV and maintained with halothane vaporized in oxygen. Electrocardiographic recordings, indirect blood pressure measurements, end-tidal carbon dioxide partial pressures, and halothane concentrations were monitored during the anesthetic period. The ease with which the fiberoptic endoscope was passed into the proximal portion of the duodenum was qualitatively score on the basis of time and maneuvering effort. None of the preanesthetic combinations made intubation of the duodenum significantly easier than that with 0.9% NaCl solution (control). Only the combination of morphine and atropine induced gastro-pyloric conditions that resulted in significantly higher (more difficult) endoscopic scores than those after preanesthetic medication with 0.9% NaCl solution.

Animals↗
PubMed1993

[Vascular compression syndrome of the duodenum. Report of 2 cases].

Two young female patients with the syndrome of vascular compression of the duodenum are reported. Both patients presented with a history of vomiting and weight loss. Barium examination of the gastrointestinal tract showed in both cases, marked stomach distention and obstruction of the third portion of the duodenum. In one patient, abdominal CT scan discarded other causes of extrinsic compression. Both patients were operated. The simpler and safer surgical procedure is the section of the Treitz ligament and duodenal liberation, which can be used in the majority of patients.

Adolescent↗
PubMed1993

Cavernous haemangioma of the duodenum. A rare cause of gastrointestinal bleeding.

Vascular malformations (VMs), including haemangioma, of the upper gastrointestinal tract, are rare causes of bleeding. Bleeding from these lesions is often recurrent and diagnosis is often delayed for months to years. A patient with severe, recurrent upper gastrointestinal bleeding requiring repeated hospitalization and blood transfusions is presented. Upper endoscopy, barium meal and small bowel enteroclysis were negative. Selective mesenteric angiography revealed a VM in the second part of the duodenum. Segmental resection of the duodenum was performed and microscopical examination showed cavernous haemangioma. VM should be considered in patients with recurrent gastrointestinal bleeding and negative conventional investigations. Mesenteric angiography may be the only investigation which will identify these lesions. Results after excision are excellent.

Adult↗
PubMed1995

Malignant lymphoma arising in the duodenum combined with gastric lymphoma and early gastric cancer: a case report.

We report here a 65-year old man with primary duodenal malignant lymphoma combined with gastric lymphoma and early gastric cancer. Malignant lymphoma in the bulbus of the duodenum was suspected of by endoscopic biopsy during follow up of duodenal ulcer. Preoperative examination revealed an extension of malignant lymphoma from the bulbus to the stomach in combination with early gastric cancer. We performed a pancreaticoduodenectomy because the tumor invaded to the second portion of the duodenum. The postoperative course was uneventful and he received adjuvant chemotherapy following surgery. To our knowledge, this case is the first report of primary duodenal malignant lymphoma combined with gastric lymphoma and early gastric cancer.

Adenocarcinoma↗
PubMedDate not supplied

Sphincterotomy of Oddi's muscle through posterior distal duodenum: a modified technique with low morbidity and mortality.

BACKGROUND/AIMS: Today, most common bile duct stones are successfully removed with endoscopic and/or laparoscopic techniques; however, in a small number of cases these procedures fail and the stones have to be removed with older techniques. These techniques involve laparotomy and supraduodenal and/or transduodenal common bile duct approaches and are associated with complication rates that may be as high as 12%. We describe in this report a modification of the classic supraduodenal and transduodenal technique that results in substantial decrease of postoperative morbidity and mortality. MATERIALS AND METHODS: Rather than approaching the common bile duct through the anterior wall of the duodenum we reflect the duodenum anteriorly and approach the common bile duct through a 5-10 mm long incision in the posterior wall of the third, horizontal duodenal segment. Prior to the advent of endoscopy and laparoscopy, we used this technique for sphincterotomy and bile duct stone removal in 212 patients. RESULTS: Four to six weeks postoperatively, the common bile ducts were free of stones in 99% of patients, and there were no instances of duodenotomy dehiscence, fistula formation, pancreatitis, infection, hemorrhage, duodenal constriction, ascending cholangitis, or death. CONCLUSIONS: The results shows that sphincterotomy and bile duct stone removal via a duodenotomy in the posterior wall of the horizontal duodenal segment has substantially lower complication rates than if the common bile duct is approached through the anterior duodenal wall. They also suggest that it is the procedure of choice in cases in which endoscopic and/or laparoscopic techniques have failed.

Adolescent↗
PubMedDate not supplied

Duodenum-preserving resection of the head of the pancreas--modified procedures and long-term results-.

BACKGROUND/AIMS: Relief of chronic pancreatitis can be accomplished surgically or with medication. Surgical treatment of pancreatitis should preserve the endocrine and exocrine function of the pancreas. This paper details the results of our modified procedure for resecting the head of the pancreas. The advantage of this procedure is small resection, preservation of endocrine and exocrine function, complete relief of pain by the pancreatic duct drainage and maintenance of function of the duodenum and bile duct. PATIENTS AND METHODS: Duodenum-preserving resection of the pancreatic head with denervation of the body and tail of the pancreas was performed in 41 patients with severe chronic pancreatitis. RESULTS: Mortality after a median follow-up period of 36 months was 2.4%. Complete relief or alleviation of pain were found in 92% of patients and any other patients of recurrent pain due to postoperative pancreatitis was not found. Eighty-seven percent of patients had maintained more than preoperative body weight. Postoperative glucose tolerance was unchanged in 88% of patients. After long-term follow-up postoperative exocrine function had been maintained at preoperative condition. CONCLUSIONS: Our procedure can maintain endocrine and exocrine function of the pancreas, relieve pain well and prevent pain due to recurrent pancreatitis.

Adult↗
PubMed1996

[A radical treatment of villous tumors of the duodenum].

Three cases of large villous tumors of the second part of the duodenum treated by pancreaticoduodenectomy are reported. These lesions are in frequent and premalignant. Their treatment can be either local, endoscopic or surgical, or radical. The malignancy of the tumors is often missed preoperatively. The frequent recurrence after local excision and the theoretical risk of lymph node invasion even for carcinoma in situ compared with the low operative risk of whipple's procedure in the authors' experience lead them to propose radical treatment for extensive villous tumors of the second part of the duodenum.

Adenoma, Villous↗
PubMed1996

[Crohn's disease of the duodenum].

Affection of the stomach and duodenum by Crohn's disease is rare and varies according to the majority of data in the literature between 0.5 and 4%. A pre-existing or concurrent distal affection, most frequently on the ileum, is common. The authors describe a rare isolated affection of the pylorus and duodenum in a 17-year-old boy with manifestations of a severe inflammatory obstruction. Crohn's disease was suspected already before operation and was confirmed by laparotomy and histological examination of a portion of the pyloric wall. The author discusses the difficulties of preoperative diagnosis and common methods of surgical treatment.

Adolescent↗
PubMed1996

Duodenum preserving resection of the head of the pancreas in painful chronic pancreatitis.

OBJECTIVE: Evaluation of duodenum preserving resection of the head of the pancreas in patients with disabling pain caused by chronic pancreatitis with an inflammatory mass in the head of the pancreas. DESIGN: Retrospective study. SETTING: University hospital. The Netherlands. SUBJECTS: 15 consecutive patients. MAIN OUTCOME MEASURES: Mortality, morbidity, pain relief, endocrine and exocrine function. RESULTS: There was no 30 day postoperative mortality. Early morbidity consisted of small bowel leak (n = 1), obstructive ileus (n = 1) and peri anastomotic abscess (n = 2). Relief of pain was achieved in 13 patients (86%) after a mean follow up of 37 months; 11 (73%) were totally free of pain, and 2 (13%) had improved. Neither endocrine nor exocrine function deteriorated significantly after resection. CONCLUSION: Duodenum preserving resection is an effective operation in patients with disabling pain caused by chronic pancreatitis with an inflammatory mass in the head of the pancreas.

Adult↗
PubMed1977

[Endoscopic demonstration of heterotopic gastric mucosa in the duodenum].

On the basis of 8 observations in 3,140 duodenoscopies is referred to the endoscopic picture of heterotopies of the gastric mucous membrane. The heterotopic mucous membrane of the stomach was found in polypoid rice-grain-sized to pea-sized lesions of the duodenum. The histological examination four times resulted in a mucous membrane of the stomach of corpus type, three times of antrum type and once only in foveolar epithelium. As to other findings endoscopically were twice observed erosions of the gastric mucous membrane or of the mucous membrane of the bulb, respectively, once an antrum polypus, in no case ulcers. Once an achlorhydria was present. A hyperchlorhydria was to be proved in no case. The clinical significance of the heterotopia of the gastric mucous membrane in the duodenum as well as the cause of its existence are discussed.

Adult↗
PubMed1977

[Combined surgical procedures in operations of stomach, duodenum and biliary system (author's transl)].

In a period of 4 years in the Clinic of Abdominal- and Transplantation Surgery of the Medical School Hannover in 52 patients with operations of the biliary system 56 combined surgical procedures and in 48 patients with operations of stomach and duodenum 51 combined surgical procedures were performed. In comparison with groups of patients, treated with similar operations as single procedures, the increase of risk was studied. It was found, that combined procedures of medium-sized trauma, which mostly depended on simultaneous injuries of both organs, caused an elevation of operation stress as well as an increase of complications. Small combined procedures indicated no elevation of risk. In accordance with our results, we postulate a very careful reflection on indication of combined surgical procedures together with operations of stomach, duodenum or biliary system.

Age Factors↗