A Case Report of Duodenal Diaphragm Misdiagnosed as a Bulimia / 대한소화기내시경학회지

Duodenal diaphragm is a rare congenital anomaly among the congenital duodenal obstructions. Its symptom and sign usually appear since birth if obstruction is complete. The clinical manifestations of incompletely obstructive duodenal diaphragm are intermittent vomiting, abdominal pain and poor weight gain. Diagnosis may be delayed in this case. Authors experienced a case of incomplete duodenal diaphragm with a central hole. A 29 months old girl presented failure to thrive, intermittent episodes of bloating, abdominal discomfort and occasional vomiting. The patient vomited every 10-14 days, then the abdominal pain and distention were relieved. She overate for about 10 days until the next projectile vomiting. The vomitus frequently contained food ingested several days previously. Plain x-ray films of abdomen showed marked gastric distention. Upper gastrointestinal series revealed marked distention of the duodenum with windsock configuration and radiolucent line at the third portion of the duodenum. On gastroscopic examination, gastric bezoar impacting the pyloric canal and antrum was noted. At operation, we found mucosal membrane in the third portion of the duodenum and bezoar(Chinese cabbage) above the membrane. Side-to-side duodeno-jejunostomy was performed and bezoar was removed. She was discharged on the 13th postoperative day without any complication.

Sonographic diagnosis of renal masses excluding simple cyst

Sonography is quite sensitive screening method for th detection of renal mass lesions, but the specificity isrelatively low. Authors analized the sonographic findings of the confirmed 67 cases of renal masses excludingsimple cyst for possible differential points between each other. The results were as follows: 1. Among the 67cases, 44 cases(65.7%) were tumorous lesions and majority were malignant tumors. 2. Iso or hyperechoic lesions arerelatively specific finding suggestive of the tumorous lesions. 83.3% of isoechoic lesions and 85.0% ofhyperechoic lesions were tumor. 3. Tumor echogenecity of the renal cell carcinoma was variable. Of the 23 renalcell carcinomas, 10 were isoechoic, 8 were hypoechoic and 5 were hyperechoic lesions. 4. In hypoechoic lesions,findings of acoustic enhancement and wall echo were suggestive of nontumorous lesion. 5. There was no directcorrelation between echogenecity of the mass and tumor vascularity. 6. IVP findings were not sensitive andnonspecific for renal mass lesions, so ultrasound could be the initial step of diagnostic modality for evaluationof the renal mass.