Cavernous haemangioma of the duodenum: a rare case of gastrointestinal bleeding

Vascular malformations (VMs), including haemangioma, of the upper gastrointestinal tract, are rare causes of bleeding. Bleeding from these lesions is often recurrent and diagnosis is often delayed for months to years. A patient with severe, recurrent upper gastrointestinal bleeding requiring repeated hospitalization and blood transfusions is presented. Upper endoscopy, barium meal and small bowel enteroclysis were negative. Selective mesenteric angiography revealed a VM in the second part of the duodenum. Segmental resection of the duodenum was performed and microscopial examination showed cavernous haemangioma. VM should be considered in patients with recurrent gastrointestinal bleeding and negative conventional investigations. Mesenteric angiography may be the only investigation which will identify these leisons. Results after excision are excellent. (AU)

Primary repair of the cholecyst-enteric fistula in gallstone ileus

Gallstone ileus is a rare cause of mechanical bowel obstruction. The attendant lack of awareness by the clinician will not only result in the diagnosis being made intraoperatively but will also affect the adequacy of the preoperative preparation of these ill patients. These patients are often elderly, septic and have significant concomitant medical illnesses. Recently two patients with gallstone ileus were managed with enterolithotomy and primary repair of the cholecyst-duodenal fistula at the University Hospital of the West Indies, Jamaica. Their clinical presentations and progress are described along with a review of the classical clinical course, radiological features, and operative choices available. (AU)

Pylorus-preserving proximal pancreatico-duodenectomy the U.H.W.I. experience of the pylorus-sparing whipple's procedure - abstract

The modified Whipple gastro-pancreatico-duodenectomy has been the time-honoured surgical management of duodeno-pancreatic disease for the past five decades. A pylorus-sparing modification of this operation has become popular due to its low morbidity and the relative lack of the long-term nutritional sequelae usually associated with the more radical procedure. We report five cases with a proximal pancreatico-duodenectomy in whom the stomach, pylorus abd first 2 cm of duodenum were preserved. The indcations for the procedure were varied and included duodeno-pancreatic haemangioma (1), duodeno-pancreato-codochal trauma (1), chronic pancreatitis (1), papillary cystic tumour of the pancreas (1), and ampullary adenocarcinoma (1). All cases had gastrostomy decompression and post-operative enteral nutrition. Two patients required enteral feeding for twelve days, the other three settled rapidly and were discharged from hospital within ten days. There were no perioperative deaths or significant long-term morbidity. Most patients regained and maintained their pre-illness body weight within the first year of follow-up. We advocate the use of a pylorus-sparing pancreatico-duodenectomy in disease requiring duodeno-pancreatectomy inclusive of periampullary malignancies (AU)

A review of the aetiology and pathogenesis of acute pancreatitis: part 1: Classification, role of infection, common channel theory and duodenal reflux

There are still contradictory opinions concerning the aetiology and pathogenesis of acute pancreatitis. The problem of lymphatic spread of infection from the biliary tract to the pancreas, which in the thirties was considered as improbable, has been re-opened by the results of more recent investigations. The common channel theory which was once considered to be the explanation for most cases of pancreatitis, can account for only a small proportion of cases of pancreatitis. There is still lack of agreement as to the role of duodenal reflux in the causation of pancreatitis (AU)

Duodenal and antral varices in portal hypertension - abstract

Varices of the oesophagus and of the fundus of the stomach are well recognised and frequently demonstrated in patients with portal hypertension. An analysis of 3,800 barium swallow and meal examinations performed in the X-ray Department of the University Hospital revealed forty-two patients with oesophageal varices secondary to portal hypertension. In twenty-four of these cases, the barium swallow had been extended to include examination of the stomach and duodenum. Eighteen of these twenty-four cases showed filling defects of the duodenal bulb and a few had filling defects of the antrum of the stomach. Evidence is presented, including special barium studies, percutaneous spleno-porto-venography and autopsy examination, which shows that the filling of the duodenal bulb and gastric antrum are probably due to varices similar in nature to these found in the oesophagus. There is also anatomical evidence for the existence of varices of the dudenum and gastric antrum(AU)