Íleo biliar, causa no habitual de oclusión intestinal

El íleo biliar es una rara complicación de la litiasis vesicular, que se comporta como un cuadro de obstrucción intestinal mecánica, cuya causa es la impactación de uno o más cálculos biliares en su luz. Es evidente que, por lo infrecuente de esta entidad en los servicios quirúrgicos, el diagnóstico de la misma es demorado o no se realiza, incidiendo en la evolución del paciente de manera desfavorable. El objetivo de este trabajo es considerar que un diagnóstico precoz del íleo biliar -basado en el análisis de los antecedentes del enfermo, las manifestaciones clínicas y la interpretación correcta en busca de los signos de la tríada de Rigler- permite una mejor evolución de los pacientes. Los estudios imagenológicos y su interpretación son fundamentales en el diagnóstico de esta entidad.

Biliary ileus is a rare complication of gallbladder lithiasis, which behaves like a mechanic intestinal obstruction, the cause of which is the impaction of one or more gallstones in its lumen. It is evident that because of the infrequency of this entity in the surgical services, its diagnosis is delayed or not carried out, affecting the patient's evolution in an unfavorable way. The aim of this paper is to consider that a precocious diagnosis of biliary ileus-based on the analysis of the patient's history, the clinical manifestations and correct interpretation in search of the signs of Rigler's triad-allows a better evolution of patients. Imaging studies and their interpretation are fundamental in the diagnosis of this entity.

Effect of diary psychological guidance on negative emotions and self-efficacy of patients with duodenal ulcer / 中国实用护理杂志

Objective To analyze the effect of diary psychological guidance on negative emotion and self-efficacy in patients with duodenal ulcer. Methods From August 2016 to September 2018, 88 patients with duodenal bulbar ulcer admitted to Harrison International Peace Hospital were divided into study group and control group by random grouping method, 44 cases in each group. The control group was given traditional intervention, while the study group was given diary psychological guidance on the basis of the control group. Both groups were assessed by SAS and SDS, Pittsburgh Sleep Scale, SF-36 Quality of Life Scale and Self-efficacy Scale before and after intervention at the end of the second week. Results After intervention, SAS and SDS of the study group were (51.3±2.0), (52.4±1.9) respectively, while those of the control group were (58.5±2.8), (59.3±3.1). There were significant differences between the two groups (t=15.278, 13.211, P < 0.05). The Pittsburgh sleep quality score, self-efficacy score and quality of life score in the study group were higher than those in the control group (t=7.892-24.031, all P<0.05). Conclusion The intervention of diary psychological guidance can improve the negative emotions such as anxiety and depression, and improve the self-efficacy of patients with duodenal ulcer.

Effect of diary psychological guidance on negative emotions and self-efficacy of patients with duodenal ulcer / 中国实用护理杂志

Objective@#To analyze the effect of diary psychological guidance on negative emotion and self-efficacy in patients with duodenal ulcer.@*Methods@#From August 2016 to September 2018, 88 patients with duodenal bulbar ulcer admitted to Harrison International Peace Hospital were divided into study group and control group by random grouping method, 44 cases in each group. The control group was given traditional intervention, while the study group was given diary psychological guidance on the basis of the control group. Both groups were assessed by SAS and SDS, Pittsburgh Sleep Scale, SF-36 Quality of Life Scale and Self-efficacy Scale before and after intervention at the end of the second week.@*Results@#After intervention, SAS and SDS of the study group were (51.3±2.0), (52.4±1.9) respectively, while those of the control group were (58.5±2.8), (59.3±3.1). There were significant differences between the two groups (t=15.278, 13.211, P < 0.05). The Pittsburgh sleep quality score, self-efficacy score and quality of life score in the study group were higher than those in the control group (t=7.892-24.031, all P<0.05).@*Conclusion@#The intervention of diary psychological guidance can improve the negative emotions such as anxiety and depression, and improve the self-efficacy of patients with duodenal ulcer.

ERCP and Direct Cholangioscopy with Gastroscope in Patients with Ectopic Opening of the Bile Duct into the Duodenal Bulb: A Report of 3 Cases / 대한췌담도학회지

Ectopic openings of the common bile duct into the duodenal bulb, which are associated with biliary tract disease or recurrent/refractory duodenal ulcers, are rare. We report three such cases, all of which were documented with gastroscope, and two of which were managed with endoscopic retrograde cholangiopancreatography (ERCP) via gastroscope. We suggest that ERCP can be performed with gastroscope, since it may offer a better working position in certain cases.

Hemorragia digestiva alta como primera manifestación clínica de neoplasia de bulbo duodenal. Presentación de caso / High digestive hemorrhages as first clinical manifestation of neoplasia from the duodenal bulb. Case presentation

Fundamentación: Las neoplasias malignas del intestino delgado son poco comunes y su diagnóstico es tardío porque suelen ser asintomáticas o los síntomas son intermitentes e inespecíficos Objetivo: Ofrecer una enseñanza clínico-endoscópica y radiológica de la forma de presentación de la neoplasia del bulbo duodenal que hizo su debut con hemorragia digestiva alta. Presentación de caso: Paciente masculino de 75 años de edad que ingresó por presentar sangrado digestivo alto en forma de vómitos oscuros, se le realizaron varios exámenes, entre ellos esofagogastroduodenoscopia así como toma de biopsia para estudio histológico cuyo diagnóstico definitivo fue adenocarcinoma del bulbo duodenal. Conclusiones: En las enfermedades que afectan el tracto gastrointestinal es necesario tener presente como diagnóstico nosológico este tipo de tumor maligno ya que un tratamiento oportuno puede asegurar una evolución satisfactoria y una supervivencia mayor para el paciente.

Background: Malignant neoplasias of the small intestine are not very common and the diagnosis is late because they are usually asymptomatic or the symptoms are intermittent and inespecific. Objective: To offer a clinical-endoscopical and radiological teaching of the way of the presentation of the neoplasia of the duodenal bulb that made its debut with high digestive hemorrhage. Case presentation: A 75 years old male patient who was admitted due to a high digestive bleeding in a way of dark vomits, several exams were performed, such as esophagogastroduodenoscopy as well as biopsy taking for histological study whose definite diagnosis was adenocarcinoma of the duodenal bulb. Conclusions: In the diseases that affect the gastrointestinal tract it is necessary to bear in mind as a nosologic diagnosis this type of malignant tumor since an timely treatment can assure a satisfactory evolution and a major survival for the patient.

Doble piloro adquirido: una complicación poco usual de enfermedad úlceropeptica. A propósito de un caso / DOUBLE ACQUIRED PYLORUS: AN UNUSUAL COMPLICATION OF PEPTIC ULCER DISEASE. ABOUT A CASE

El Doble Píloro (DP) es un hallazgo endoscópico inusual en el que el antro gástrico se conecta al bulbo duodenal por dos orificios separados por un septo, tabique o puente. Su etiología puede ser congénita o adquirida siendo esta última la forma más común como complicación de una enfermedad ulcero péptica (EUP). La mayoría de las fistulas están localiza­das en la curvatura menor de antro gástrico. En los casos de DP adquirido se han descrito tres teorías en cuanto a su forma­ción. Puede presentarse con dolor en epigástrico, dispepsia o hemorragia digestiva aunque en ocasiones es un hallazgo ca­sual endoscópico o radiológico. En este caso presentamos a un paciente quien acude con clínica de Hemorragia Digestiva Superior a quien se le realiza gastroscopia donde se eviden­cia este hallazgo poco usual el cual fue confirmado mediante estudio radiológico. En general el pronóstico es favorable.

The Double Pylorus (DP) is an unusual finding in the gastros­copy where the gastric antrum and the duodenal bulb is con­nected to by two holes separated by a septum or bridge. Its etiology may be congenital or acquired the latter being the most common form as a complication of peptic ulcer disease (EUP). Most fistulas are located on the lesser curvature of the gastric antrum. There have been described three theories in the formation of acquired DP. It may present with epigastric pain, dyspepsia or gastrointestinal bleeding but sometimes it is an endoscopic or radiological incidental finding. We present a patient who presents with upper gastrointestinal bleedings­ymptoms in whom a gastroscopy where performed with this unusual finding which was confirmed by radiological study. In general the prognosis is favorable.

Ectopic Opening of the Common Bile Duct into the Duodenal Bulb Accompanied with Cholangitis and Gallbladder Cancer: A Report of Two Cases

An ectopic opening of the common bile duct (CBD) into the duodenal bulb is a very rare congenital anomaly of the biliary system, which may cause recurrent duodenal ulcer or biliary diseases such as choledocholithiasis and cholangitis. Endoscopic retrograde cholangiopancreatography (ERCP) plays a major role in the diagnosis of this anomaly. We report two such cases: one in a 61-year-old man and the other in a 57-year-old man. In the first case, this anomaly caused acute cholangitis with multiple CBD stones, which were successfully treated by ERCP. In the second case, abdominal computed tomography showed pneumobilia, which was further evaluated using ERCP. Besides, this patient was diagnosed with an ectopic opening of the CBD associated with gallbladder cancer. We report these unusual cases and review the relevant medical literature.

Diagnosis and treatment of ectopic opening of the common bile duct in the duodenal bulb / 中华消化外科杂志

Objective To investigate the diagnosis and treatment of ectopic opening of the common bile duct in the duodenal bulb.Methods The clinical data of 3 patients who were admitted to the Binzhou People's Hospital and 9 patients who were admitted to the Tianjin People's Hospital from January 2006 to December 2013 with ectopic opening of the common bile duct in the duodenal bulb were retrospectively analyzed.Seven patients had choledocholithiasis and 5 had stenosis at the end of common bile duct.The medical histories and clinical features in patients were analyzed and routine blood test and serum liver function test were done.All the patients received the endoscopic retrograde cholangiopancreatography (ERCP) examination and were cured.All the patients were followed up via outpatient examination and telephone interview up to August 2014.Results Six patients had histories of cholangitis recurrence and 2 had histories of duodenal ulcer recurrence.All the patients had pain in the right hypochondriac region of the abdomen.Seven patients had fever,chills,skin yellowing sclera and tenderness in the right hypochondriac region of the abdomen.The levels of alkaline phosphatase (ALP) and glutamyltranspeptidase (GGT) in 11 patients,the levels of TBil and DBil in 8 patients and the count of WBC in 7 patients were increased.(1) The results of ERCP showed as follows:there was no papillar opening at the second and third segment of duodenum.The crack-like opening located at the duodenal post-bulb with rough and erosive mucosal surfaces and intermittent outflow of bile.Duodenal ulcer was detected in 5 patients and duodenal bulb metamorphosis in 3 patients.All the 12 patients received successfully intubations.(2)The results of retrograde cholangiography showed as follows:the end of common bile duct of 12 patients was taper and sickle-shaped.Intra-and extrahepatic bile duct dilation was detected in 10 patients,choledocholithiasis in 7 patients and clear findings for the pancreatic duct in 5 patients.Among the 12 patients,8 received balloon dilation (5 with stenosis at the end of common bile duct,3 with choledocholithiasis),3 received laparoscopic common bile duct exploration (LCBDE) combined with cholangioenterostomy due to diameter of stone more than 1.5 cm and ectopic opening stenosis of the common bile duct in the duodenal bulb.One patient was treated by percutaneous transhepatic cholangiography (PTC) lithotomy of common bile duct after unsuccessful ERCP without bleeding and pancreatitis-related complications.The symptoms of cholangitis in 3 patients were alleviated after balloon dilation,2 patients had recurrence of cholangitis and were cured by Roux-en-Y cholangioenterostomy.The mean open surgery time and mean duration of postoperative hospital stay in 5 patients were 85 minutes (range,60-150 minutes) and 10 days (range,8-14 days),respectively.All the 12 patients were followed up with a median time of 38 months (range,8-90 months).During the follow-up,10 patients survived well without recurrence of cholangitis and cholelithiasis.Two patients had recurrence of cholangitis at postoperative month 2 and month 14,including 1 patient with the recurrence of common bile duct sand-like stones,and they were readmitted to hospital and treated by Roux-en-Y cholangioenterostomy without recurrence by follow-up.Conclusions The clinical symptoms of ectopic opening of the common bile duct in the duodenal bulb included recurrence of cholangitis,duodenal ulcer history,pain in the right hypochondriac region of the abdomen,skin yellowing sclera,abnormal liver function,crack-like openings in the duodenal bulb by ERCP examination with outflow of bile,cholangiography-guided taper and sickle-shaped end of common bile duct.The treatment should be aimed at the concomitant diseases.

A Case of an Anomalous Opening of the Common Bile Duct and Pancreatic Duct into the Duodenal Bulb, and the Patient Presented with Acute Cholangitis and Recurrent Duodenal Ulcer / 대한소화기내시경학회지

There are various congenital anomalies of the biliary system, but an ectopic opening of the common bile duct into the duodenal bulb is an extremely rare finding. Despite the recent improvement in the diagnosis and management of pancreatobiliary lesions, the general lack of knowledge and understanding about these variations is undoubtedly responsible for many of the problems that occur during the medical and surgical management of these lesions. We report here on a case of a 65-year-old man who had an ectopic opening of the common bile duct into the duodenal bulb, and this cause acute cholangitis with bile duct sludge, and also recurrent duodenal ulcer. In this case, we used abdomen CT, MRCP, duodenoscopy, EUS and ERCP for making the diagnosis. The cholangitis and duodenal ulcer was improved with medical therapy, and the patient was discharged without any surgical procedure. We report here on this unusual case and we include a review of the relevant medical literature.

A Case of Anomalous Drainage of the Common Bile Duct into the Duodenal Bulb with Pancreatic Duct Anomaly / 대한소화기내시경학회지

The common bile duct normally enters the posteromedial aspect of the second part of the duodenum. However, anomalous drainage of the common bile duct into the stomach, pyloric channel, duodenal bulb and fourth portion of the duodenum has been reported in the literature. An anomalous pancreatic duct, with ectopic drainage of the common bile duct, is particularly rare. Herein, we report the case of a 69-year-old woman who showed pancreatic ductal variation and anomalous drainage of the common bile duct into the duodenal bulb. The patient required a cholecystectomy and choledochoenteric anastomosis to relieve the obstructive jaundice and abdominal pain.

A Case of the Duodenal Bulb Abscess / 대한소화기내시경학회지

Duodenal abscess is a rarely reported disease throughout the entire world. Duodenal abscesses are developed mostly from the complication of duodenal ulcer perforation, and only small percentage of duodenal abscesses are the result of cholecysto-duodenal fistula which was made by gall bladder perforation. We report a 84-year-old male patient who presented to the emergency department with severe anorexia and generalized weakness for 2 weeks. The upper gastrointestinal endoscopy done and revealed a protruding mass at the lesser curvature of the duodenal bulb. As soon as the mass was punched with a biopsy forceps, a large amount of abscess began to pour out into the intestinal lumen. Abdominal CT scan demonstrated the presence of an air-fluid level the in gall bladder and also abscess in the porta hepatitis which was located between the gall bladder and the duodenum. Because the patient refused any surgical intervention, we treated him conservatively with intravenous antibiotics. Patient's symptom of anorexia was slowly resolved, and patient was discharged 10 days later.

A human infection of Echinostoma hortense in duodenal bulb diagnosed by endoscopy

As gastroduodenoscopy performed more frequently, case reports of human echinostomiasis are increasing in Korea. A Korean woman presented at a local clinic with complaints of abdominal pain and discomfort that had persisted for 2 weeks. Under gastroduodenoscopy, two motile flukes were found attached on the duodenal bulb, and retrieved with endoscopic forceps. She had history of eating raw frog meat. The two flukes were identified as Echinostoma hortense by egg morphology, 27 collar spines with 4 end-group spines, and surface ultrastructural characters. This report may prove frogs to be a source of human echinostome infections.

A Case of Enteritis Cystica Profunda in the Duodenal Bulb / 대한소화기내시경학회지

Enteritis cystica profunda (ECP) is characterized by mucin-filled cystic spaces that are partially lined by non-neoplastic columnar epithelium, and these are found in the wall of the small bowel. This is a very rare disease compared to cystica profunda involving the stomach or colon. The cause of ECP is still unclear. Most ECP is related to or it may accompany other intestinal diseases. We encountered one case of ECP of the duodenal bulb that presented as polyp, and this was not related to adenocarcinoma or any other intestinal diseases like Crohn's disease or ulcerative colitis. Endoscopic polypectomy was done and the ECP was later confirmed through histological evaluation.

A Tubulovillous Adenoma of Duodenal Bulb Treated by Endoscopic Mucosal Resection / 대한소화기내시경학회지

Solitary tubulovillous adenoma of the duodenal bulb is a rare tumor, which has not been reported in the Korean literature. Most of duodenal adenoma is located in the second portion of the duodenum. We report an unusual case of tubulovillous adenoma of the duodenal bulb. The lesion was treated by the endoscopic mucosal resection and was histologically diagnosed as tubulovillous adenoma.

A Case of Anomalous Drainage of the Common Bile Duct into the Duodenal Bulb Presenting with Obstructive Jaundice / 대한소화기내시경학회지

The common bile duct classically enters the posteromedial aspect of the second part of the duodenum through an oblique, 1 to 2 cm long intramural tunnel. Some case reports of the common bile duct emptying into other sites including the fourth part of the duodenum, the pyloric canal, stomach and duodenal bulb have appeared in the literature. We report a case of a 40-year-old man who showed anomalous drainage of the common bile duct into the duodenal bulb presenting with obstructive jaundice and duodenal ulcer. This patient required choledochoenteric anastomosis to relieve obstructive jaundice and abdominal pain. We report the case with a review of other cases in Korean literature.

Relationship between Helicobacter pyloriinfection and gastric metaplasia in the mucosa of duodenal bulb / 中华消化杂志

Objective To investigate the relationship between Helicobacter pylori(H. pylori)infection and gastric metaplasia in the duodenal bulb and to pursue whether they play critical roles in pathogenesis of duodenitis and ulcer.Methods Eighty-two archive paraffin blocks of duodenal biopsy were obtained. All sections were stained with H-E, AB/PAS and Giemsa stains for histology, gastric metaplasia and H. pyloriassessment. There were 10 patients with normal duodenum, 47 with duodenitis and 25 with ulcer confirmed by endoscopy. Results There was a discrepancy in diagosis of the normal duodenal bulb mucosa between endoscopy and histopathology. Mild to moderate infiltration of inflammatory cell without gastric metaplasia were detected in 60% of cases with the normal duodenal bulb mucosa judged by endoscopy. Gastric metaplasia in duodenal bulb was the major phenomena in the patients with duodenitis and ulcer (37/82, 45%). H. pyloriinfection in the duodenal bulb always appeared in areas of gastric metaplasia. H. pyloriwas identified in 28 out of 37 (76%) cases in the gastric metaplasia mucosa. The prevalence of gastric metaplasia in the duodenal bulb between the patients with ulcer (72%) and duodenitis (40%) was significantly different (P=0.0078). The frequency of H. pyloricolonization was higher in the patients with duodenal ulcer (89%) than the patients with duodenitis (63%), but did not reach statistical significance(P=0.062). H. pyloriinfection was also higher in the ulcer patients with active, healed or scar stage, being 9/10, 5/6 and 2/2, respectively. Conclusions There is a difference in the frequency of H. pyloricolonization in the gastric metaplasia mucosa in the patients with ulcer and duodenitis, which suggests that infection with H. pylorimay play an important role in ulcer recurrence.

A Case of Tubular Adenocarcinoma on Fistula of Duodenal Bulb / 대한소화기내시경학회지

The first documented case of duodenal carcinoma was described by Hamburger in 1746. Primary adeno-carcinoma of duodenum is rare. Malignant tumors of the small bowel are reported to account for about 1% of all gastrointestinal carcinoma. The autopsy incidence of duodenal adenocarcinoma is about 0.3% of all malignancy. The second and third portions of the duodenum are the usual sites of adenocarcinoma. Cancer in the duodenal bulb is exceedingly rare. Most of them revealed an intraluminal mass or wall thickening. But we have experienced a case of exophytic growth pattern adenocarcinoma such as the fistula of duodenal bulb in 49 year old male patient with hematemesis. For its great rarity, we report this case with review of literatures.

A Case of Multicentric Duodenal Carcinoid / 대한소화기내시경학회지

Carcinoid tumors are the most common endocrine tumors of gastrointestinal tract. Argentaffin cells are the origin of carcinoids. These cells belong to the amino precursor uptake and decarboxylation (APUD) system. These cells give the tumor its most distinguishing feature: the ability to produce biogenic amines and polypeptide hormones that, in turn, give rise to the dramatic carcinoid syndrome. We treated a case of multi-centric carcinoid tumor of the duodenum in a 63-year-old male patient. He was admitted to the hospital because of epigastric pain. On the gastrofiberscopic examination, 1.0 x1.5 cm and 0.7 x0.8 cm sized two polyps (Yamada type II, I) were noticed on the duodenal bulb. The biopsy specimen showed carcinoid tumors of different histologic types. The level of 24-hour urine 5-HIAA of this case was normal. He was treated with subtotal gastrectomy with Billroth-II anastomosis. We report this case with literature review.

A Case of Anomalous Termination of the Common Bile Duct and the Pancreatic Duct into the Duodenal Bulb, Associated with Common Bile Duct Stones / 대한소화기내시경학회지

Usually, the papilla of Vater is located in the midportion or the distal half of the descending duodenum. Isolated cases of common bile duct termination in other sites, including the fourth portion of the duodenum, the pyloric ring, the duodenal bulb and the stomach, have been reported. A case is here in reported involving abdominal pain in the right upper quadrant area, in which an ERCP demonstrated an anomalous termination of the common bile duct and pancreatic duct into the duodenal bulb separately. This anomaly was associated with a bile duct dilatation and single common bile duct (CBD) stone. Trial of CBD stone removal during an ERCP failed. The patient's condition improved after a cholecystectomy and choledochojejunostomy.

A Case of Duodenal Carcinoid Tumor / 대한소화기내시경학회지

Carcinoid tumors are well-differentiated epithelial neoplasms that usually can be diagnosed without difficulty based on their distinctive histologic patterns. These tumors are composed of variable numbers of calls that contain endocrine secretory granules in their cytoplasm, which can be identified by histochemistry, immunohistochemistry, and electron microscopy, Carcinoid tumors of the duodenum are relatively rare, the reported incidence being 2.0-8.9% of all gastrointestinal carcinoid tumors dianosed in Western countries. The rate of occurrence among all duodenal tumors is 3-5.5%. We experienced a case of carcinoid tumor of the duodenum in a 53 year-old male patient. He was admitted to our hospital because of epigastric pain. On the gastrofiberscopic examination, 0.7 cm sized Yamada type II polyp with central ulceration was noticed on the duodenal bulb. The biopsy specimen revealed carcinoid tumor. He was treated with polypectomy.