ABSTRACT
INTRODUCTION: In Bouveret's syndrome, a biliary stone obstructs the duodenum. Surgical treatment is plagued by high morbidity and mortality. Therefore, endoscopic treatment has become a first-line approach. Areas covered: A literature search of Medline and Google Scholar databases was performed using the terms endoscopic treatment, non-operative treatment, Bouveret's syndrome, and gallstone ileus. Sixty-one cases of successful endoscopic treatment were found over the period 1978-2016 and are summarized herein. Therapeutic modalities used in 52 patients with complete success included mechanical lithotripsy (40% of cases), electrohydraulic lithotripsy (21% of cases), extraction of the intact stone and laser lithotripsy (15% of cases each), extracorporeal shockwave lithotripsy and duodenal stenting (4% of cases each). In the remaining 9 patients, stone fragments migrated distally and required surgical removal. Cholecystectomy was performed in five (8.2%) of 61 patients and gallbladder cancer was detected in three (4.9%) patients. Expert commentary: Meticulous preparation, including that of instruments, personnel, patient anesthesia, and X-ray availability, is key to success in this unusual situation. Partial success (stone fragmentation and mobilization to another location) may render surgery easier as these patients present with dense adherences in the right upper quadrant. Cholecystectomy is reserved for highly selected patients (e.g. relapsing ileus, gallbladder cancer).
Subject(s)
Cholecystectomy , Duodenal Obstruction/therapy , Endoscopy, Digestive System , Gallstones/therapy , Lithotripsy , Stents , Aged , Aged, 80 and over , Cholecystectomy/adverse effects , Duodenal Obstruction/diagnostic imaging , Duodenal Obstruction/etiology , Endoscopy, Digestive System/adverse effects , Endoscopy, Digestive System/methods , Female , Gallstones/complications , Gallstones/diagnostic imaging , Humans , Lithotripsy/adverse effects , Lithotripsy/methods , Male , Middle Aged , Recurrence , Risk Factors , Syndrome , Treatment OutcomeABSTRACT
The use of self-expandable enteral stents for palliation of malignant stenosis may present the complication of concealing the ampulla of Vater behind the metallic mesh. Anchoring in the duodenal wall (distal or partial migration) may also be a complication of biliary metallic stents and therefore may cause difficulty in gaining access to the biliary tract. In these cases of difficult access, a fenestration on the prosthesis ( biliary or enteral) can be created to allow reaching the obstructed biliary tract by means of argon plasma (AP). Were retrospectively analysed 7 cases. Under endoscopic vision, AP was directed to filgurate and cut 6 biliary prosthesis and a duodenal stent. Fulguration and cut of biliary stent was performed in 5 cases of distal partial migration and cholangitis. In one case of obstruction caused by distal migration inside the duodenal stent light, cutting of the biliary stent was performed. A window was created in the enteral prosthesis in order to access the ampulla of Vater and place a biliary tract prosthesis. All cases were resolved successfully and without complications. We conclude that the use of AP to fulgurate and cut nitinol prosthesis was effective and presented no complications in this series.
Subject(s)
Argon Plasma Coagulation , Duodenal Obstruction/therapy , Pancreatic Neoplasms/complications , Stents , Adult , Aged , Aged, 80 and over , Device Removal , Duodenal Obstruction/etiology , Humans , Middle Aged , Palliative Care , Pancreatic Neoplasms/therapy , Retrospective StudiesABSTRACT
The use of self-expandable enteral stents for palliation of malignant stenosis may present the complication of concealing the ampulla of Vater behind the metallic mesh. Anchoring in the duodenal wall (distal or partial migration) may also be a complication of biliary metallic stents and therefore may cause difficulty in gaining access to the biliary tract. In these cases of difficult access, a fenestration on the prosthesis ( biliary or enteral) can be created to allow reaching the obstructed biliary tract by means of argon plasma (AP). Were retrospectively analysed 7 cases. Under endoscopic vision, AP was directed to filgurate and cut 6 biliary prosthesis and a duodenal stent. Fulguration and cut of biliary stent was performed in 5 cases of distal partial migration and cholangitis. In one case of obstruction caused by distal migration inside the duodenal stent light, cutting of the biliary stent was performed. A window was created in the enteral prosthesis in order to access the ampulla of Vater and place a biliary tract prosthesis. All cases were resolved successfully and without complications. We conclude that the use of AP to fulgurate and cut nitinol prosthesis was effective and presented no complications in this series.
Subject(s)
Adult , Aged , Aged, 80 and over , Humans , Middle Aged , Pancreatic Neoplasms/complications , Stents , Duodenal Obstruction/therapy , Argon Plasma Coagulation , Palliative Care , Pancreatic Neoplasms/therapy , Retrospective Studies , Device Removal , Duodenal Obstruction/etiologyABSTRACT
BACKGROUND: The usual treatment of pyloroduodenal peptic stenosis has been mainly surgical, through pyloroplasty or gastric resection, with or without vagotomy. Since the first description of treatment for this peptic complication by endoscopic balloon dilation perfomed by Benjamin in 1982 [2], this procedure has become a therapeutic option in association with the medical treatment of peptic disease. The aim of this study is to evaluate the results involving clinical, endoscopic, and gastric emptying scintigraphy parameters. METHODS: Between August 1998 and February 2000, 20 patients with pyloroduodenal stenosis refractory to conservative treatment were treated at the Gastrointestinal Endoscopy Unit of the University of São Paulo Medical School. All patients who presented clinical manifestations of pyloroduodenal stenosis underwent upper gastrointestinal endoscopy to confirm peptic stenosis. Biopsy of the narrowing for the confirmation of a benign disease and gastric biopsy for Helicobacter pylori detection were performed. The treatment consisted of dilation of the stenosis with type TTS (Through The Scope) hydrostatic balloon under endoscopic control, treatment of Helicobacter pylori infection, and gastric acid suppression with oral administration of proton pump inhibitor. All patients, except one who was excluded from this study, were submitted to a clinical endoscopic assessment and gastric emptying evaluation by ingestion of (99m)Tc before and after the treatment. Endoscopic evaluation considered the diameter of the stenotic area before and after treatment. A scintigraphic study compared the time of gastric emptying before and after balloon dilation. RESULTS: Nineteen patients completed treatment by hydrostatic balloon dilation. Clinical symptoms such as bloating (p < 0.0001), epigastric pain (p = 0.0159), gastric stasis (p < 0.0001), and weight gain (p = 0.036) showed significant improvement. The diameter of the stenotic area increased significantly (p < 0.01) after the dilation treatment as well as a better gastric emptying of (99m)Tc (p < 0.0001). CONCLUSION: The dilation of the peptic pyloroduodenal stenosis using a hydrostatic balloon is a safe and effective procedure. The evaluation with gastric scintigraphy by ingestion of (99m)Tc is an effective method of assessment for the improvement of gastric function, because its results corresponded to the clinical improvement after endoscopic treatment.
Subject(s)
Catheterization , Duodenal Obstruction/diagnostic imaging , Duodenal Obstruction/therapy , Pyloric Stenosis/diagnostic imaging , Pyloric Stenosis/therapy , Catheterization/methods , Constriction, Pathologic , Duodenal Obstruction/complications , Duodenal Obstruction/physiopathology , Endoscopy, Gastrointestinal , Female , Gastric Emptying , Humans , Male , Middle Aged , Pain/etiology , Pain/physiopathology , Pyloric Stenosis/complications , Pyloric Stenosis/physiopathology , Radionuclide Imaging/standards , Stomach Diseases/etiology , Stomach Diseases/physiopathology , Technetium , Treatment Outcome , Weight GainABSTRACT
Se presenta la experiencia en el empleo de prótesis expandibles metálicas en patología neoplásica del tubo digestivo. Entre enero de 1993 y agosto de 1996 colocamos 35 prótesis expandibles metálicas en 33 pacientes, la edad promedio fue de 76 años (50-94). Veintiseis pacientes se presentaron con disfagia, uno con fístula traqueoesofágica con neumopatía y seis con obstrucción intestinal por estenosis colorrectal. Observamos 33 por ciento de complicaciones mayores; hemorragia, migración de la prótesis y oclusión.La mortalidad dentro de los 30 días fue del 7,4 por ciento. En las estenosis altas se obtuvo una adecuada paliación de la disfagia y en las estenosis colorrectales permitió resolver la oclusión intestinal como tratamiento definitivo o prequirúrgico, evitando las intervenciones complejas de urgencia y favoreciendo operaciones en un tiempo. Futuros estudios prospectivos deberán evaluar el costo beneficio de estos nuevos procedimientos
Subject(s)
Humans , Male , Female , Middle Aged , Colonic Neoplasms/therapy , Duodenal Neoplasms/therapy , Esophageal Neoplasms/therapy , Surgical Mesh/standards , Duodenal Obstruction/therapy , Intestinal Obstruction/therapy , Prostheses and Implants/classification , Rectal Neoplasms/therapy , Stomach Neoplasms/therapy , Deglutition Disorders/therapy , Colonic Neoplasms/complications , Duodenal Neoplasms/complications , Esophageal Neoplasms/complications , Tracheoesophageal Fistula/therapy , Surgical Mesh/classification , Palliative Care , Palliative Care/statistics & numerical data , Rectal Neoplasms/complications , Stomach Neoplasms/complications , Deglutition Disorders/classificationABSTRACT
Se presenta la experiencia en el empleo de prótesis expandibles metálicas en patología neoplásica del tubo digestivo. Entre enero de 1993 y agosto de 1996 colocamos 35 prótesis expandibles metálicas en 33 pacientes, la edad promedio fue de 76 años (50-94). Veintiseis pacientes se presentaron con disfagia, uno con fístula traqueoesofágica con neumopatía y seis con obstrucción intestinal por estenosis colorrectal. Observamos 33 por ciento de complicaciones mayores; hemorragia, migración de la prótesis y oclusión.La mortalidad dentro de los 30 días fue del 7,4 por ciento. En las estenosis altas se obtuvo una adecuada paliación de la disfagia y en las estenosis colorrectales permitió resolver la oclusión intestinal como tratamiento definitivo o prequirúrgico, evitando las intervenciones complejas de urgencia y favoreciendo operaciones en un tiempo. Futuros estudios prospectivos deberán evaluar el costo beneficio de estos nuevos procedimientos (AU)
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Esophageal Neoplasms/therapy , Stomach Neoplasms/therapy , Deglutition Disorders/therapy , Surgical Mesh/standards , Duodenal Obstruction/therapy , Intestinal Obstruction/therapy , Rectal Neoplasms/therapy , Colonic Neoplasms/therapy , Duodenal Neoplasms/therapy , Prostheses and Implants/classification , Esophageal Neoplasms/complications , Stomach Neoplasms/complications , Rectal Neoplasms/complications , Colonic Neoplasms/complications , Duodenal Neoplasms/complications , Deglutition Disorders/classification , Surgical Mesh/classification , Tracheoesophageal Fistula/therapy , Palliative Care/statistics & numerical data , Palliative Care/methodsABSTRACT
Foram tratados oito pacientes com estenose péptica pilórica e do bulbo duodenal com baläo dilatador sob visäo endoscópica. A úlcera estenosante do bulbo duodenal apresentava-se em atividade em três casos e cicatizada em dois. A úlcera pilórica em um paciente apresentava-se em fase ativa e em dois, cicatrizada. O baläo dilatador foi posicionado na regiäo da estenose com auxílio de fio-guia em dois pacientes; e nos demais, esse posicionamento foi realizado sem fio-guia e sob visäo endoscópica. A dilataçäo foi hidrostática com injeçäo de água no baläo de 15mm de diâmetro em cinco pacientes e pneumática em três, com baläo de 20mm de diâmetro. Näo houve complicaçöes com o procedimento. Seis (75 por cento) pacientes apresentavam-se assintomáticos, sem recidiva de estenose ou da úlcera e com ganho de peso no período de seguimento de três a 34 meses. O método é seguro e eficaz no tratamento das úlcers pépticas estenosantes do piloro e do bulbo duodenal. Com o advento de medicamentos antiulcerosos potentes e a erradicaçäo do Helicobacter pylori, o tratamento dilatador poderá ser importante alternativa à cirurgia
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Catheterization , Endoscopy, Digestive System , Pyloric Stenosis/therapy , Duodenal Obstruction/therapy , Peptic Ulcer/complications , Pyloric Stenosis/etiology , Treatment OutcomeABSTRACT
Os autores apresentam uma paciente de 87 anos de idade com leucemia linfoide cronica e o quadro de obstrucao digestiva alta, causado por uma fistula colecisto-duodenal com obstrucao duodenal (sindrome de Bouveret). A paciente foi tratada cirurgicamente, sendo realizada extracao do calculo atraves de gastrotomia e gastroenteroanastomose, com boa evolucao pos-operatoria. Em virtude da raridade desta sindrome, os autores apresentam uma revisao da literatura com enfase nos metodos diagnosticos e terapeuticos desta afeccao.
Subject(s)
Humans , Female , Aged , Gastric Fistula/complications , Intestinal Fistula/surgery , Duodenal Obstruction/diagnosis , Duodenal Obstruction/therapyABSTRACT
Até recentemente, o tratamento do pseudocisto do pâncreas era basicamente cirúrgico. Entretanto, dois acessos näo-cirúrgicos säo atualmente possíveis: a aspiraçäo percutânea sob monitorizaçäo ultra-sonográfica ou tomográfica e drenagem endoscópica. OBJETIVO. Relatar os resultados obtidos com a drenagem endoscópica e pseudocisto pancreático. MÉTODOS. Foram estudados 11 doentes com pseudocisto da cabeça do pâncreas e um caso de coleçäo paraduodenal que se originou após surto de pancreatite aguda necrotizante. A cistoduodenostomia endoscópica foi realizada na parede duodenal em contato com o pseudocisto. Foi utilizado um duodenoscópio padräo Olympus para alcançar o abaulamento da parede duodenal e para realizar a fistula diatérmica. RESULTADOS. O percentual de sucesso foi 91,7 por cento. A hemorragia ocorreu em um caso (8,3 por cento), controlada sem transfusäo de sangue. A cistoduodenostomia endoscópica foi o tratamento definitivo em 10 pacientes examinados 36 meses após o procedimento. Um paciente foi submetido a gastrojejunostomia após 14 meses por obstruçäo duodenal consequüente a surto recidivante de pancreatite. Näo havia recidiva do cisto. Näo houve óbito decorrente do procedimento endoscópico. CONCLUSAO. A cistoduodenostomia endoscópica constitui um procedimento alternativo para a drenagem de pseudocisto paraduodenal sempre que estiver restrito a indicaçäo precisa morfológica de contigüidade com abaulamento da luz do duodeno
Subject(s)
Adult , Middle Aged , Humans , Male , Female , Drainage , Duodenal Obstruction/therapy , Pancreatic Pseudocyst/therapy , Follow-Up Studies , Duodenoscopy , Duodenal Obstruction/diagnosis , Pancreatic Pseudocyst/diagnosisABSTRACT
Until recently, the treatment of pancreatic pseudocysts was mainly surgical. However, two non-surgical invasive approaches are now possible: percutaneous aspiration under ultrasonic or CT monitoring and endoscopic drainage. PURPOSE--To report the result obtained using endoscopic drainage of pancreatic pseudocysts. METHODS--11 consecutive patients admitted with pancreatic pseudocyst had chronic pancreatitis and 1 patient had a well defined paraduodenal collection originated from acute necrotising pancreatitis. Endoscopic cystoduodenostomy was performed in the area of close contact with the digestive wall. A standard Olympus duodenoscope was used to reach the bulging wall and to allow the diatermic fistula. RESULTS--The success rate was 91.7%. Hemorrhage occurred in 1 patient (8.3%) controlled without blood transfusion. Endoscopic cystoduodenostomy was the definitive treatment in 10 patients 36 months after the procedure. One patient underwent gastrojejunostomy after 14 months for duodenal obstruction following relapsing pancreatitis. There was no relapsing cyst. There was no death following the endoscopic procedure. CONCLUSION--the endoscopic cystoduodenostomy constitutes an alternative procedure for the drainage of paraduodenal pseudocysts whenever restricted to the precise morphological indication of paraintestinal pseudocyst bulging into the duodenal lumen.
Subject(s)
Drainage/methods , Duodenal Obstruction/therapy , Pancreatic Pseudocyst/therapy , Adult , Duodenal Obstruction/diagnosis , Duodenoscopy , Female , Follow-Up Studies , Humans , Male , Middle Aged , Pancreatic Pseudocyst/diagnosisABSTRACT
Se presenta un caso de oclusión duodenal arterio-mesentérica y se hacen consideraciones sobre aspectos anatomicoclínicos y procedimientos diagnósticos complementarios. Se analiza el papel de la nutrición enteral como una técnica de elección en el manejo médico de esta patología
Subject(s)
Adult , Enteral Nutrition/methods , Duodenal Obstruction/therapy , Mesenteric Vascular Occlusion/diet therapy , Nutritional Status/physiologyABSTRACT
Os autores reportam caso de hematoma intramural do duodeno, após trauma fechado do abdome, ocorrido em acidente automobilístico. O diagnóstico tardio, no oitavo dia após o acidente, confirmado através de estudos radiológicos e ecográfico, fundamentou o tratamento conservador com êxito. Säo tecidos comentários valorizando a necessidade da exploraçäo do duodeno em caso de laparotomia por trauma fechado do abdome e sobre o tratamento conservador, quando o diagnóstico é tardio, sem suspeita de outras complicaçöes como perfuraçäo e peritonite
Subject(s)
Humans , Female , Adult , Hematoma/diagnosis , Duodenal Obstruction/diagnosis , Duodenal Obstruction/therapySubject(s)
Abnormalities, Multiple/therapy , Colon/abnormalities , Duodenal Obstruction/congenital , Infant, Premature, Diseases/therapy , Intestinal Atresia/therapy , Abnormalities, Multiple/surgery , Combined Modality Therapy , Duodenal Obstruction/therapy , Female , Humans , Infant, Newborn , Infant, Premature, Diseases/surgery , Intestinal Atresia/surgeryABSTRACT
Se presenta el cuadro clínico, diagnóstico y tratamiento de un paciente egresado del Servicio de Cirugía del Hospital Provincial Docente "Manuel Ascunce Domenech" con el diagnóstico de hematoma duodenal. Los signos y síntomas presentados fueron el dolor abdominal, vómitos abundantes y signos de deshidratación severa. El rayos x de estómago y duodeno arrojó una obstrucción a nivel de la tercera porción duodenal, y se efectuó un tratamiento conservador con buenos resultados(AU)
Subject(s)
INFORME DE CASO , Humans , Male , Adult , Hematoma/diagnosis , Duodenal Obstruction/therapy , Stomach , DuodenumSubject(s)
Humans , Male , Female , Infant, Newborn , Congenital Abnormalities/diagnosis , Congenital Abnormalities/therapy , Infant, Newborn, Diseases/diagnosis , Infant, Newborn, Diseases/therapy , Hernia, Umbilical/diagnosis , Meningocele/diagnosis , Meningocele/therapy , Meningomyelocele/diagnosis , Meningomyelocele/therapy , Neonatology/standards , Anus, Imperforate/diagnosis , Anus, Imperforate/therapy , Esophageal Atresia/diagnosis , Esophageal Atresia/therapy , Bladder Exstrophy/diagnosis , Bladder Exstrophy/therapy , Choanal Atresia/diagnosis , Choanal Atresia/therapy , Intestinal Atresia/diagnosis , Intestinal Atresia/surgery , Intestinal Atresia/therapy , Duodenal Obstruction/diagnosis , Duodenal Obstruction/therapy , Intestinal Obstruction/diagnosis , Intestinal Obstruction/therapySubject(s)
Humans , Male , Female , Infant, Newborn , Infant, Newborn, Diseases/diagnosis , Infant, Newborn, Diseases/therapy , Congenital Abnormalities/diagnosis , Congenital Abnormalities/therapy , Neonatology/standards , Meningocele/diagnosis , Meningocele/therapy , Meningomyelocele/diagnosis , Meningomyelocele/therapy , Hernia, Umbilical/diagnosis , Bladder Exstrophy/diagnosis , Bladder Exstrophy/therapy , Anus, Imperforate/diagnosis , Anus, Imperforate/therapy , Intestinal Obstruction/diagnosis , Intestinal Obstruction/therapy , Duodenal Obstruction/diagnosis , Duodenal Obstruction/therapy , Intestinal Atresia/surgery , Intestinal Atresia/diagnosis , Intestinal Atresia/therapy , Choanal Atresia/diagnosis , Choanal Atresia/therapy , Esophageal Atresia/diagnosis , Esophageal Atresia/therapyABSTRACT
Clásicamente la alimentación oral post-operatoria del R.N. intervenido de Obstrucción Duodenal Congénita, se inicia después de 5 a 7 días o más, cuando se demuestra mediante la Sonda Nasogástrica la permeabilidad de la boca anastomótica: ausencia o escasa secreción no teñida de bilis, empezando con agua azucarada a pequeñas dosis, seguir con hidrolizados de proteínas o bien leche en pequeña cantidad hasta dar la alimentación láctea a peso y edad del bebé, más o menos a los 10 a 12 días. La técnica de alimentación precoz que se preconiza consiste en iniciar la alimentación antes de las 60 hrs. del post-operatorio, con leche cada 4 hrs. e ir aumentando progresivamente la cantidad, hasta lograr dar, entre el 4to. al 6to. día del post-operatorio, la alimentación láctea normal a peso y edad del recién nacido, sin tener en cuenta la cantidad o calidad de la secreción obtenida por la Sonda Nasogástrica, a diferencia de los autores consultados, que sí lo tienen en cuenta. Las leyes de la física respecto a los líquidos y gases; los beneficios del drenaje aspirativo mediante la sonda nasogástrica y los criterios para la realimentacián oral constituyen el fundamento de la técnica. Luego de exponer las consideraciones teóricas, se presenta la aplicación de la nueva técnica de alimentación oral en R.N. con dichas malformaciones y se discuten los parámetros de análisis de los casos, la técnica empleada, los criterios y fundamentos que la sustentan y nuestro aporte se concreta en las conclusiones que enunciamos