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.

Síndrome de Bouveret: A propósito de un caso / BOUVERET´S SYNDROME: CASE REPORT

El íleo biliar es una causa poco frecuente de obstrucción intestinal. Puede manifestarse de formas variadas según el sitio de obstrucción y las características del paciente. Cuando la obstrucción se localiza a nivel duodenal, bloqueando el paso del contenido gástrico, se trata de una entidad denominada síndrome de Bouveret

Gallstone ileus is an uncommon cause of intestinal obstruction. It can manifest itself in various shapes according to the site of obstruction and the patient´s characteristics. When the obstruction is located at the duodenum, blocking the passage of gastric contents, it is an entity called Bouveret´s syndrome

uncommon diagnosis of Windsock deformity for a common presentation

We report a two-year-old Indonesian female who presented with vomiting and weight loss for more than one month and was ultimately diagnosed with duodenal obstruction due to a windsock deformity. This is a rare and intrinsic congenital anomaly of the duodenum. The diagnosis as well as immediate and conclusive surgical management is discussed

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.

Cirugía mínimamente invasiva en recién nacidos de < 2. 500 g / Minimally invasive surgery in newborns weighting less than 2, 500 g

Newborns (NB) represent a surgical challenge for the surgeon due to their physiological characteristics and reduced surgical spaces. During the last decade, minimally invasive surgery (MIS) has been adopted as a treatment for this group of patients. Objective: To report our experiences of MIS on NB weighing less than 2,500 grams. Patients and Method: A retrospective descriptive study was conducted analyzing the records of newborns weighing less than 2,500 g and subjected to MIS between April, 2009 and 2012. No patients were excluded. Results: 25 newborns participated on this study; among the treated conditions, congenital diaphragmatic hernia (1), Esophageal Atresia (4 complete repairs and 2 fistula ligation), duodenal obstruction (7), Gastroesophageal reflux disease (6 Nissen procedures, 4 including gastrostomy), Laparoscopic gastrostomy (2) Intestinal obstruction (two bowel resections, end to end anastomosis), and Hypertrophic pyloric stenosis (1). The average weight was 1,920 g (1,300-2,490 g) and 10 of the infants were preterm newborns. 3 mm instruments were used, 5 mm optic 30°. Neither intraoperative complications nor conversions were observed. A patient with tracheoesophageal atresia presented a fistula at the site of anastomosis with spontaneous resolution. Conclusions: MIS has revolutionized surgery, resulting in less intestinal adhesions, postoperative pain, shorter hospital stays and better aesthetic results. Due to the availability of smaller size materials, these procedures could be performed safely.

El Recién Nacido (RN) quirúrgico representa un reto para el cirujano, por sus características fisiológicas y espacios quirúrgicos reducidos. Durante la última década se incorporó la cirugía mínimamente invasiva (CMI) en este grupo de pacientes. Objetivo: Reportar nuestra experiencia en CMI en RN < 2.500 g. Pacientes y Método: Estudio descriptivo retrospectivo, se analizaron fichas de RN < 2.500 g sometidos a CMI entre abril de 2009 y abril de 2012. No se excluyeron pacientes. Resultados: Se incluyeron 25 RN. Las patologías resueltas fueron: Hernia diafragmática congénita (1), Atresia Esofágica (4 reparaciones completas, 2 ligaduras de fístula), Obstrucción Duodenal (7), Reflujo Gastro-esofágico (6 operaciones de Nissen; 4 con gastrostomía), gastrostomía laparoscópica (2), Obstrucción Intestinal (2 resecciones intestinales, anastomosis término-terminal), Estenosis Hipertrófica del Píloro (1). Peso promedio: 1.920 gr (1.300-2.490 gr), 10 RN pre-término. Se utilizó instrumental de 3 milímetros (mm), óptica de 5 mm de 30°. No se presentaron complicaciones intra-operatorias, ni conversión. Un paciente con atresia tráqueo-esofágica, presentó una fístula en el sitio de anastomosis con resolución espontánea. Conclusiones: La CMI ha revolucionado la cirugía, manifestándose en disminución de adherencias intestinales, menor dolor postoperatorio, estadías hospitalarias más cortas y mejor resultado estético. Con el desarrollo material de menor tamaño, estos procedimientos se pudieron realizar en forma segura en esta serie.

Obstrução duodenal por mucosa gástrica heterotópica / Duodenal obstruction for heterotopic gastric mucosa

A mucosa gástrica heterotópica (MGH) é uma entidade rara, com malignização incomum, descrita em todo o trato gastrointestinal e fora dele. O relato é de uma mulher de 37 anos, com queixa de dor epigástrica associada a vômitos pós-prandiais com três meses de evolução, causado por MGH localizada na quarta porção duodenal. Submetida à ressecção do seguimento acometido, encontra-se em acompanhamento sem queixas ou sinais de recidiva. A MGH deve ser lembrada como um diagnóstico diferencial nos sangramentos e obstruções duodenais; a ressecção endoscópica ou cirúrgica, se factível, deve ser realizada com o intuito terapêutico.

The heterotopic gastric mucosa (HGM) is a rare event, with uncommon malignant, described throughout the gastrointestinal tract and beyond. The report is about a 37 years-old female, with epigastric pain associated with postprandial vomiting with three months of evolution, caused by HGM located in the fourth portion of the duodenum. The patient underwent resection of the affected segment and since then there has been no complaints or signs of recurrence. The HGM should be remembered as a differential diagnosis in bleeding and duodenal obstruction. The endoscopic or surgical resection, if feasible, should be performed with therapeutic purposes.

Oclusión duodenal por malrotación intestinal en el adulto / Duodenal occlusion by intestinal malrotation in the adult

Los pacientes con malrotación intestinal presentan manifestaciones clínicas en las primeras etapas de la vida, ya sea con un cuadro de obstrucción duodenal por bandas de Ladd o con un vólvulo del intestino medio. La aparición en la edad adulta es poco común, y con frecuencia las consecuencias del diagnóstico tardío son graves. Caso clínico: paciente masculino de 62 años, con epigastralgia de 40 años de evolución y vómitos de contenido gastrobiliar postprandial mediato y esporádicos. El seriado radiológico gastroduodenal mostró dilatación duodenal, vaciamiento retardado y localización del ángulo duodenoyeyunal y asas delgadas a la derecha de la columna vertebral. Se diagnosticó oclusión mecánica crónica de intestino delgado alto por malrotación intestinal y bandas de Ladd. La laparotomía evidenció dilatación duodenal, con bandas adherenciales desde el colon ascendente, lo cual provocó una oclusión extrínseca. Se realizó procedimiento quirúrgico de Ladd. Tuvo como complicación un absceso del Douglas postoperatorio que se trató y egresó asintomático

Although it may occur in asymptomatic way, almost all patients with intestinal malrotation present clinical manifestations in early stages of life, either with a picture of duodenal obstruction by Ladd´s bands or with a volvulus of the midgut. The appearance in adulthood is uncommon; frequently the consequences of late diagnosis are often serious.Case report: a 62-year-old male patient, with epigastralgia of 40 years of evolution, mediate and sporadic postprandial gastrobiliary vomiting. The gastroduodenal radiological series showed duodenal dilation, delayed évidement and location of the duodenojejunal flexure and thin ansae to the right of the spine. Chronic mechanical occlusion of upper small intestine by intestinal malrotation and Ladd´s bands was diagnosed. Laparotomy evidenced duodenal dilation, adhesive bands from the ascending colon, which caused an extrinsic occlusion. The patient had a postoperative abscess of Douglas that was treated and he was discharged from hospital asymptomatic

[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

Oclusão duodenal após cirurgia da aorta abdominal: relato de caso / Duodenal obstruction following abdominal aortic surgery: case report

A maior parte dos artigos sobre obstrução duodenal após cirurgia aórtica cita dados referentes às correções da doença aneurismática e não da doença aterosclerótica. Não obstante, é consenso que se trata de uma complicação rara, cuja incidência é menor do que 1 por cento. Os autores relatam o caso de um paciente submetido a enxerto aorto-bifemoral que apresentou, como complicação pós-operatória, oclusão duodenal. O paciente foi tratado com reintervenção cirúrgica e uso de remendo de grande omento para síntese do retroperitônio. A revisão da literatura indica que a maioria dos casos responde bem ao tratamento conservador, e a conduta cirúrgica normalmente só é necessária quando aderências são a causa da obstrução ou quando o tratamento clínico não é satisfatório após 2 semanas.

Most articles on duodenal obstruction following aortic surgery report data relative to repairs of aneurysmal disease, not atherosclerotic disease. However, duodenal obstruction is an uncommon complication, occurring in less than 1 percent of patients. We report a case of a patient submitted to aortobifemoral bypass reconstruction who had duodenal obstruction as postoperative complication. The patient was treated with surgical intervention and omental patching for retroperitoneal synthesis. Literature review indicates that most cases respond well to the conservative treatment, and surgical conduct is usually only required when adherences are causing the obstruction or when clinical treatment is not satisfactory after 2 weeks.

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.

Gastroenteroanastomosis laparoscópica como tratamiento paliativo en la obstrucción duodenal tardía por cáncer de páncreas irresecable / Laparoscopic gastroenteroanastomosis as palliative treatment in duodenal obstruction late unresectable pancreatic cancer

Antecedentes: Los pacientes con obstruccion duodenal tardía por tumor de páncreas irresecable requieren algún tipo de paliación, ya sea endoscópica o quirúrgica. Objetivo: Presentar nuestra experiencia con la gastroenteroanastomosis videopaparoscópica como método paliativo en el tratamiento de la obstrucción duodenal tardía. Lugar de aplicación: Centro Terciario de Referencia. Diseño: Retrospectivo. Población: Pacientes con obstrucción duodenal tardía por tumor de páncreas irresecable. Método: Mediante un análisis retrospectivo de una base de datos se analizaron los resultados de la gastroenteroanastomosis videolaparoscópica para el tratamiento de la obstrucción duodenal. Resultados: veinticuatro pacientes fueron tratados con gastroenteroanastomosis laparoscópica, veintidos de estos 24 pacientes tuvieron una supervivencia entre 2 y 4 meses. Cuatro enfermos (16%) presentaron retardo del vaciamiento gástrico, recibiendo tratamiento médico 2 pacientes y tratamiento quirúrgico los otros 2. El resto pudo alimentarse por vía oral hasta el momento de su muerte. Conclusiones: la gastroenteroanastomosis laparoscópica es un método válido, seguro, con baja incidencia de fístula, de bajo costo y eficaz para el tratamiento paliativo de la obstrucción duodenal tardía en los tumores de páncreas irresecables.

Endoscopic ultrasound-guided biliary stent placement using Soehendra stent retriever.

Symptomatic bilary obstruction with duodenal nar-rowing requires either surgical or percutaneous biliary drainage procedure. We report a 54-year-old woman suffering from carcinoma of the head of pancreas, who had combined duodenal and bilary obstruction and underwent successful endoscopic ultrasound-guided transduodenal biliary stent placement.

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.

Síndrome de Bouveret: caso clínico y revisión de la literatura / Bouveret syndrome: report of one case

El síndrome de Bouveret es una rara entidad clínica consistente en una obstrucción duodenal secundaria al paso de cálculos desde la vesícula biliar al duodeno, a través de una fístula colecisto o colédoco-duodenal. La presentación clínica es más bien inespecífica, siendo difícil el diagnóstico preoperatorio. La ecografía y TAC abdominal, como la endoscopia digestiva alta son los exámenes diagnósticos más útiles, siendo, en ocasiones, terapéutico. Este trabajo reporta el caso de un paciente de 76 años, que consulta por un cuadro compatible con una obstrucción intestinal causada por litiasis biliar y cáncer.