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Two cases of schwannoma and leiomyoma of duodenum are reported. The semiology of the benign duodenal tumors are analysed. The treatment, in all cases surgical, depends on the site of the tumor.
Under consideration were results of treatment of 71 patients with associated ulcers of the stomach and duodenum. Resection of the stomach was performed in 11 patients, various kinds of vagotomy--in 61 patients. Long-term results of operations in 69 patients were analyzed. Truncal vagotomy with an obligatory dissection of the gastric ulcer is a reliable method of treatment of the associated ulcers.
Two children in whom the diagnosis of intramural duodenal hematoma was made have been treated. One patient had the hematoma evacuated at surgery and one was successfully managed with nasogastric suction and parenteral fluid administration. The non operative treatment for intramural duodenal hematoma is recommended after perforation of the duodenum (type IIB, III, IV) or other associated injuries requiring laparotomy have been satisfactorily excluded.
Six separate foci of superficial adenocarcinoma were seen in the first part of the duodenum of a 53-year-old man with a multicentric superficial adenocarcinoma of the stomach. To our knowledge, duodenal involvement in such a tumor has not been reported before. The duodenal foci were partly covered by gastric-type surface epithelium, suggesting that they might have arisen in areas of gastric metaplasia or heterotopia.
The authors report a case of leiomyoma of the second part of the duodenum and note in the light of 55 cases in the literature, the main characteristics of this tumour including digestive hemorrhage, especially melena, which is the commonest mode of presentation. They compare it with other muscle tumours, e.g. sarcoma and myoid tumours. A barium meal and eventually superior mesenteric arteriography are the two main aids in diagnosis which remains by chance in 15% of cases. The volume of the tumour, the intimacy of its relations with the bile ducts influence the choice of surgery. The risk of hemorrhage and the histological uncertainty almost always lead to surgical operation.
Celiac sprue is associated with an increased risk of malignant lymphoid tumors. A patient is presented with celiac disease and adenocarcinoma of the duodenum; this association suggests that a careful search for complicating malignant tumors be undertaken in those patients with sprue whose clinical course has changed or deteriorated.
A modified x-ray method was applied in 41 patients with peptic ulcer of the duodenum to study twice (without gastrozepin intake and after its administration in courses) the rate of evacuation from the gastrointestinal tract (GIT) of radiographic contrast capsules taken with a trial meal. Administration of gastrozepin in courses significantly decelerated the rate of evacuation of the radiographic contrast capsules from the GIT with an initially accelerated evacuatory function of the GIT and slightly accelerated GIT evacuation with an initially decelerated evacuatory function.
We report an unusual case of a polyp arising from ectopic gastric mucosa in the duodenum. The polyp demonstrated both hyperplastic and adenomatous proliferation. Adenomatous proliferation in a duodenal polyp arising from ectopic gastric mucosa is, to our knowledge, unique. The areas of adenomatous change were morphologically indistinguishable from those of adenomatous polyps arising in the stomach; hence, the adenomatous change observed in this polyp was regarded as a neoplastic process.
Adenocarcinoma, malignant lymphoma and leiomyosarcoma are the main malignant tumors found most frequently in the small intestine and adenocarcinoma should be differentiated from these lesions as well as benign tumors. Ten cases with primary adenocarcinoma of the duodenum and 14 of the small intestine (the jejunum and ileum) were diagnosed and treated surgically in our clinic during recent 22 years. Analysing the clinical signs, symptoms and roentgenological features of these patients, the diagnosis, treatment and prognosis for these lesions were discussed and reviewed. To enhance the 5-year survival rate for these patients, the early diagnosis in the curative stage should be established.
In the present paper we report about a patient with a large tubulo-villous duodenal adenoma associated with a carcinoma of the ampulla of Vater. Despite of lacking pre- and intraoperative evidence of malignancy a Whipple operation was performed because of extensive growth of the duodenal adenoma and its location near the ampulla of Vater. The carcinoma of the ampulla could be diagnosed only postoperatively in the resected duodenum. The problems of the presented case and the operative procedure is discussed based on a review of the literature.
By means of optico-structural machine analysis, epitheliocytes of mucous membrane of the oral walls have been studied in 21 healthy persons and in 30 persons suffering from ulcerous disease of the stomach and duodenum. Changes in densitometric parameters of epitheliocytic nuclei at the ulcerous disease demonstrate increasing amount of heterochromatin and, hence, increasing degree of cell differentiation. Changes in contents and distribution of SH-groups in cell cytoplasm indicate that keratin is accumulated in it and that keratinization processes in the mucous membrane epithelium increase. In this way it is shown that the densitometric parameters are informative on distribution of hetero- and euchromatin in nuclei and SH-groups in epitheliocytic cytoplasm of the mucous membrane in the oral wall for estimation of morphofunctional state of these cells, normal and under pathological conditions.
Results of the surgical treatment of perforations of asymptomatic ulcers of the stomach and duodenum in 63 patients are analyzed. Closure of the perforation opening is thought by the authors to be operation of choice in the treatment of such ulcers. Good and satisfactory results were obtained in 83% of the observations.
On the basis of the experience with the treatment of complicated periampular diverticulum of the duodenum in 12 patients the authors recommend to perform diverticulectomy in combination with transduodenal papillosphincteroplasty, wirsungduodenoplasty and septectomy, which allows reliable suturing of the cervix of the diverticulum ablated and eliminates narrowing of the terminal portions of the common bile duct and Wirsung's duct. The long-term results (from 1 to 3 years) were good.
Besides the method of laser coagulation and electrocoagulation the endoscopic injection therapy of gastrointestinal bleeding in the stomach and in the duodenum seems to be a successful, inexpensive and simple method. In our hospital 62 pat. were treated by endoscopic injection therapy since 1978. A definitive hemostasis could be achieved in 83%, while the method did not succeed in 17% of patients.
Aberrant pancreas to the duodenal site is a by no means simple problem of diagnosis as it is only rarely that X-ray, gastroscopy or biopsy suggest it. The case of aberrant pancreas in the duodenum, simulating a peptic lesion, is reported. Following an anatomo-pathological study, the typical aspects of the case are stressed.
Three hundred and eighty three patients with epigastric pain underwent radiological and endoscopic examination of the bulb of the duodenum. Clinical, radiological and endoscopic characteristics were compared in the 79 patients with a duodenal ulcer and in the 68 with duodenitis only. Pain and a past history of ulcer disease were of no use in differentiating duodenal ulcer from duodenitis only. Radiological deformity of the bulb appeared to be a sign of duodenitis and not of duodenal ulcer, in contrast to a crater and convergence of the folds. No endoscopic sign was of value in differentiating duodenitis only from duodenitis associated with an ulcer. Active duodenal ulcers could be differentiated from scarred duodenal ulcers only on the basis of endoscopic findings. Endoscope is the best means for the study and diagnosis of duodenal disease. On the basis of these results and data already published, an analysis was undertaken of the relationship between duodenal ulcer and duodenitis only, and it is felt that many arguments are in favour of a unitary hypothesis, duodenal ulcer and duodenitis possibly being two forms of duodenal ulcer disease.
A case of a large leiomyoma of the duodenum and how it presented is reported. Difficulties in making a preoperative diagnosis and the surgical approaches to its treatment are discussed.
We present several cases from our teaching file of submucosal lesions of the stomach and duodenum with emphasis upon the differential diagnosis between the extramural, intramural submucosal, and mucosal location. Difficulty is sometimes found with intraluminal masses. Differential diagnosis has been presented with possible hints to narrow the differential diagnosis for an intramural submucosal mass.