Obstrucción duodenal congénita de etiología múltiple: reporte de un caso con malrotación intestinal, bandas de Ladd y membrana duodenal intrínseca como causantes de obstrucción intestinal en el neonato / Congenital duodenal obstruction of multiple etiology: case report with intestinal malrotation, Ladd bands and intrinsic duodenal membrane as causes of intestinal obstruction in the neonate

Resumen: La obstrucción duodenal congénita agrupa un amplio espectro de anomalías en el desarrollo del intestino delgado; se clasifica según su etiología tanto en extrínseca como intrínseca. Su presentación es relativamente común, teniendo una incidencia de 1: 2.500-10.000 nacidos vivos y normalmente presenta asociación con aneuploidías (como la trisomía 21) y malformaciones cardíacas. Las imágenes tienen un papel importante en la aproximación diagnóstica y la radiografía de abdomen simple, es el primer escalón en la aproximación de la obstrucción intestinal. El tratamiento involucra una exploración quirúrgica del abdomen con corrección de los defectos encontrados. Este es un reporte de caso de un neonato que presentó obstrucción duodenal congénita de etiología tanto extrínseca (malrotacion intestinal y bandas de Ladd) como obstrucción intrínseca (membranas duodenales).

Abstract: Congenital duodenal obstruction groups together a broad spectrum of abnormalities in the development of the small intestine; it is classified according to its etiology as both extrinsic and intrinsic. Its presentation is relatively common, having an incidence of 1: 2.500-10.000 live births and it is normally associated with aneuploidy (such as trisomy 21) and cardiac malformations. Images play an important role in the diagnostic approach, with simple abdominal radiography being the first step in the approximation of intestinal obstruction. The treatment corresponds to a surgical exploration of the abdomen with resolution of the defects found. This is a case report of a newborn who presented congenital duodenal obstruction of both extrinsic etiology (intestinal malrotation and Ladd bands) and intrinsic obstruction (duodenal membranes).

Obstrucción duodenal por Strongyloides stercoralis, una complicación inusual / Duodenal obstruction by Strongyloides stercoralis, an unusual complication

Resumen La estrongiloidiasis es una enfermedad desatendida en Latinoamérica. Las manifestaciones gastrointestinales son inespecíficas y la obstrucción duodenal es una complicación infrecuente. Presentamos el caso clínico de un varón de 31 años, procedente de la selva central de Perú, que ingresó por una obstrucción intestinal alta, con úlceras y una estenosis duodenal evidenciadas en la endoscopia digestiva alta. El informe histopatológico reveló la presencia de larvas de Strongyloides stercoralis. La evolución clínica y endoscópica fueron favorables con el tratamiento con ivermectina. Existen poco más de 20 casos publicados de obstrucción duodenal por S. stercoralis. Adicionalmente, se confirmó una infección por HTLV-1, asociación descrita frecuente.

Strongyloidiasis is a neglected disease in Latin America. Gastrointestinal manifestations are nonspecific and duodenal obstruction is a rare complication. Here we present the case of a 31-year-old male from the central jungle of Peru, admitted due to a high intestinal obstruction, with duodenal ulcers and stenosis evidenced in the upper endoscopy. The histopathological report revealed presence of larvae of Strongyloides stercoralis. Clinical and endoscopic follow up were favorable with ivermectin treatment. There are near 20 reported cases of duodenal obstruction due to S. stercoralis. Additionally, infection by HTLV-1 was confirmed, being this a frequent association.

Membrana duodenal: a propósito de un caso / Duodenal membrane: presentation of a case / Membrana duodenal: sobre o assunto de um caso

La atresia de duodeno es una causa poco frecuente de oclusión intestinal. Generalmente el diagnóstico se realiza en etapa prenatal o en el período neonatal principalmente para aquellos casos de oclusión completa, mientras que aquellos con oclusión incompleta pueden diagnosticarse más tardíamente. Se presenta el caso clínico de una paciente con una forma de presentación infrecuente, con diagnóstico luego del año de vida. Se realizó una duodeno-duodeno anastomosis, con buena evolución postoperatoria.

Duodenal atresia is a rare cause of intestinal occlusion. Generally, the diagnosis is made in the prenatal stage or in the neonatal period mainly for those cases of complete occlusion, whereas those with incomplete occlusion may be diagnosed later. We present the case of a patient with an uncommon presentation, with diagnosis after one year of life. A duodenum-duodenum anastomosis was performed, with good postoperative evolution.

A atresia duodenal é uma causa rara de oclusão intestinal. O diagnóstico geralmente é feito no estágio pré-natal ou no período neonatal principalmente para os casos de oclusão completa, enquanto aqueles com oclusão incompleta podem ser diagnosticados mais tarde. Apresentamos o caso de uma paciente com uma apresentação incomum, com diagnóstico após o ano de vida. Uma anastomose duodeno-duodeno foi realizada, com boa evolução pós-operatória.

Colédoco-duodenostomía guiada por ecoendoscopia en cáncer de páncreas avanzado con obstrucción duodenal / Endoscopic ultrasound-guided choledocho-duodenostomy in advanced pancreatic cancer with duodenal obstruction

La colangiopancreatografía retrógrada endoscópica (CPRE) se considera el tratamiento de primera línea para el drenaje biliar en pacientes con cáncer de páncreas. En los casos de fracaso por CPRE, generalmente se realiza un drenaje biliar transparietohepático o una derivación biliar quirúrgica. En la última década, las indicaciones y la utilidad de la ecoendoscopia en pacientes con cáncer de páncreas han ido creciendo, y se han informado numerosos casos de drenajes biliares guiados por ecoendoscopia como una alternativa al drenaje biliar percutáneo o quirúrgico en fracasos en la CPRE. Nuestro objetivo es comunicar un caso con cáncer de páncreas localmente avanzado que se presentó con ictericia indolora y síndrome coledociano con obstrucción biliar y duodenal, en el que se realizó una colédoco-duodenostomía guiada por ecoendoscopia mediante la colocación de una prótesis metálica autoexpandible.

Endoscopic retrograde cholangiopancreatography (ERCP) is considered the first-approach for biliary drainage. In cases of ERCP failure, patients are usually referred for percutaneous transhepatic biliary drainage or surgical biliary bypass. In the last decade, the indications of endoscopic ultrasound (EUS) in the management of patients with pancreatic cancer have increased, and numerous cases of EUS-guided biliary drainage have been reported in patients with failures during the ERCP. Our goal is to report a patient with locally advanced pancreatic cancer who presented with painless jaundice and cholestasis with biliary and duodenal obstruction. A EUS-guided choledochoduodenostomy was performed by placement of a self-expanding metal stent.

[Traumatic obstruction of duodenum [report of 2 cases]]

Duodenal hematoma occurs rarely due to blunt or penetrating trauma and it may cause intestinal obstruction. Half of the patients with duodenal hematoma show symptoms of obstruction 48 hours after trauma. After ruling out other visceral injuries, treatment is essentially conservative and laparoscopic or surgical drainage is rarely necessary. First case was a 16-year-old man who referred to the hospital with abdominal pain, vomiting and tenderness of upper abdominal quadrant, 2 days after blunt abdominal trauma. Diagnosis was made with CT scan and upper GI radiography. After 10 days of conservative treatment, patient was discharged from hospital in a good condition. The second case was a 25-year-old man who referred to the hospital 3 days after blunt abdominal trauma. Patient symptoms were; vomiting, pain and tenderness in upper abdominal regions. Diagnosis was made with ultrasonography, CT scan and upper GI contrast radiography. After 6 days of conservative therapy he tolerated oral diet and was discharged from hospital with good condition. Trauma is not a common cause of alimentary tract occlusion. If obstructive symptoms appear after trauma, the hematoma of intestine particularly duodenum must be considered. The protocol for conservative therapy of hematoma includes: 1] Early diagnosis and ruling out any duodenal leakage through upper GI radiography at admission and 5-7 days later, 2] On time diagnosis of associated injuries like pancreatic injuries, 3] Parenteral nutrition and intravenous hyperalimentation if needed

Duodenal tuberculosis: radiological features on barium studies and their clinical correlation in 28 cases.

BACKGROUND: A retrospective analysis of 28 cases of duodenal tuberculosis (TB) was done to evaluate radiological findings and their value in the diagnosis of the disease. SUBJECTS AND METHODS: Upper gastrointestinal and small bowel series of 28 patients with duodenal tuberculosis were analysed for radiological findings. The diagnosis of duodenal TB was confirmed by surgery and biopsy in 18, on the basis of radiological findings and response to treatment in 9, and on the basis of findings on upper gastrointestinal scopy and biopsy in 1 patient. RESULTS: The study included 28 patients (14 males, 14 females). The mean age was 32.1 (range 5-65). Twenty-three (82.2%) patients presented with obstructive symptoms while five manifested with dyspeptic symptoms. Of the latter, 4 had ulcerations in the third and fourth parts of the duodenum. In the remaining patient, the mucosa of the duodenum could not be clearly visualised. Two patients had extrinsic impression at the D2-D3 and D3-D4 segments. In 23 patients with obstructive symptoms, 18 demonstrated luminal narrowing of varying degrees and 5 had a sharp band-like cut-off at the third part of the duodenum. Of the 18 patients with luminal narrowing, 13 had extrinsic compression, 12 had proximal dilatation and 14 had ulcerations mainly in the second and third parts of the duodenum. Biliary involvement was seen in 3 patients without any signs or symptoms directly referable to the biliary involvement. CONCLUSION: Though duodenal TB lacks specific radiological features, barium studies help to localise and define the area of narrowing and ulcerations and help to confirm the presence of lymph nodes causing compression of the duodenum.