Bleeding duodenal diverticula managed With surgical resection: A case report

@#The duodenum is the most common extra-colonic site of diverticulum. If present, it rarely manifests with symptoms or complications. A case is discussed involving a 78-year-old female who presented with massive upper gastrointestinal bleeding from duodenal diverticula. Due to hemodynamic instability, she eventually underwent duodenal resection, with a side-to-side duodenojejunostomy as a means of restoring intestinal continuity. The postoperative course was unremarkable. The patient was able to feed enterally and had no recurrence of bleeding.

Coristoma pancreático dentro de un divertículo duodenal: a propósito de un caso / Pancreatic Choristoma within a duodenal diverticulum, an accidental finding: apropos of a case

Resumen El coristoma pancreático, o páncreas heterotópico, es una condición rara en gastroenterología. Esta entidad consiste en el hallazgo de tejido pancreático aberrante, en alguna zona del tracto gastrointestinal, sin continuidad vascular o anatómica con el páncreas normal, es poco reportado y presenta sintomatología variable. Presentamos el caso de un individuo de 46 años con dolor abdominal a quien se le encontró mediante exámenes invasivos un divertículo duodenal, el cual al examen histopatológico e inmunohistoquímico mostró un coristoma pancreático.

Abstract Pancreatic choristoma, also called heterotopic pancreas is a rare condition in gastroenterology. This entity consists of the presence of aberrant pancreatic tissue in some other area of the gastrointestinal tract without vascular or anatomical continuity with the normal pancreas; it has been seldomly reported and it could exhibit variable symptomathology. We herein report the case of a 46-year-old male, who presented with abdominal pain and was found, through invasive examinations to have a pancreatic choristoma within a duodenal diverticulum. The diagnosis was made using histopathology and immune-histochemistry testing.

Impact of Periampullary Diverticulum on ERCP Performance: A Matched Case-Control Study

BACKGROUND/AIMS: Periampullary diverticulum (PAD) is frequently encountered during endoscopic retrograde cholangiopancreatography (ERCP) and has been associated with stone formation in the bile duct. The effects of PAD on the ERCP procedure have been often debated. We aimed to compare the therapeutic success of ERCP between patients with PAD and matched controls. METHODS: We reviewed all ERCPs with findings of PAD in a national database (n=1,089) and compared them with age- and gendermatched controls in a 1:3 fashion (n=3,267). Demographics, endoscopic findings, visualization of main structures, and therapeutic success rates were compared between groups. Secondary analysis compared PAD cases and controls who had gallstone disease. RESULTS: The average cohort age was 68.4±14.3 years and 55.1% were male. ERCP success was similar in both groups, and no significant inter-group differences were found in the multivariate analysis. The presence of PAD did not affect the rates of sphincterotomy or visualization of main biliary structures. Secondary analysis showed similar success rates for gallstone removal between patients with PAD and controls. CONCLUSIONS: PAD may not be considered a hinderance to ERCP success. Further research is needed to determine the best approach to cannulate the ampulla and provide endoscopic therapy for different subtypes of PAD.

Influence of common bile duct stones and juxta-papillary duodenal diverticula on endoscopic retrograde cholangiopancreatography and related coping strategies / 临床肝胆病杂志

Juxta-papillary duodenal diverticula (JPD) may easily cause biliary and pancreatic diseases. JPD changes papillary position and shape and increases the difficulties in endoscopic retrograde cholangiopancreatography (ERCP) intubation and stone removal, and it may also cause a series of complications. With reference to related articles in China and foreign countries, this article briefly describes the typing and development of JPD and its association with biliary and pancreatic diseases, analyzes the influence of common bile duct stones and JPD on ERCP, and summarizes related coping strategies, in order to provide suggestions and bases for clinical diagnosis and treatment.

Influence of common bile duct stones and juxta-papillary duodenal diverticula on endoscopic retrograde cholangiopancreatography and related coping strategies / 临床肝胆病杂志

Juxta-papillary duodenal diverticula (JPD) may easily cause biliary and pancreatic diseases. JPD changes papillary position and shape and increases the difficulties in endoscopic retrograde cholangiopancreatography (ERCP) intubation and stone removal, and it may also cause a series of complications. With reference to related articles in China and foreign countries, this article briefly describes the typing and development of JPD and its association with biliary and pancreatic diseases, analyzes the influence of common bile duct stones and JPD on ERCP, and summarizes related coping strategies, in order to provide suggestions and bases for clinical diagnosis and treatment.

Association of juxtapapillary duodenal diverticulum with pancreaticobiliary diseases and with diagnosis and treatment of endoscopy / 中华消化内镜杂志

Objective To study the relationship between juxtapapillary duodenal diverticulum (JPDD) and pancreaticobiliary diseases, and the effect of JPDD on the diagnosis and treatment of ERCP. Methods A retrospective analysis was performed on data of 1230 patients who had received ERCP in general surgery departments of Shengjing Hospital of China Medical University from January 2012 to January 2017. The patients were divided into JPDD group ( n=360) and non-JPDD group ( n=870) according to whether JPDD was found. Patients with JPDD were divided into intradiverticular papilla group ( n=41) and non-intradiverticular papilla group ( n=319) according to whether the papilla located in diverticulum. The incidence of pancreaticobiliary diseases, success rate of cannulation, success rate of stones removal, and incidence of postoperative complications among each group were compared by using chi-square test or Fisher's exact probability. P < 0. 05 was statistically significant. Results The incidence of choledocholithiasis, primary choledocholithiasis and recurrent choledocholithiasis were 87. 78％ (316/360), 31. 11％ (112/360), and 6. 67％ (24/360), respectively, in the JPDD group, and 75. 52％ (657/870),19. 08％ (166/870), and 4. 02％ (35/870), respectively, in the non-JPDD group. There were significant differences between the two groups (χ2=23. 158, P<0. 001; χ2=21. 068, P<0. 001; χ2=3. 897, P=0. 048) . No significant differences were observed in the success rate of cannulation and complete stones removal during the first ERCP session, as well as the incidence of postoperative hemorrhage, pancreatitis and hyperamylasemia between the two groups ( all P>0. 05) . The incidence of recurrent choledocholithiasis in the intradiverticular papilla group and the non-intradiverticular papilla group were 14. 63％ ( 6/41) and 5. 64％ (18/319), respectively, with significant difference (χ2 =4. 721, P=0. 030). There were no significant differences between the two groups in the incidence of choledocholithiasis and primary choledocholithiasis, the success rate of cannulation and complete stones removal during the first ERCP session, as well as the incidence of postoperative hemorrhage, pancreatitis and hyperamylasemia ( all P>0. 05) . Conclusion JPDD is associated with the occurrence of primary choledocholithiasis. JPDD patients, especially the patients with intradiverticular papilla, are more likely to have recurrent choledocholithiasis after ERCP treatment.

Hemostatic clips to facilitate intubation during ERCP with ampulla around duodenal diverticulum / 中国内镜杂志

Objective To investigate the effectiveness of hemostatic-clip-assisted method during ERCP with ampulla around duodenal diverticulum. Methods 25 patients with ampulla around duodenal diverticulum encountered cannulation difficulty, 11 cases underwent with clip-assisted method, 14 cases with ordinary ways. Number of successful cases, cannulation time, post-operation complication were analyzed. Results All the 11 cases succeeded in clip group. 12 patients succeeded in none-clip group. Cannulation time between the two groups were discrepant. There was no difference in number of successful cases and post-operation complication rate. Conclusion Successful application of hemostatic clip help to expose and facilitate cannulation of an ampulla around a duodenal diverticulum.

Divertículo duodenal simulando neoplasia quística de páncreas / Duodenal diverticulum as a cystis neoplasm of pancreas

Resumen Objetivo: El divertículo duodenal se presenta con una frecuencia del 1 al 23% según series radiológicas y de autopsias. La localización más frecuente es la segunda porción duodenal cercana a la cabeza pancreática, por lo cual puede ser confundido con neoplasias pancreáticas quísticas. Material y Método: Presentamos un paciente con diagnóstico de sospecha radiológica, mediante ecoendoscopia y punción aspiración con aguja fina (PAAF), de neoplasia mucinosa de páncreas que fue intervenido, encontrándose un endurecimiento de la cabeza pancreática y un divertículo duodenal yuxtavateriano, realizándose extirpación en bloque ante la sospecha de malignidad. Resultado: El posoperatorio del paciente fue favorable y el resultado anatomopatológico del tejido pancreático informó de tejido pancreático sin anomalías y divertículo duodenal. Discusión: El diagnóstico diferencial preoperatorio del divertículo duodenal con la neoplasia mucinosa quística de páncreas es muy complejo, ya que la punción del líquido del interior del divertículo puede ser similar al de un proceso neoplásico mucinoso pancreático. Ante la sospecha diagnóstica y la presencia de clínica está indicado realizar laparotomía exploradora, para obtener un diagnóstico de certeza.

Objective: The duodenal diverticulum presents with a frequency of 1 to 23% according to radiological series and autopsies. The most frequent localization is the second duodenal portion near the pancreatic head so it may be confused with cystic pancreatic neoplasms. Material and Method: We present a patient with diagnosis of radiological suspicion by means of echoendoscopy and fine needle aspiration biopsy (FNAB) of a mucinous neoplasm of the pancreas that was intervened, being a hardening of the pancreatic head and a duodenal juxtavaterian diverticulum, being performed a block removal on suspicion of malignancy. Result: The patient's postoperative period was favorable and the anatomopathological result of the pancreatic tissue was of pancreatic tissue without anomalies and duodenal diverticulum. Discussion: The preoperative differential diagnosis of duodenal diverticulum with mucinous cystic neoplasia of the pancreas is very complex, since the puncture of the fluid inside the diverticulum may be similar to that of a neoplastic process of the pancreatic mucin. Before the suspected diagnosis and the presence of clinic is indicated to perform exploratory laparotomy, to obtain a diagnosis of certainty.

Síndrome de Lemmel: una causa rara de obstrucción biliar no neoplásica de la vía biliar. Presentación de un caso / A Case of Lemmel’s Syndrome: A Rare Cause of Non-Neoplastic Obstruction of the Biliary Tract

Se reporta el caso de una paciente de 77 años de edad con un síndrome ictérico obstructivo, sin presencia de coledocolitiasis u otra alteración del árbol biliar distinta a la presencia de un divertículo duodenal. Se considera que cursa con síndrome de Lemmel, por lo que se realiza manejo endoscópico con esfinterotomía y colocación de stent. El síndrome de Lemmel es una patología poco frecuente que debe tenerse en cuenta como causa de ictericia obstructiva

We report the case of a 77-year-old woman with jaundice but no evidence of choledocholithiasis or other alterations of the biliary tree except for a duodenal diverticulum. Lemmel’s syndrome was diagnosed and an endoscopic sphincterotomy with stenting was performed. Lemmel’s syndrome is a rare disease that must be considered as a cause of obstructive jaundice

Surgical treatment of recurrent cholelithiasis caused by peripapillary duodenal diverticulum / 中华肝胆外科杂志

Objective To study the diagnosis and therapy of recurrent cholelithiasis caused by peripapillary duodenal diverticulum.Methods The clinical data of 40 patients with repeated formation of bile duct stones caused by peripapillary duodenal diverticulum were retrospectively reviewed,and the data on surgical treatment were analyzed.Results All the patients underwent duodenal diverticulum operation and subtotal gastrectomy (Billroth Ⅱ).Twenty-one patients in addition underwent R-Y cholangiojejunostomy,14 patients and 5 patients underwent choledochotomy with T-tube drainage and duodenotomy with Oddi sphincterotomy,respectively.In forty patients,three patients presented temporarily biliary fistula,two patients lost touch,three-eighty fully recover from an illness in three years.Conclusion Recurrence of bile duct stones caused by peripapillary diverticulum may be cured by duodenal diverticulum operation combined with bile duct surgery,which is a feasible and efficacious treatment.

A patient presenting with recurrent post-prandial abdominal discomfort and vomiting.

Duodenal diverticulum is the second most common diverticulum of gastrointestinal tract. Among duodenal diverticulum, incidence of intramural duodenal diverticulum is 100 as per report till date. It is usually asymptomatic, but in middle or adult age, it may present with postprandial abdominal discomfort, often complicates in the form of bleeding, perforation or rarely neoplasm. So, this congenital duodenal deformity requires urgent definitive treatment. Here we presented a case presenting with postprandial abdominal discomfort with occasional vomiting. He was advised upper gastrointestinal endoscopy. It showed evidence of duodenal septa at the junction of 1st and 2nd part. Scope was negotiated through one channel. He was advised barium meal of stomach, duodenum and follow through, which ultimate demonstrated presence of a rare abnormality, duodenal intramural diverticulum, which if not treated, can produce severe complication in future.

Biliary manometry in patients with common bile duct stones and juxtapapilary duodenal diverticulum / 中华消化内镜杂志

Objective To explore the impact of juxtapapilary duodenal diverticulum on the formation of choledocholithiasis and biliary manometry after surgery.Methods The clinical data of 97 patients with common bile duct stones who successfully underwent ERCP and biliary manometry treatment from May 2011 to March 2014 were retrospectively analyzed.Ninty-seven common bile duct stone patients were divided to two groups,that is,52 cases of juxta-papilary duodenal diverticulum (experimental group) and 45 cases without juxta-papilary duodenal diverticulum (control group).The biliary manometric results before and after EST of both groups were compared.Results The basal pressure of sphincter Oddi of the experimental group before EST [(84.8 ± 26.1) mmHg] was higher than that of the control group before EST [(75.5 ± 14.6) mmHg] (P ＜ 0.05,1 mmHg =0.133 kPa);and that after EST was also higher than that of the control group after the operation[(19.8 ± 14.2)mmHg VS (15.9 ± 9.8)mmHg,P ＜ 0.05].The biliary pressure of common bile duct stone patients with JPD was higher than those without JPD before and after EST but with no significant difference(P ＞ 0.05).The biliary manometry was performed in 81 patients after one month and it was found that the basal pressure of sphincter Oddi of experimental group was still higher than that of the control group [(34.8 ± 17.1) mmHg VS (29.6 ± 15.3)mmHg,P ＜ 0.05].The biliary pressure of common bile of the experimental group was higher than that of the control group [(19.9 ± 11.2) mmHg VS (17.1 ± 13.1)mmHg,P ＜0.05].Conclusion The existence of juxtapapilary duodenal diverticulum increases the pressure of common bile duct and Oddi sphincter and leads to CBD stones.

A Rare Cause of Acute Upper Abdominal Pain: Diverticulitis of the 3rd Portion of the Duodenum

Duodenal diverticulitis is a rare cause of upper abdominal pain and is usually not considered when evaluating patients with acute upper abdominal pain. Furthermore, the duodenum is located near the pancreas and bile duct, and duodenal diverticulitis can be misdiagnosed as acute pancreatitis, cholangitis, cholecystitis, or other pancreatobiliary disorders such as pancreatic cystic neoplasms. Recently, we experienced a rare case of duodenal diverticulitis in the 3rd portion of the duodenum. The patient presented with deep seated upper abdominal pain aggravated by supine posture and relieved by sitting up. The patient was initially diagnosed with acute pancreatitis. However, serum levels of pancreatic enzymes were normal and abdominal CT scan revealed diverticulitis in the 3rd portion of the duodenum. The patient was successfully managed conservatively. Delayed diagnosis of duodenal diverticulitis can result in substantial morbidity and mortality if duodenal perforation occurs and should be considered as a possible cause of upper abdominal pain.

Divertículos periampulares diagnosticados durante colangiopancreatografía retrógrada endoscópica / Periampullar diverticula diagnosed under endoscopic retrograde cholangiopancreatography

Introducción: con el desarrollo de la endoscopia digestiva, Ryan y colaboradores realizan el primer diagnóstico endoscópico de divertículo duodenal en 1984. El duodeno es el segundo lugar del tubo digestivo donde se detectan divertículos con más frecuencia, localizándose en la segunda porción del duodeno aproximadamente el 75 %. La presencia de divertículo en la segunda porción del duodeno, periampulares, ha sido reportada entre un 5 % y 32,8 % de los pacientes en las series de estudios de colangiopancreatografías retrógradas endoscópicas. Objetivo: determinar la frecuencia con que se diagnosticaron divertículos periampulares durante la colangiopancreatografía retrógrada endoscópica y caracterizar estos pacientes. Métodos: se realizó un estudio descriptivo, transversal en pacientes que se realizaron la colangiopancreatografía retrógrada endoscópica en el período comprendido desde 23 de febrero de 2010 hasta el 23 de febrero de 2013, quedando conformada la población de estudio por 35 pacientes con diagnóstico de divertículo periampular durante la colangiopancreatografía retrógrada endoscópica. Se analizaron las variables edad y sexo, localización del divertículo con respecto a la papila mayor y diagnóstico colangiográfico. Los pacientes se clasificaron según la clasificación de Noda. Resultados: no existieron diferencias significativas con respecto al sexo, y la edad media de los pacientes fue de 68,9 años. Predominaron los pacientes tipo D y el diagnóstico colangiográfico más frecuente fue la litiasis coledociana. Conclusiones: la incidencia de divertículo periampular en la población estudiada se encuentra entre los rangos reportados por la literatura médica, con una edad promedio de los pacientes de 68,9 años y siendo la litiasis coledociana el diagnóstico colangiográfico más frecuentemente asociado, con la particularidad de esta serie de casos de no encontrarse diferencias entre sexos y de predominar los pacientes tipo D.

Background: with the development of digestive endoscopy, Ryan and collaborators carried out the first endoscopic diagnose of duodenal diverticulum in 1984. The duodenum is the second place of the digestive duct where diverticula are detected more frequently, about 75 % of them located in the second portion of the duodenum. The diverticulum presence in the second portion of the duodenum, periampullar ones, has been reported in between 5 % and 32,8 % of patients in the series of endoscopic retrograde cholangiopancreatography studies. Objective: to determine the frequency periampullar diverticula were diagnosed during endoscopic retrograde cholangiopancreatography and to characterize these patients. Methods: a descriptive, cross-sectional study was performed in patients treated by endoscopic retrograde cholangiopancreatography from February 23rd, 2010 to February 23rd, 2013, being the population based study 35 patients with diagnose of periampullar diverticulum by endoscopic retrograde cholangiopancreatography. The following variables were analyzed: age, sex, diverticulum location with respect to the major papilla and cholangiographic diagnose. Patients were classified according to Noda´s classification. Results: there were not significant differences regarding to sex, and patients´ average age was 68,9 years. Type D patients prevailed and the most frequent cholangiographic diagnose was choledocholithiasis. Conclusions: the incidence of periampullar diverticulum in the studied population is between the ranges reported by medical literature, with a patients´ average age of 68,9 years, being choledocholithiasis the most frequent cholangiographic associated diagnose; the particularity of this case series is that there were not found differences between sexes, and type D patients predominated.

Clinical analysis of 51 choledocholithiasis patients combined with juxtapapillary duodenal diverticular treated by endoscopic sphincterotomy / 中国医师进修杂志

Objective To investigate the relationship between juxtapapillary duodenal diverticular (JPDD) and choledocholithiasis,and the effects of JPDD on endoscopic sphinctemtomy(EST) in treatment of choledocholithiasis.Methods Fifty-one cases of choledocholithiasis combined with JPDD (choledocholithiasis combined with JPDD group) and 210 cases of choledocholithiasis without JPDD (choledocholithiasis without JPDD group) were treated by EST,and the clinical data of patients in the two groups were retrospectively analyzed.The relationship between JPDD and choledocholithiasis was studied.The JPDD' influence on the intubation success rate of endoscopic retrograde cholangiopancreatography (ERCP),the success rate of the stone removal by EST and complication were analyzed.Results The incidences of choledocholithiasis in patients of JPDD diameter ＜ 1 cm,1-3 cm and ＞ 3 cm were 39.3％(11/28),53.2％ (33/62) and 7/8 respectively.The larger the JPDD diameter,the higher the incidence of choledocholithiasis,and there was statistical difference (P ＜ 0.01).The incidence of choledocholithiasis in peripheral type JPDD was significantly higher than that in parallel type and circumvolution type [81.0％(17/21) vs.41.9％(26/62) and 8/15],and there were statistical differences (P ＜0.05).There was no statistical difference in the intubation success rate of ERCP between the two groups (P ＞ 0.05),but the success rate of the stone removal by EST in choledocholithiasis combined with JPDD group was significantly lower than that in choledocholithiasis without JPDD group [91.8％ (45/49) vs.99.5％ (208/209)].The incidence of EST incision bleeding was significantly higher than that in choledocholithiasis without JPDD group [11.1％ (5/45) vs.1.9％ (4/208)],and there was statistical difference (P ＜ 0.01) ; there were statistical differences in the incidences of others complication between the two groups (P ＞ 0.05).Logistic regression analysis showed that JPDD was independent risk factor for EST incision bleeding (P =0.043).Conclusions JPDD is relative with choledocholithiasis.JPDD makes EST a little more difficult and risky,while EST is still a safe and effective therapy for choledocholithiasis patients combined with JPDD.

A Case of Duodenal Diverticulum Mimicking a Peripancreatic Abscess / 대한내과학회지

The duodenum is the second most common site, after the colon, of diverticuli in the alimentary tract. Although most patients with duodenal diverticuli are asymptomatic, previous studies have demonstrated a possible association between duodenal diverticuli and choledocholithiasis and pancreatitis. In addition, duodenal diverticuli mimicking periampullary tumors and cystic neoplasms of the pancreas have been reported. We report a case of a duodenal diverticulum that mimicked a peripancreatic abscess. A 65-year-old woman was admitted for epigastric pain and vomiting. Abdominal CT confirmed the diagnosis of acute pancreatitis. Follow-up abdominal CT performed for a sustained fever revealed several newly developed peripancreatic abscesses. Most of the abscesses were drained percutaneously, but those around the uncinate process seldom respond to treatment. This patient was confirmed to have a duodenal diverticulum by endoscopy and duodenography. Duodenal diverticuli must be considered in a differential diagnosis of peripancreatic abscesses.

Divertículo duodenal perforado como causa de abdomen agudo quirúrgico / Perforated duodenal diverticulum as cause of surgical acute abdomen

La enfermedad diverticular duodenal es considerada en el ámbito de la cirugía de vías digestivas como inusual. Por su parte, la complicación menos frecuente referida en la literatura médica lo constituye la perforación aguda, y cuando esta ocurre siempre se practicará tratamiento quirúrgico de urgencia. Resulta polémico llegar a un consenso general que dirija la metodología diagnóstica, debido a su atípica forma de presentación. La tomografía abdominal ha resultado de gran utilidad en el diagnóstico de esta entidad. Se reportan tasas de mortalidad altas (25-30 por ciento) originadas, generalmente, por la dificultad diagnóstica frente a esta enfermedad. Se presenta un nuevo caso de divertículo duodenal perforado en una paciente, del sexo femenino, de 60 años de edad. La técnica quirúrgica empleada en esta oportunidad consistió en la exclusión duodenal y el drenaje del retroperitoneo(AU)

The duodenal diverticular disease is considered within surgery of digestive tracts as unusual. The less frequent complication referred in medical literature is the acute perforation and when it occurs always will be carried out the emergency surgical treatment. It is polemic to arrive to a general consensus directing the diagnostic methodology due to its atypical way of presentation. The abdominal tomography has been very useful in diagnosis of this entity. Authors report high mortality rates (25-30 percent) in general originated by the diagnostic difficulty in face of this disease. A new case of perforated duodenal diverticulum of a female sex patient aged 60. The surgical technique used in this opportunity was the duodenal exclusion and the retroperitoneal drainage(AU)

Divertículo duodenal em colangiografia endoscópica - CPRE: estudo retrospectivo / Duodenal diverticulum in endoscopic colangiograpy - ERCP: retrospective trial

Os divertículos duodenais se manifestam com relativa frequência durante os procedimentos de colangiografia endoscópica (CPRE), e são superados apenas pelos divertículos do cólon. Sua provável origem seria decorrente da debilidade da parede duodenal na área de fusão entre o pâncreas ventral e dorsal durante o período embrionário. Tais divertículos, localizados na região periampular, dificultam a canulação da via biliar quando são de grande tamanho. Nessa revisão, foram analisados os vídeos e informes de 2.641 CPREs, realizados entre janeiro de 2005 a abril de 2007, em clínica de terapia endoscópica. Foi traçado o perfil social dos pacientes, patologias associadas e estabelecida a taxa de sucesso do procedimento. O baixo índice de insucesso (apenas 1,02%) não reflete a dificuldade de canulação, sendo necessário, em algumas vezes, técnicas alternativas para canulação profunda da via biliar principal.

Duodenal diverticulum are present with relative frequency during Endoscopic Colangiograpy (ERCP). They are surpassed just by large intestine diverticulum. Their probable ethiology would be due to duodenal wall weakness at fusion place between ventral and dorsal pancreas in embryo. These diverticulum, at periampular region, make bile duct cannulating difficult when they are large. Videos and comments of 2641 ERCPs were analysed, performed between january 2005 and april 2007, at endoscopic therapy clinic. Patients social profile was traced, related pathologies and procedure success rate. Low rate of unsuccess (just 1,02%), doesn?t represent difficulty of cannulating, been necessary sometimes, alternative techniques for deep cannulating of common bile duct.

Heterotaxia Syndrome with Intraluminal Duodenal Diverticulum

Both heterotaxia and intraluminal duodenal diverticulum (IDD) are uncommon congenital anomalies. Heterotaxia is a group of situs anomalies and IDD is a type of duodenal atresia. Heterotaxia is commonly associated with intraabdominal abnormalities causing intestinal obstruction, but heterotaxia with IDD is extremely rare. Herein we report a case of 21-year-old female who presented with symptoms of duodenal obstruction due to IDD associated with heterotaxia. This is the second case found as a result of a search through PubMed. We first used 3-dimentional virtual computed tomograph endoscopy for making the diagnosis and the treatment plan of this patient.

Meta-analysis of curative effect of operations for duodenal diverticulum / 中华消化外科杂志

Objective To evaluate the curative effect of different operative methods for duodenal diverticulum. Methods Articles of operations for duodenal diverticulum that were published between January 2000 to August 2006 were retrieved from China Journal Full-text Database, and the symptom remission rate and complication rate were underwent Meta-analysis. All data were analyzed by chi-square test. Results There was significant difference in symptom remission rate between Billroth Ⅱ subtotal gastrectomy, Roux-en-Y gastrojejunostomy and diverticulectomy, diverticulum inverting suture, sphincteroplasty of Oddi (χ~2= 21.269, 4.285, 12.914, 19.266, 3.938, P < 0.05). The difference in complication rate between Billroth Ⅱ subtotal gastrectomy, Roux-en-Y gastrojejunostomy and diverticulectomy, diverticulum inverting suture reached statistical significance (χ~2 =4.164, 9.166, 7.926,4.659, 4.858, P < 0.05). Conclusion For duodenal diverticulitis and the related complications which can not be effectively managed by internal medical treatment and with obvious symptom, Billroth Ⅱ subtotal gastrectomy and Roux-en-Y gastrojejunostumy are safe and effective.