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.

A Classic Case of Annular Pancreas and its Clinical Implications / Un Caso Clásico de Páncreas Anular y sus Implicaciones Clínicas

Annular pancreas is a rare developmental anomaly where the head of the pancreas surrounds the second part of the duodenum like a ring. This may cause the duodenal constriction, obstruction, peptic ulcers and other complications. We saw a classic case of annular pancreas. The head of pancreas surrounded the second part of duodenum completely. However there was no narrowing of the duodenum. The case may be of importance for gastroenterologists, surgeons and radiologists.

El páncreas anular es una rara anomalía del desarrollo, donde la cabeza de este órgano rodea, como un anillo, la segunda parte del duodeno. Ésto puede causar constricción y obstrucción duodenal, úlceras pépticas y otras complicaciones. Reportamos un caso clásico de páncreas anular. La cabeza del páncreas rodeó la segunda parte del duodeno por completo. Sin embargo, no hubo una estenosis duodenal. Este caso puede ser de importancia para los gastroenterólogos, cirujanos y radiólogos.

Atypical radiographic manifestations of duodenal diverticula: a pictorial essay

Duodenal diverticula are frequently encountered in daily practice of radiology centers. Dissimilar figures with different dimensions and unlikely positions of duodenal diverticula-sometimes unusual-may be found. In this pictorial essay, we present various atypical shapes, dimensions and locations of duodenal diverticula which are found during many years of experience in the field of gastrointestinal fluoroscopic contrast assessments

Duodenal duplication with accessory papilla causing recurrent pancreatitis in a child: a case report

We discuss a 16-year-old male patient who presented with three episodes of recurrent pancreatitis within the last 6 months. Preoperative imaging studies suggested a choledochal cyst within the second portion of the duodenum. Patient was taken to surgery and the lesion was removed. Pathology examination of the cyst revealed a duodenal duplication. The accessory pancreatic papilla entering the closed duplication cyst was the main cause of the pancreatitis in this child.

Imaging of congenital anomalies of the gastrointestinal tract.

The radiological imaging plays a vital role in the evaluation of patients with congenital anomalies of the gastrointestinal tract. The evaluation of these patients, most of which present early after birth, frequently requires the use of various imaging modalities for making the correct diagnosis and planning surgical correction. This article reviews the common congenital anomalies of the gastrointestinal tract including obstructive lesions, anomalies of rotation and fixation, anorectal anomalies, and intestinal duplications. The plain radiograph is often diagnostic in neonates with complete gastric of upper intestinal obstruction and further radiologic evaluation may be unnecessary. An upper gastrointestinal series should be performed in all patients with incomplete intestinal obstruction. Sonography is useful in the evaluation of many congenital anomalies affecting pediatric gastrointestinal tract especially hypertrophic pyloric stenosis, enteric duplication cysts, midgut malrotation, meconium ileus and meconium peritonitis. Moreover, CT and MRI has assumed a greater importance as these provide excellent anatomic details which may be necessary for correct diagnosis as well as treatment planning. This is particularly true in evaluation of congenital anomalies such as esophageal/enteric duplications, vascular rings and anorectal anomalies. It is important to be familiar with the role nad usefulness of the various imaging modalities so that these can be used judiciously to avoid unnecessary radiation exposure while minimizing the patient discomfort.

Waugh's Syndrome.

A case of Waugh's Syndrome, association of malrotation and intussusception, is being reported. It is suggested that this possibility must be kept in mind and looked for, when a case of intussusception is being treated either by surgery or by hydrostatic reduction. If not when the child develops intestinal problems like obstruction, secondary to malrotation, in the post operative period, it could be misdiagnosed as recurrent intussusception.

Multiple tubular and cystic intestinal duplications.

Duodenal and colonic duplication presenting as mass in a neonate is rare. We report a 52-cm-long tubular, total colonic and 5-cm-long cystic duodenal duplication in a two-day-old neonate. Both the duplications could be excised without resection of the normal bowel.

Umbilical cord allantoic cysts in a newborn with vacterl association.

Allantoic cysts of umbilical cord are very rare. A preterm, low birth weight, male newborn with a new constellation of anomalies, allantoic duct cysts in the umbilical cord and associated perinatally lethal malformations of VACTERL sequence, is reported. In addition, the neonate also had duodenal atresia, patent urachus, obstructive uropathy and bifid scrotum. Association of Allantoic cysts with VACTERL sequence has not been described earlier.

Pâncreas anular: ressecção pancreática ou derivação duodenal / Anular pancreas: pancreatic resection or duodenal by-pass

OBJETIVOS: Apresentar a experiência dos autores no tratamento do pâncreas anular, comparando os dados com os da literatura. MÉTODOS: É relatada a experiência do Departamento de Cirurgia Geral do Hospital de Clínicas de Porto Alegre em pâncreas anular com a descrição de quatro pacientes. A doença manifestou-se em três faixas etárias distintas: uma no período neonatal, outra na infância e duas na fase adulta. O quadro clínico de obstrução intestinal alta esteve presente em três dos quatro pacientes. Dor abdominal foi queixa constante entre os adultos. A investigação diagnóstica foi realizada através do estudo contrastado do estômago e duodeno, da endoscopia digestiva e da tomografia abdominal. A confirmação diagnóstica somente foi possível durante a laparotomia. A derivação duodenal foi a técnica cirúrgica empregada em dois casos e a ressecção do tecido pancreático nos pacientes adultos. RESULTADOS: Os quatros pacientes evoluíram favoravelmente no período pós-operatório. O tempo de internação hospitalar variou de 9 a 12 dias, com média de 10,5 dias. Não houve complicação cirúrgica e todos os pacientes permanecem assintomáticos em acompanhamento ambulatorial. CONCLUSAO: A raridade desta anomalia não permite um estudo mais detalhado e comparativo. Os resultados aqui apresentados como os encontrados na literatura demonstram que a derivação duodenal e a ressecção pancreática são alternativas eficazes e seguras quando bem indicadas.

Divertículo intraluminal do duodeno: relato de caso / Intraluminal diverticulum of the duodenum: a case report

Os autores apresentam um caso de divertículo intraluminal do duodeno em uma paciente de 44 anos de idade, com sintomas escassos e incaracterísticos. O diagnóstico radiológico foi confirmado à cirurgia e houve controle pós-operatório. A anomalia, uma forma rara de duplicação, com diagnóstico radiológico unicamente pelo exame baritado convencional pré-operatório, consiste de uma estrutura em "fundo de saco", revestida de ambos os lados por mucosa normal, projetando-se na luz do duodeno. Após a revisão da literatura, os autores tecem considerações acerca do diagnóstico.

The authors present a case of intraluminal diverticulum of duodenum in a 44-year-old female with poor and uncharacteristic symptoms. The radiological diagnosis was confirmed by surgery. The patient was also followed up after surgery. This anomaly, a rare form of duplication, consists of a "pocket-like" structure lined on both sides by duodenal mucosa projecting into the duodenal lumen.

Ectopic pancreas mimicking superior mesenteric artery syndrome.

Ectopic pancreas rarely produces symptoms and often goes undetected. We report a 28-year-old man with ectopic pancreas presenting with symptoms and radiological findings mimicking superior mesenteric artery syndrome. Excision of the lesion and duodeno-jejunostomy led to relief.

Situs ambiguous

The case of a female child is described who presented with recurrent respiratory infections and 'recurrent right subphrenic abscess". Detailed radiological work-up identified situs ambiguous abdominis with bronchiectasis, duodenal malrotation, umbilical hernia and spina bifida

Neonatal Boerhaave's syndrome with duodenal atresia.

Neonatal Boerhaave's syndrome is a rare condition. Most cases are idiopathic. We report a case of neonatal Boerhaave's syndrome associated with duodenal atresia which could have precipitated the former.

Surgical treatment for congenital duodenal obstruction.

Thirty-four congenital duodenal obstructions (19 duodenal atresia, 7 duodenal web, 7 annular pancreas and one duodenal stenosis) were surgically treated in Siriraj Hospital between 1990 and 1999. Eleven per cent of duodenal atresia had no bile-stained vomiting. Duodenal web which received web excision and duodenoplasty in 43 per cent of cases, also presented with bile-stained vomiting. Duodeno-duodenostomy, duodeno-jejunostomy and web excision with duodenoplasty were performed in 29, 2 and 3 patients respectively. Duodeno-duodenostomy and web excision with duodenoplasty had no difference in the feeding capability. There was no statistically significant difference in duration of TPN, ability to be early fed, post-operative onset of full feeding and hospital stay between diamond-shaped (n = 18) and side-to-side (n = 11) duodeno-duodenostomy. Although transanastomotic feeding tube (n = 4) decreased a percentage of TPN requirement and made early feeding possible, the onset of full feeding, duration of TPN and hospital stay were not different from those who had no transanastomotic tube (n = 30).

Symptomatic volvulus due to mid gut malrotation in an adult.

Anomalies of rotation and fixation of gut occur most commonly in the neonatal period and usually become symptomatic in infancy. We report an adult patient with symptomatic volvulus due to mid gut malrotation.

Malrotation of the gut manifested during pregnancy.

The diagnosis of intestinal obstruction during pregnancy poses problems, as vomiting which is an important symptom of the obstruction can be attributed to hyperemesis of pregnancy and radiological investigation are avoided during this period. A case of intestinal obstruction due to volvulus resulting from congenital malrotation of the gut is reported here. The patient first presented during pregnancy. The case emphasises the need for thorough investigations in a case of persistent vomiting in pregnancy.

Síndrome de chilaiditi associada a megaduodeno e megacólon transverso / Chilaiditi syndrome associated to megaduodenum and transverse megacolon

Chilaiditi syndrome is a rare abnormality, uncommon in children, whith an incidence increasing with the age, ranging from 0.025 per cents to 0.28 per cents in the general population usually affecting males. The patients are usually asymptomatics and the syndrome is incidently discover through radiologic exams. However, abdominal pain and distention, nauseas, vomits and changes in intestinal habits, and even intestinal obstruction can occur. The authors report a case of a patient with Chilaiditi's syndrome associated to megastomach, megaduodenum and megacolon

Metodología diagnóstica en la obstrucción intestinal del recién nacido / Diagnostic radiology of neonatal intestinal obstruction

La obstrucción intestinal (OI) es la emergencia quirúrgica más frecuente en el recién nacido. Entre abril de 1988 y marzo de 1999 fueron estudiados 235 pacientes que presentaron OI. La radiografía simple de abdomen en dos proyecciones (decúbito dorsal, de pie, capo volta o invertograma) fue diagnóstica en todos los casos. Hallazgos: OI alta: atresia duodenal (n=28), malrotación (n=33). OI baja: malformación anorrectal (con atresia anal) (n=64), atresia yeyunal/ileal (n=49), enfermedad de Hischsprung (n=39), íleo meconial (n=22). La radiografía simple de abdomen permite una evaluación adecuada del paciente en la misma sala de Neonatología. Reemplaza a la seriada esofagogastroduodenal en el estudio de la obstrucción intestinal del recién nacido, utilizando el aire como contraste y evitando además los riesgos de aspiración por vómitos y disminuyendo la exposición a las radiaciones