Tratamiento laparoscópico de la membrana duodenal / Laparoscopic treatment of the duodenal membrane

La membrana duodenal congénita se presenta con mayor frecuencia en la región ampular, y se expresa clínicamente como obstrucción intestinal durante el periodo neonatal. En algunos escenarios el diagnóstico de esta condición clínica pasa inadvertida cuando dicha membrana es incompleta, como en los casos de membrana duodenal fenestrada. En consecuencia, se modifica la forma de presentación y se dificulta su diagnóstico temprano. Se cuenta con distintos accesos terapéuticos para esta enfermedad, desde los abiertos, hasta los endoscópicos y laparoscópicos. Se presenta el caso de una lactante con diagnóstico tardío de membrana duodenal fenestrada, que se trató quirúrgicamente mediante acceso laparoscópico.

Congenital duodenal membrane is more frequently seen in the ampullary region and is clinically expressed as intestinal obstruction in the neonatal period. In some settings, the diagnosis of this clinical condition is glossed over when the membrane is incomplete as it happens in fenestrated duodenal membrane. Consequently, its way of presentation changes and thus the early diagnosis becomes difficult. There are different therapeutic accesses to this disease, from open to endoscopic and laparoscopic ones. This is a nursling who was lately diagnosed as fenestrated duodenal membrane case and was surgically treated through the laparoscopic access.

A Case of Biliary Ascariasis with Duodenal Stenosis / 대한소화기내시경학회지

Infestation with Ascaris lumbricoides is one of the most common helminthic diseases in humans. The highly motile mature worm can cause intestinal obstructions, pancreaticobiliary diseases, appendicitis, and peritonitis. However, biliary ascariasis associated with duodenal stenosis is extremely rare. We report a case of biliary ascariasis with duodenal stenosis in a 70-year-old man. The patient was admitted to our hospital with a 2 month history of epigastric pain and vomiting. An esophagogastroduodenoscopy showed stenosis of the second portion of the duodenum and an impacted living round worm in the ampulla of Vater. The round worm was extracted with a snare without any complications, and the patient received albendazole treatment. A pathological examination of the stenotic portion of the biopsy specimen revealed chronic inflammation with eosinophilic infiltration throughout the mucosa. The patient remained asymptomatic at a follow-up examination. Duodenal stenosis should be considered in the complications of ascariasis, particularly in areas where this parasitic infestation is endemic.

A Case of Congenital Duodenal Web Causing Duodenal Stenosis in a Down Syndrome Child: Endoscopic Resection with an Insulated-Tip Knife

A 35-month-old girl visited our hospital with repetitive vomiting and abdominal distention; this was especially aggravated after the introduction of solid and semisolid foods. At 5 months of age, the patient, who had Down's syndrome, had undergone surgery for ventricular septal defect, atrial septal defect, and patent ductus arteriosus, and had subsequently been frequently hospitalized for respiratory infections and other viral infectious diseases. After her admission, the abdominal distension improved with fasting and intravenous fl uid therapy. Radiograph from a small-bowel series revealed a thin fi lling defect with a dilated duodenal bulb in the distal region of the second portion of the duodenum, suggesting a duodenal web, and endoscopy revealed duodenal stenosis. We therefore performed endoscopic resection with an insulated-tip knife because of the history of prior operations, fasting problems after operations, and respiratory infections. Seven days later, scar formation was noted on the second portion of the duodenum, the scope passed well at the excision site, and no retained food material was noted on the follow-up endoscopy. After the procedure, the patient's abdominal distention and repetitive vomiting subsided, and she was discharged with the ability to eat eat an age-appropriate normal diet. There were no specifi c symptoms or other complications for 1 year after the procedure.

Annular pancreas in Thais.

Objective: To study a congenital malformation of pancreas, the annular pancreas, and openings of pancreatic ducts. This abnormality can cause duodenal obstruction. Methods: The annular pancreas and duodenum of an 86-year-old Thai female cadaver was removed. The length and width of the annular pancreas were measured, as well as the internal diameter of the duodenum at the surrounded part and also the higher level. The openings of pancreatic duct were also carefully observed. Results: The second part of the duodenum was completely surrounded by the pancreatic tissue. The uncinate process extended over the anterior surface of the third part of the duodenum. The differences between the diameter of the duodenum at the surrounded part and at the higher level were 0.2 cm. there is no duodenal obstruction in this case. There were 2 openings of the pancreatic duct which opened to the second part of the duodenum. These ducts situated higher than the normal level, and were the primitive remains of the dorsal and ventral pancreatic buds. Conclusions: Not all the cases of the annular pancreas cause duodenal obstruction. In the cases that the pancreatic tissue loosely surrounds the duodenum, the diameters of the duodenum at the surrounding and at the slightly higher level are nearly the same. The pancreatic openings showed the primitive characters, i.e., there were 2 openings represented 2 origins of the pancreatic buds.

Estenosis duodenal por páncreas anular. Presentación de un caso esporádico / Duodenal stenosis for annular páncreas. A sporadic case presentation

La obstrucción intestinal duodenal es frecuente en el recién nacido como causa de oclusión, puede ser completa (atresia duodenal) secundaria a un trastorno de revacuolización de la luz intestinal o por una rotación irregular del páncreas hacia la derecha del duodeno. Presentamos a un recién nacido con edad gestacional de 35.4 semanas, conteo de Apgar de 8-8 puntos, que nace con signos de shock hipovolémico secundario a una anemia aguda por desgarro del corión, con una Encefalopatía Hipóxica Isquémica(EHI). Desarrolló posteriormente una intolerancia digestiva con abundante residuo gástrico, valorándose una oclusión intestinal incompleta alta, posiblemente por una estenosis duodenal. Se le realizan radiografías de abdomen simple de pie apoyándose la sospecha clínica por la presencia de imagen típica "en doble burbuja", se realizó laparotomía exploradora encontrando en el acto quirúrgico una Estenosis Duodenal secundaria a un Páncreas Anular. Es egresado a los 45 días de vida con buen peso corporal y reflujo gastroesofágico grado III como complicación. Actualmente se encuentra bajo seguimiento ambulatorio multidisciplinario y en franca evolución satisfactoria.

Duodenal intestinal obstruction is frequent in newborn as a cause of occlusion, it can be complete (duodenal atresia), secondary to a disorder of revacuolization of the intestinal lumen, or due to an irregular rotation of pancreas towards theright of duodenum. A newborn with a gestational age of 35.4 weeks, apgar score of 8.8 who was born with signs of hypovolemic shock secondary to an acute anemia caused by chorion tear with an Ischemic Hypoxic Encephalopathy, who subsequently deveoped a digestive intolerance with abundant gastric residue. An incomplete intestinal occluson was assessed - possibly as a result of a duodenal stenosis - simple abdominal X - rays was performed, supporting clinical suspicion because of the presence of a typical image in "double bubble". An exploratory laparatomy was carried out, finding in surgery a Duodenal Stenosis secondary to an annular Pancreas. The patient was discharged from the hospital 45 days after being born with a good weight and as complication a gastroesophageal reflux of third degreee. Currently the patient undergoes ambulatory-multidisciplinary follow-up, and is making a satisfactory progress.

A Case of Obstructive Jaundice after Insertion of Metallic Stent for Duodenal Obstruction by Recurrent Duodenal Ulcer / 대한소화기내시경학회지

Insertion of self-expandable metallic stent has been performed as a palliative therapeutic modality for cases with gastrointestinal obstruction caused by inoperable malignancies such as pancreatic cancer, stomach cancer, and cholangiocarcinoma. Although the clinical efficacy is not established yet, it can also be performed for benign gastroduodenal obstruction. Especially, when balloon dilatation is failed and patients are at high risk for surgery or general anesthesia, and when patients refuse operation, insertion of metallic stent can be considered. Complications of this therapeutic modality include intestinal perforation, hemorrhage, migration or malposition of metallic stent, and occlusion of stent by ingrowth and overgrowth of tumor or impaction of food. We report a rare case of obstructive jaundice developed after the insertion of gastroduodenal stent for duodenal obstruction caused by recurrent duodenal ulcer.

A Clinical Study of Congenital Intestinal Atresia and Stenosis

Seventy neonates with congenital intestinal atresia and stenosis who were treated at pediatric surgical service, Hanyang University Hospital from September 1979 to December 1996 were analyzed retrospectively. The lesion occurred in 27 cases at the duodenum, in 26 cases at the jejunum, in 13 cases at the ileum, and in 2 cases at the pylorus and colon each. The atresia predominated over the stenosis by the ratio of 4 : 1. Male to female ratio was 1.3 : 1. The average gestational age was 38 weeks, and the average birth weight was 2,754 grams. Though 22.9% were borne prematurely and 34.3% had low birth weight, 92.3% of them had a weight appropriate for gestational age. The clinical manifestations were bile-stained vomiting (70%), abdominal distention (35.7%), jaundice (37.1%), and delayed passage of meconium (51.4%). Polyhydramnios (40%) was more frequently observed in duodenal and jejunal atresia while microcolon in ileal atresia (58.3%). Weight loss and electrolyte imbalance occurred more frequently in the duodenal stenosis cases because of delayed diagnosis. Twenty (55.6%) of 37 jejunoileal atresia cases had evidence of intrauterine vascular accident : 4 intrauterine intussusception, 3 intrauterine volvulus and 3 strangulated intestine in gastroschisis, and 10 cases of intrauterine peritonitis. There were one or more associated anomalies in 45 patients (64.3%). Preoperatively proximal loop volvulus developed in 3 cases and proximal loop perforation in 5 cases and one case each of distal loop perforation, duodenal perforation and midgut volvulus occurred in the jejunoileal atresia. There were 10 multiple atresia cases and 14 short bowel cases. Overall mortality rate was 20%.