ABSTRACT
BACKGROUND: Duodenum inversum is an often unrecognized anomaly of duodenal rotation/fixation at upper gastrointestinal (UGI) contrast study because the duodenojejunal junction appears normally located. OBJECTIVE: This anomaly is important to diagnose because it may result in obstructive gastrointestinal symptoms. CONCLUSION: We describe a case of duodenum inversum mimicking superior mesenteric artery (SMA) syndrome that improved after surgical therapy.
Subject(s)
Duodenum/abnormalities , Superior Mesenteric Artery Syndrome/diagnosis , Adolescent , Diagnosis, Differential , Duodenum/diagnostic imaging , Duodenum/surgery , Female , Humans , Radiography , SyndromeABSTRACT
BACKGROUND/PURPOSE: Impaired gallbladder emptying has been identified as a cause of chronic abdominal pain in adults. This study aims to define a pediatric population with functional abnormalities of gallbladder contractility and to assess clinical outcome after cholecystectomy. METHODS: Children and adolescents (n = 42) with abdominal complaints underwent gallbladder emptying studies, measured by either ultrasonography or scintigraphy with intravenous cholecystokinin (CCK). On ultrasound studies, gallbladder volume was measured before injection and 15 minutes after injection. Measures of gallbladder emptying by scintigraphy were taken at least 30 minutes after CCK injection. A study was classified as abnormal for contractility less than 50%. Cholecystectomy was performed and outcomes were evaluated during office visits and by telephone interview. RESULTS: Abdominal pain and fatty food intolerance were the predominant symptoms. Patients were treated by open (n = 2) or laparoscopic (n = 40) cholecystectomy. In 20 cases the gallbladder showed chronic inflammation on pathology. Response to surgical therapy was excellent in 41 patients (mean follow-up, 20.4 months). CONCLUSIONS: Children and adolescents with persistent abdominal pain should undergo functional assessment of gallbladder contractility. Patients with abnormal gallbladder contractility benefit from cholecystectomy.
Subject(s)
Abdominal Pain/etiology , Gallbladder Diseases/physiopathology , Gallbladder Emptying , Adolescent , Child , Cholecystokinin , Chronic Disease , Female , Gallbladder/diagnostic imaging , Gallbladder Diseases/complications , Gallbladder Diseases/diagnosis , Humans , Male , Radionuclide Imaging , Radiopharmaceuticals , Technetium Tc 99m Diethyl-iminodiacetic AcidABSTRACT
The neuromuscular apparatus of the gastrointestinal tract develops early in gestation, but normal patterns of innervation and contractile activity are not achieved until near birth. This article reviews the ontogeny of gastrointestinal neuromuscular anatomy and the development of coordinated peristaltic function in the different regions of the gastrointestinal tract. This information provides a basis for understanding the difficulties encountered in successfully providing enteral feeding to the preterm infant.
