Leiomyosarcoma of the duodenum.
This is a case report of a large leiomyosarcoma of the duodenum in a 10-year-old boy who weighed only 22 kg. He was successfully treated with a Whipple procedure or pancreatoduodenectomy.
Child↗
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Intramural hematoma of duodenum following endoscopic intestinal biopsy.
We present the fourth case to be reported in the literature of intramural hematoma of the duodenum following endoscopic small bowel biopsy. It is the first reported to have been diagnosed by ultrasonography and confirmed by contrast roentgenograms. Conservative treatment was effective in achieving satisfactory resolution of the obstruction within seven days, as evidenced by barium meal examination. The mechanism of trauma, in light of the other cases reported in the literature, is discussed.
Biopsy↗
Adenosquamous carcinoma of the duodenum. An immunohistochemical study.
A rare adenosquamous carcinoma of the duodenum occurred in an 84-year-old woman. Histologically the neoplasm showed evidence of glandular and squamous differentiation, and both components showed malignant characteristics. Intermediate elements sharing squamous and glandular features, were found and were immunoreactive for carcinoembryonic antigen, epithelial membrane antigen and cytokeratins of both low and high molecular weight. A review of the literature and discussion about the histogenesis is included.
Adenocarcinoma↗
Neurofibrosarcoma of the duodenum.
A case of neurofibrosarcoma of the second part of the duodenum is reported. The presenting symptom was upper GI tract bleeding. An emergency pancreaticoduodenectomy was performed to remove a 6 x 8 cm tumour invading the head of the pancreas and the ampulla of Vater. Histopathologically, a low grade malignant neurofibrosarcoma without lymph node invasion was evident. No adjuvant therapy was judged to be necessary. The patient is well and free of disease 5 years following the resection of the neoplasm.
Duodenal Neoplasms↗
Mucosal defense and repair. Role of prostaglandins in the stomach and duodenum.
When considering the diseases of the stomach and duodenum, peptic ulcer disease has been the one of greatest clinical impact. Although there are several components that contribute mechanistically to ulcer disease, it is recognized that gastroduodenal mucosal prostaglandins play a central pathogenic role, especially in ulcers related to the use of NSAIDs. As a result of understanding the mechanisms of NSAID-induced ulceration, the crucial function that gastroduodenal mucosal prostaglandins have in mucosal defense and repair is appreciated. It now is held widely that mucosal prostaglandin deficiency increases susceptibility to ulcer formation and that exogenous administration of supplemental prostaglandins reduces ulcer risk. This article reviews the role that mucosal prostaglandins play in defense of the gastric and duodenal mucosa against injury and ulceration.
Age Factors↗
Tumor and tumor-like lesions of duodenum: CT and barium imaging features.
Neoplasms of the duodenum, either primary or secondary, are uncommon. However, imaging diagnosis for presurgical evaluation is extremely important due to complex regional anatomy. Computed tomography (CT) and barium-based double contrast examination (UGI series) are most frequently employed to evaluate the tumor invasion and intraluminal mucosal pattern. In this pictorial review, the CT and UGI series imaging features of benign and malignant duodenal tumors and tumor-like lesions are demonstrated and discussed.
Barium Sulfate↗
Sensitivity of beta-casein phosphopeptide-iron complex to digestive enzymes in ligated segment of rat duodenum.
Binding iron to the phosphorylated beta(1-25) peptide derived from beta-casein improves iron bioavailability in the rat. The aim of the present work was to learn how injected beta(1-25) and iron-beta(1-25) complex behave in the duodenum of rats using the technique of intestinal ligation in situ and reversed-phase (RP)-high performance liquid chromatography-electrospray mass spectrometry analysis of the lumen contents. The results demonstrate that beta(1-25) is sensitive to digestive enzymes including proteases/peptidases and phosphatases during duodenal transit. The lumen contents of rats perfused with iron free beta(1-25) contained all peptidic sequences derived from beta(1-25). In contrast, the phosphorylated part of beta(1-25) [i.e., beta(15-24)] was not detected in lumen of rats perfused with iron-beta(1-25) complex.
Journal Article↗
Quality of life in chronic pancreatitis: a prospective trial comparing classical whipple procedure and duodenum-preserving pancreatic head resection.
Few data are available with respect to quality of life after pancreatic head resection in patients with chronic pancreatitis. The aim of this study was to compare the classical Whipple pancreatoduodenectomy (PD) with the Beger duodenum-preserving pancreatic head resection (DPPHR), in terms of quality of life, using standardized, valid, and reliable questionnaires. Sixty-five consecutive patients were included in this study. The PD procedure was chosen when pancreatic cancer could not be ruled out (n = 30); otherwise DPPHR was performed (n = 35). Quality of life was measured prospectively three times with the European Organization for Research and Treatment of Cancer (EORTC) Quality-of-Life Questionnaire (QLQ-C30) and the Gastrointestinal Quality-of-Life Index (GIQLI). Both procedures led to a significant improvement in quality of life, especially with regard to pain status. However, at the second follow-up examination (18 to 24 months postoperatively), all functional scales and the most important symptom scales of the EORTC QLQ-C30 revealed a better quality of life in the DPPHR group compared to the PD group. After classical PD, more patients seem to develop diabetes mellitus. The EORTC QLQ-C30 was found to be a better tool for quality-of-life assessment than the GIQLI in patients with chronic pancreatitis.
Chronic Disease↗
Malignant rhabdoid tumor of the duodenum.
A polypoid malignant rhabdoid tumor of the duodenum is presented. The pattern of metastatic spread in this 58-year-old man included multiple duodenal and small intestinal transmural tumor implants and a large peribronchial lymph node causing superior vena cava syndrome. Microscopically, the tumor was composed of a diffuse population of rhabdoid cells characterized by homogeneous globular cytoplasmic inclusions that tended to indent or displace eccentric, vesicular nuclei with nucleoli. No glandular features were noted. Immunohistochemical and ultrastructural evaluation revealed that these inclusions contained vimentin, an intermediate filament of the mesenchymal cytoskeleton. Phenotypic features of a rhabdoid tumor have been reported in 10 poorly differentiated malignancies of the gastrointestinal tract. This is the first case report of a malignant rhabdoid tumor of the small intestine. Regardless of the site of the lesion, tumors showing these features are generally associated with a poor prognosis.
Duodenal Neoplasms↗
[An interesting case in the pediatric polyclinic. Crohn disease with involvement of the distal esophagus, stomach and duodenum].
Weight loss, day-time sleep and loss of appetite were leading symptoms in a thirteen years old girl, in whom consecutively the diagnosis of Crohn's disease of the stomach and the duodenum was made after endoscopy and biopsy were performed. There were no complaints of diarrhea, abdominal pain or other symptoms suspicious for this chronic inflammatory bowel disease.
Adolescent↗
Acute intermittent arteriomesenteric occlusion of the duodenum after use of Harrington's spinal instrumentation: case report.
We report on a traumatic paraparetic patient, who developed acute intermittent arteriomesenteric occlusion of the duodenum after the use of Harrington's spinal instrumentation. This rare condition was treated conservatively. It is presumed that some degree of hyperlordosis of the lumbar spine by the rods was responsible for this phenomenon.
Adult↗
Postoperative peritonitis originating from the duodenum: operative management by intubation and continuous intraluminal irrigation.
BACKGROUND: The mortality rate associated with postoperative peritonitis remains high, especially when the source of infection cannot be eradicated. Such is the case with peritonitis arising from the duodenum, as primary closure is futile and intubation alone may be followed by local complications. METHODS: Forty-nine consecutive patients with postoperative peritonitis originating from a duodenal leak and a mean Acute Physiology And Chronic Health Evaluation II score of 17.7 were treated according to the following procedure: a three-channelled spiral drain was inserted through the leak and extraluminal drains were placed near the duodenal defect. Intraluminal irrigation was undertaken immediately through the infusion channel of the spiral drain. RESULTS: Eleven patients died and 26 suffered complications. The mean duration of intubation was 21 days. CONCLUSION: Intubation with intraluminal irrigation has proved effective in a homogeneous group of patients with peritonitis due to duodenal leakage.
Adult↗
Primary adenocarcinoma of the duodenum in the elderly: clinicopathological and immunohistochemical study of 17 cases.
Seventeen cases of primary duodenal adenocarcinoma occurring in the elderly (older than 65 years) were examined to clarify their clinicopathological features and biological behavior. The mean age was 77.4 years (range, 66-104), and there was no appreciable difference in the incidence between the sexes (female: male ratio, 8: 9). Thirteen patients had tumors located in the first portion of the duodenum, three in the second portion and one in the third portion. Grossly, there were three varieties of lesions: six polypoid, four flat-elevated and seven ulcerative-invasive. Sixteen cases showed well-differentiated adenocarcinoma, three of which were difficult to distinguish from adenoma, and one was poorly differentiated adenocarcinoma. Three of 16 tumors had poor differentiation in the invasive area, whereas mucosal lesions were well differentiated. Eight tumors had invaded the duodenal wall with occasional involvement of the pancreas. Immunohistochemistry demonstrated p53 protein overexpression in two intramucosal (22.2%) and five invasive (62.5%) cancers. In the intramucosal area the mean Ki-67-positive rate (PR) of the tumors with distant metastasis was significantly higher than that of the tumors without metastasis (46.0 vs 31.6%; P < 0.05), while there was no significant difference in the association between PR and gross feature or depth of the tumors. Clinical follow-up showed three of the five patients with invasive cancer died of carcinoma within 28 months. Compared with published data from other investigators, the results of the present study indicate a proximal shift of duodenal carcinoma in the elderly. Furthermore, it is concluded that invasive duodenal adenocarcinomas with high PR should be considered as potentially aggressive tumors, although their histology may indicate a high degree of differentiation.
Adenocarcinoma↗
Local excision of periampullary villous tumours of the duodenum.
AIMS: Our goal was to describe our technical approach to transduodenal submucosal resection of periampullary villous tumours of the duodenum. METHODS: We address technical tips to aid in exposure and reconstruction of pancreaticobiliary continuity with special reference to the indications for adding biliary sphincteroplasty, pancreatic septectomy, and local resection of neoplasms extending past the immediate ampullary mucosa into the bile and/or pancreatic ducts. CONCLUSIONS: This approach has proven safe, easy and without significant morbidity.
Adenoma, Villous↗
Duodenojejunal intussusception secondary to hamartomatous polyps of duodenum surrounding the ampulla of Vater.
Duodenojejunal intussusception is a rare pediatric emergency. A case of duodenojejunal intussusception secondary to hamartomatous polyps of the second portion of duodenum in a 10-month-old boy is reported. Surgical excision of the polyps and reduction of the intussusception were performed. Pathologic examination found hamartomatous polyps. This is the third case report of children in literature, but this is the first case of a child with intussusception surrounding the ampulla of Vater and a successful excision performed without damaging the ampulla of Vater.
Ampulla of Vater↗
Lymphangioma of the duodenum. (Diagnosis by endoscopic resection).
Submucosal lymphangiomas of the gastrointestinal tract are extremely rare entities. A case of a lymphangioma of the duodenum in a 66-year-old woman is reported. Diagnosis was made by endoscopy and tumor excision with a diathermy snare. The patient complained of crampy upper abdominal pain which only partially was referable to an gastric ulcer and stopped after polypectomy. Endoscopically, compressibility of the tumor is a characteristic sign. Roentgenographically, it may be easily overlooked.
Aged↗
Villous adenoma of the duodenum. Endoscopic diagnosis and resection.
The authors report a new case of villous adenoma of the duodenum diagnosed by X-ray examination and duodenoscopy. Endoscopic removal allows an accurate histologic diagnosis. This endoscopic resection relieves symptoms and spares the patient a laparotomy. It seems to be an acceptable treatment of benign duodenal tumors.
Adenoma↗
[Hamartoma of the duodenum].
HISTORY AND ADMISSION FINDINGS: A 61-year-old man had been suffering from repeated episodes of postprandial vomiting and a feeling of fullness as well as a weight loss of 8 kg for two months. Three years prior to this, a laparoscopic cholecystectomy had been carried out at a different institution after a pancreatitis on the assumption of a biliary genesis. There were no sings of jaundice or gastro-intestinal bleeding. The physical examination was -- apart from epigastric pain -- unremarkable. INVESTIGATIONS: The routine laboratory parameters and tumor markers were within normal range. Endoscopy revealed a thickened duodenal wall with a stenosis at the level of the papilla, and a tumorous mass in the duodenal bulb. The biopsy specimens gave no evidence of malignancy. The barium upper GI series revealed an excentric stenosis of the duodenal pars II. Computerized tomography showed no evidence for tumor growth extending beyond the wall or a pathologic enlargement of the adjacent lymph nodes. THERAPY AND COURSE: A pylorus-preserving partial duodenopancreatectomy was performed and the postoperative course was without any complications. The histological examination of the resectate showed -- besides a chronically fibrosing pancreatitis -- a hamartoma of the duodenal wall. CONCLUSION: Besides the endoscopic removal of a hamartoma of the duodenum a surgical transduodenal resection represents the most frequently applied procedure. The partial duodenopancreatectomy is a rather rare therapeutic option. It was chosen in our patient on account of the atypical presentation of the tumor, unclear histology and an adequate operative risk.
Duodenal Diseases↗