Obstrucción duodenal y hemorragia digestiva alta como presentación inicial de una tuberculosis duodenal aislada / Duodenal obstruction and upper gastrointestinal bleeding as the initial presentation of an isolated duodenal tuberculosis

Resumen La tuberculosis duodenal primaria es muy infrecuente, incluso en regiones endémicas. El diagnóstico plantea un gran reto, y requiere un alto índice de sospecha, apoyado en estudios de imágenes, microbiología, e histopatología obtenida por biopsia endoscópica o quirúrgica. Presentamos el caso de un varón de 31 años, sin infección por VIH ni antecedente de tuberculosis, que debutó con una obstrucción duodenal. Posterior a una laparatomía exploradora presentó una estenosis duodenal y una hemorragia digestiva alta. Luego de varias biopsias no concluyentes, sólo la última, realizada con la técnica "biopsia sobre biopsia", demostró la presencia de granulomas con bacilos ácido-alcohol resistentes. El diagnóstico de tuberculosis fue confirmado por reacción de polimerasa en cadena de tejido duodenal. No se evidenció compromiso de otros órganos. La respuesta terapéutica fue excelente.

Primary duodenal tuberculosis is rare, even in endemic regions. The diagnosis poses a major challenge and requires a high index of suspicion, supported by imaging studies, microbiology, and histopatology obtained by endoscopic or surgical biopsy. We report the case of a 31-year-old man, without HIV infection or any previous history of tuberculosis, who presented with duodenal obstruction. After exploratory laparotomy, he presented a duodenal stenosis and upper gastrointestinal bleeding. A total of four diagnostic procedures (one laparotomy and three endoscopies) were performed, all of which included biopsies. Only the last endoscopy made with the technique "biopsy upon biopsy" showed the presence of acid fast bacilli and granulomas. The diagnosis of tuberculosis was confirmed by polymerase chain reaction in duodenal tissue. There was no evidence of involvement of other organs by tuberculosis. The patient had an excellent therapeutic response.

Large Brunner's gland hamartoma with annular stricture causing gastric outlet obstruction

No abstract available.

Aortoduodenal syndrome: a rare cause of intestinal obstruction

No abstract available.

Obstrução duodenal por hematoma parietal pós-trauma: relato de caso e revisão da literatura / Post-traumatic duodenal obstruction by intramural hematoma: a case report and literature review

Os hematomas parietais de alças intestinais por trauma abdominal fechado, determinando rápida obstrução luminal, são lesões raras e podem ser confundidas com afecções neoplásicas estenosantes (parietais ou por mecanismo de compressão extrínseca). Neste estudo é relatado um caso de obstrução intestinal por hematoma parietal da terceira porção duodenal pós-trauma e são discutidos o diagnóstico por imagem e o tratamento para tal obstrução.

Intramural duodenal hematomas secondary to blunt trauma, determining rapid luminal obstruction, are rare, benign lesions and may be confused with obstructive neoplastic conditions (either parietal or produced by extrinsic compression mechanisms). The present report describes a case of post‑traumatic intestinal obstruction by an intramural hematoma in the third duodenal segment. Imaging diagnosis and the conservative management of such obstruction are discussed.

Nonrotation of the Prearterial Segment of Midgut Presenting as Duodenal Obstruction in a 60-Year-Old Man / 대한소화기학회지

Intestinal malrotation is a developmental anomaly resulting from embryologic failure of fixation and rotation of the gut and predisposed to midgut vovulus and small bowel obstruction. Although various forms of malrotation anomalies in the gut can occur, nonrotation of prearterial segment with the initial symptomatic presentation at advanced age has been rarely reported. Here, we report a case of nonrotation of the prearterial segment of the midgut presenting with duodenal obstruction in a 60-year-old man. To our best knowledge, this is the first case reported about nonrotation of prearterial segment of the midgut in Korea.

Síndrome de Bouveret: Resolución endóscopica y quirúrgica de cuatro casos clínicos / Bouveret syndrome: Report of four cases

Bouveret syndrome is a duodenal obstruction caused by a biliary stone. Aim: To report patients with Bouveret syndrome. Material and Methods: Retrospective review of medical records of patients with Bouveret syndrome treated between 1976 and 2006. Results: We report three women and one man with a mean age of 62.5 years. None had a previous diagnosis of cholelithiasis. AH presented with colicky pain in the right upper quadrant and vomiting, suggesting gastric retention. The diagnosis was suspected after a barium meal in two patients and with a CT scan on the other two. The endoscopical extraction or fragmentation of stones was attempted in three patients but was successful only in one. Three patients were operated and a stone impacted in the first portion of the duodenum was identified, along with a cholecystoduodenal fistula. A duodenostomy and stone extraction was performed. One patient was subjected to a cholecystectomy fistula repair and gastrojejunoanastomosis. No patient died and all were discharged within 8 to 12 days after surgery. Conclusions: Bouveret syndrome is an uncommon complication of cholelithiasis. Endoscopy can be diagnostic and therapeutic. Surgery is the other therapeutic option.

Biliary-duodenal Fistula Following Radiofrequency Ablation Therapy for Hepatocellular Carcinoma / 대한소화기학회지

Hepatocellular carcinoma (HCC) is one of the most common malignant neoplasms occuring worldwide. Surgical resection currently provides the best chance of long-term tumor free survival, but the most HCCs are not candidates for surgical excision due to poor liver function or poor medical background. Numerous noninvasive alternatives to surgical resection have been introduced to treat liver cancers. Radiofrequency thermal ablation has begun to receive much attention as an effective and minimally invasive technique for the local control of HCC. The biliary system related complications after radiofrequency ablation has rarely been reported. We report a case of biliary-duodenal fistula with liver abscess after radiofrequency ablation for HCC. The case was treated by abscess drainage and antibiotics.

Bouveret's syndrome

Gastric Outlet Obstruction [GOO] due to impaction of a gallstone in the duodenum after migration through a bilioduodenal fistula is known as Bouveret's syndrome. Its clinical symptoms are entirely vague and nonspecific. Because of its rarity, insidiousness and unpredictable symptomatology, Bouveret's syndrome is never thought of in the differential diagnosis as aetiology of gastric outlet obstruction. Recent advances in fiberoptics technology, advent of modern imaging modalities and minimally-invasive techniques like endoscopy and laparoscopy has brought a great revolution in the management of Bouveret's syndrome and have tremendously decreased morbidity and mortality associated with this rare clinical entity

Obstruction of the duodenum by a preduodenal portal vein in situs inversus

Mirror image transposition of abdominal and thoracic viscera is termed situs inversus. Duodenal obstruction in situs inversus is rare. A preduodenal portal vein, though not uncommon in situs inversus, rarely causes duodenal obstruction. Where obstruction by a preduodenal portal vein is diagnosed, a duodeno-duodenostomy is the recommended treatment. A duodenal diaphragm and other more common causes of duodenal obstruction should also be excluded in these patients.

Congenital duodenal diaphragm in eight children

Congenital duodenal obstruction [CDO] is a common and usually easy to diagnose cause of intestinal obstruction in the newborn, except when the cause of the obstruction is a duodenal diaphragm. We describe our experience with eight children who had intrinsic duodenal obstruction secondary to a duodenal diaphragm. The medical records of 22 children with the diagnosis of congenital intrinsic duodenal obstruction were reviewed for age at diagnosis, sex, gestation, birth weight, clinical features, associated anomalies, method of diagnosis, treatment and outcome. Operative findings and procedures were obtained from the operative notes. Eight of the 22 children [36.4%] had congenital duodenal diaphragm [CDD]. In all children, the diagnosis was made from plain abdominal X-ray, which showed the classic double-bubble appearance, and barium meal, which showed duodenal obstruction. Four patients had associated anomalies, including two with Down's syndrome. Intraoperatively, five patients were found to have duodenal diaphragm with a central hole, while the other three had complete duodenal diaphragms. Postoperatively, all patients did well. Six required total parenteral nutrition. Conclusions: The 100% survival rate among these children is comparable to that in Western countries, and can be attributed to the lack of major associated abnormalities, good perioperative management, and the availability of total parenteral nutrition

Diagnosis and management of duodenal obstruction due to renal cell carcinoma.

Two cases of duodenal obstruction secondary to renal cell carcinoma are described. One case had delayed metastasis to duodenum four years after right radical nephrectomy and the second case had a large right renal cell carcinoma with duodenal involvement. The possibility of duodenal involvement or metastasis should be kept in mind in any patient presenting with upper gastrointestinal obstructive symptoms and with right sided renal tumour or radical nephrectomy in the past. Whenever suspected, radiography and if required endoscopic assessment should be supplemented to diagnose this condition. Extensive local disease or presence of concurrent metastasis usually rules out the possibility of cure. We describe the clinico-radiological features of this condition along with a review of the literature.

Tuberculous duodenal obstruction--a case report.

Proximal duodenal obstruction due to tuberculosis can masquarade as duodenal ulcer. Although commonest cause of duodenal obstruction is ulcer, other causes must be considered, particularly tuberculosis which is common in tropics.

Estenosis duodenal congénita en el adulto: informe de dos casos / Congenital duodenal stenosis in the adult: report of two cases

Las estenosis duodenal congénita (EDC) se manifiesta muy rara vez en los adultos, pues lo común es su detección en los primeros días de vida; sin embargo, cuando llega a presentarse en el paciente adulto, es difícil de establecer el diagnóstico preciso. Informamos de dos pacientes con EDC que se manifestó en la vida adulta; ambos fueron atendidos y tratados en el Departamento de Cirugía de la Escuela de Medicina en el Unversidad de Alabama, EUA desde 1970. En ninguno de los dos casos se logró establecer el diagnóstico preoperatorio definitivo. La EDC debería considerarse como una etiología posible en los pacientes que se presentan con obstrucción del vaciamiento gástrico o duodenal. Debido a que la inspección extrínseca del duodeno en el periodo transopertorio no es confiable, el paso de una sonda de Foley a través de toda la longitud duodenal por vía de una gastrotomía o duodenotomía proximal es una medida útil para asegurar la permeabilidad o localizar el área estenótica.

Cirurgia de urgência no recém-nascido / Emergency surgery in the newborn

O tratamento cirúrgico das urgências neonatais exige recursos técnicos e humanos altamente especializados, e constitui importante segmento da Cirurgia Pediátrica. Dentre inúmeras afecçöes seräo abordadas, por sua incidência e gravidade, a atresia de esôfago, a hérnia diafragmática, as obstruçöes duodenais congênitas (atresia duodenal, pâncreas anual, a má-rotaçäo intestinal e membrana duodenal), as atresias jejuno-ileais, a doença de Hirschsprung, as anomalias ano-retais em suas várias formas, o íleo e a peritonite meconiais, a onfalocele, a gastrosquise e a enterite necrotizante neonatal. Aspectos clínicos e da fisiologia, bem como a conduta diagnóstica e os cuidados pré-, intra e pós operatórios säo analisados aqui, de maneira sucinta e objetiva

Sindrome de Bouveret: relato de caso / Bouveret's syndrome: case report

Os autores apresentam uma paciente de 87 anos de idade com leucemia linfoide cronica e o quadro de obstrucao digestiva alta, causado por uma fistula colecisto-duodenal com obstrucao duodenal (sindrome de Bouveret). A paciente foi tratada cirurgicamente, sendo realizada extracao do calculo atraves de gastrotomia e gastroenteroanastomose, com boa evolucao pos-operatoria. Em virtude da raridade desta sindrome, os autores apresentam uma revisao da literatura com enfase nos metodos diagnosticos e terapeuticos desta afeccao.

Estenosis duodenal: revisión bibliográfica y presentación de un caso clínico

Presentamos el caso clínico de un recien nacido (RN) con diagnóstico de obstrucción duodenal, en el que se sospechó la existencia de algún tipo de malformación gastrointestinal, debido a la presencia de alteraciones en ecocardiografías realizadas a la madre durante la gestación, lo que motivo la formación de un equipo especial para la atención del RN desde el momento del nacimiento. Ponemos además énfasis en la importancia que tiene el diagnóstico prenatal de este tipo de anomalias congénitas, pues depende del tratamiento precoz la recuperación total del paciente. Es de importancia este tipo de diagnóstico para referir a la madre a centros especializados que cueten con los medios necesarios para atender al parto y al neonato al nacimiento.