Iatrogenic duodenal diverticulum perforation: a systematic review.

BACKGROUND: Duodenal diverticulum occurs in approximately 20% of the population and can lead to life-threatening complications such as perforation. Most perforations are secondary to diverticulitis, with iatrogenic causes being exceptionally rare. This systematic review explores the aetiology, prevention and outcomes of iatrogenic perforation of duodenal diverticulum. METHODS: A systematic review was performed according to the PRISMA guidelines. Four databases were searched, including Pubmed, Medline, Scopus and Embase. The primary data extracted were clinical findings, type of procedure, prevention and management of perforation and outcomes. RESULTS: Forty-six studies were identified, of which 14 articles met inclusion criteria and comprised 19 cases of iatrogenic duodenal diverticulum perforation. Four cases identified duodenal diverticulum pre-intervention, nine were identified peri-intervention, and the remainder were identified post-intervention. Perforation secondary to endoscopic retrograde cholangiopancreatography (n = 8) was most common, followed by open and laparoscopic surgery (n = 5), gastroduodenoscopy (n = 4) and other (n = 2). Operative management with diverticulectomy was the most frequent treatment (63%). Iatrogenic perforation was associated with 50% morbidity and 10% mortality. CONCLUSION: Iatrogenic perforation of duodenal diverticulum is exceptionally rare and associated with high morbidity and mortality. There are limited guidelines surrounding standard perioperative steps to prevent iatrogenic perforations. A review of preoperative imaging helps identify potential aberrant anatomy, such as a duodenal diverticulum, to allow for recognition and prompt management initiation in the event of perforation. Intraoperative recognition and immediate surgical repair are safe options for this complication.

Risk Factors that Affect Morbidity and Mortality in Patients with Perforated Peptic Ulcer Diseases in a Teaching Hospital.

BACKGROUND: This study was done to identify risk factors that affect the morbidity and mortality of patients operated for a perforated peptic ulcer in a resource-limited setting. METHODS: A two years (January 1, 2016 -December 30, 2018) retrospective cross-sectional study was done on patients admitted and operated for PPU at Yekatit 12 Hospital, Addis Ababa, Ethiopia. RESULTS: A total of 93 patients were operated. The median age affected was 29 years (Range 15-75 years). Male to female ratio was 7.5:1. Chewing chat, smoking and alcohol use were seen in 22 (23.6%), 35(37.6%), and 34(36.5%), cases respectively. Only 23.6% gave previous history of dyspepsia. The median duration of illness was 48hours and the duodenal to gastric ulcer perforation ratio was 6.5:1. In majority of the cases (63.3%) the perforation diameter was =10mm (63.3%). Cellan-Jones repair of the perforations was done in 92.5% of cases. A total of 47 complications were seen in 25 cases. The total complications and mortality rates were 25(26.8%) and 6(6.5%) respectively. The most common postoperative complication was pneumonia (13.97%) followed by superficial surgical site infection (10.8%). Mortality rate was highest among patients >50yrs [AOR (95%CI) =2.4(230)]. Delayed presentation of >24 hours [AOR (95%CI) =4.3(1.4-13.5)] and a SBP =90mmhg [AOR (95%CI) =4.8(1-24)] were found to be significantly related with higher complication rate. CONCLUSIONS: Patients who presented early and immediate corrective measures were instituted had better outcomes while those seen late developed unfavorable out-come with significantly higher complications. Therefore, early detection and treatment of PPU is essential.

Therapeutic value of endoscopy for primary duodenal lesions / 中华消化内镜杂志

Objective To study the therapeutic value of endoscopy for primary duodenal lesions. Methods Data of 79 consecutive patients with primary duodenal lesions, who underwent endoscopic treatment from January 2015 to January 2018 at Beijing Friendship Hospital, were retrospectively analyzed. Patients were divided into the complication group and the non-complication group, and further grouped according to lesion locations and endoscopic categories. Baseline data of patients, endoscopic treatment, wound closure method, pathological results, the occurrence and outcome of complications were studied. Results A total of 79 patients successfully went through endoscopic treatment, including 59 cases of endoscopic mucosal resection ( EMR) , 5 cases of endoscopic submucosal dissection ( ESD) , 6 cases of full-thickness resection with OTSC metal clips, and 9 cases of endoscopic piecemeal mucosal resection ( EPMR) . In all 79 cases, complications occurred in 8 patients ( 10. 1％) during the perioperative period, all at the duodenal descending segment and duodenal papilla. In all 47 cases whose lesions located at duodenal papilla and duodenal descending segment, the complication incidence was 17. 0％ ( 8/47) , significantly higher than that of non-descending and papilla part [ 0 ( 0/32 ) , P=0. 012 ] . Two ( 2. 5％) cases had complications requiring further intervention with endoscopy or surgery. Among 8 patients with complications, 1 patient ( 2. 1％) developed intraoperative perforation, 1 patient ( 2. 1％) developed delayed bleeding, 6 patients ( 12. 8％) developed mild acute pancreatitis, and these 8 patients recovered after treatment. These 47 patients were further divided into the duodenoscopy group and the gastroscopy group according to endoscopic categories, the complications incidence in the duodenoscopy group ( 28. 0％, 7/25) was also significantly higher than that in the gastroscopy group [ 4. 5％( 1/22) , P=0. 037] . Conclusion Endoscopic treatment is safe and effective for primary duodenal lesions. But for the operations in the duodenal descending segment and the duodenal papilla, as well as in the case of duodenoscopy, it is necessary to be more vigilant about the occurrence of complications.

Pancreas preserving distal duodenectomy: A versatile operation for a range of infra-papillary pathologies.

AIM: To investigate the range of pathologies treated by pancreas preserving distal duodenectomy (PPDD) and present the outcome of follow-up. METHODS: Neoplastic lesions of the duodenum are treated conventionally by pancreaticoduodenectomy. Lesions distal to the major papilla may be suitable for a pancreas-preserving distal duodenectomy, potentially reducing morbidity and mortality. We present our experience with this procedure. Selective intraoperative duodenoscopy assessed the relationship of the papilla to the lesion. After duodenal mobilisation and confirmation of the site of the lesion, the duodenum was transected distal to the papilla and beyond the duodenojejunal flexure and a side-to-side duodeno-jejunal anastomosis was formed. Patients were identified from a prospectively maintained database and outcomes determined from digital health records with a dataset including demographics, co-morbidities, mode of presentation, preoperative imaging and assessment, nutritional support needs, technical operative details, blood transfusion requirements, length of stay, pathology including lymph node yield and lymph node involvement, length of follow-up, complications and outcomes. Related published literature was also reviewed. RESULTS: Twenty-four patients had surgery with the intent of performing PPDD from 2003 to 2016. Nineteen underwent PPDD successfully. Two patients planned for PPDD proceeded to formal pancreaticoduodenectomy (PD) while three had unresectable disease. Median post-operative follow-up was 32 mo. Pathologies resected included duodenal adenocarcinoma (n = 6), adenomas (n = 5), gastrointestinal stromal tumours (n = 4) and lipoma, bleeding duodenal diverticulum, locally advanced colonic adenocarcinoma and extrinsic compression (n = 1 each). Median postoperative length of stay (LOS) was 8 d and morbidity was low [pain and nausea/vomiting (n = 2), anastomotic stricture (n = 1), pneumonia (n = 1), and overwhelming post-splenectomy sepsis (n = 1, asplenic patient)]. PPDD was associated with a significantly shorter LOS than a contemporaneous PD series [PPDD 8 (6-14) d vs PD 11 (10-16) d, median (IQR), P = 0.026]. The 30-d mortality was zero and 16 of 19 patients are alive to date. One patient died of recurrent duodenal adenocarcinoma 18 mo postoperatively and two died of unrelated disease (at 2 mo and at 8 years respectively). CONCLUSION: PPDD is a versatile operation that can provide definitive treatment for a range of duodenal pathologies including adenocarcinoma.

Juxtapaillary duodenal diverticula in patients of acute calculous cholangitis / 中华普通外科杂志

Objective To evaluate the clinical significance of juxtapaillary duodenal diverticula (JPDD) in patients of acute calculous cholangitis (AC) with different severity grade.Methods A retrospective analysis was carried out for 488 AC cases of different severity from January 2011 to December 2013 who underwent duodenoscopy in Dongyang People's Hospital.Results Of the 488 patients, the JPDD was found in 2.87％, 6.15％ and 4.10％ in patients with mild, moderate and severe AC, respectively.The prevalence of JPDD in severe AC were significantly higher in the moderate and mild AC (x2 =4.486, P =0.034;x2 =14.686, P ＜ 0.001);Procalcitonin (PCT) concentrations in severe AC of JPDD were significantly higher in moderate and mild AC of JPDD (t =10.420 9, P ＜ 0.001;t =4.870 4, P ＜ 0.001).The cannulation failure rate and the amylase were significantly higher in JPDD patients compares to patients without JPDD (x2 =36.95, P ＜ 0.001;t =8.29, P ＜ 0.001).Conclusions JPDD detection rate increases with aging and seems to be associated with acute cholangitis (AC) with different severity grade and PCT concentration.JPDD predicts a higher cannulation failure rate and the amylase level after duodenoscopy.

Caracterización de úlceras gástricas y duodenales / Characterization of gastric and duodenal ulcers

La úlcera péptica es una lesión en la mucosa gastrointestinal (estómago o duodeno) que se extiende más allá de la muscularis mucosae y que permanece como consecuencia de la actividad de la secreción ácida del jugo gástrico. Objetivo: describir las características epidemiológicas y clínicas de las úlceras gástricas y duodenales en pacientes que acudieron al servicio de videoendoscopías del Centro Médico Alta Tecnología Hernando Dionisio Amaya Benavides de Tucupita en Venezuela, en el periodo 2010-2013. Material y métodos: se realizó un studio descriptivo de corte transversal. Se revisaron 1972 expedientes de pacientes mayores de 15 años, procedentes de instituciones médicas de Barrio Adentro, estatales y privadas, que acudieron al servicio de videoendoscopía del Centro Médico de Alta Tecnología Hernando Dionisio Amaya Benavides de Tucupita, en el periodo 2010-2013. Se estudiaron variables demográficas y clínicas. Resultados: la morbilidad por úlceras pépticas resultó de 9,83%, diagnosticado en 105 pacientes, con mayor frecuencia en el sexo masculino en edades comprendidas entre 45 y 54 años. La principal procedencia en el caso de las úlceras gástricas es de los consultorios médicos populares (CMP), presente en 36 pacientes; en el caso de las duodenales, los procedentes de servicios estatales. La porción más afectada por úlceras gástricas en estómago fue el antro, con 110 úlceras diagnosticadas (94%) y en el duodeno, cara anterior del bulbo, con 51 úlceras de las registradas en esta porción (50%). Conclusiones: la úlcera gástrica es más frecuente que la duodenal, la epigastralgia constituyó el síntoma principal que motivó el estudio en los pacientes ulcerosos. La labor de enfermería contribuye a la realización efectiva en el servicio de videoendoscopía.

Peptic ulcer is an injury to the gastrointestinal mucosa (stomach and duodenum) extending beyond the muscularis mucosae and which remains as a result of the activity of acid secretion in the gastric juice. Objetive: To describe the epidemiological and clinical characteristics of gastric and duodenal ulcers in patients who attended the service videoendoscopias Medical Center of High Technology Dionisio Hernando Amaya Benavides Tucupita in Venezuela, in the 2010 period features-2013. Material and methods: Came on descriptive cross-sectional study. 1972 records of patients older than 15 years, from Barrio Adentro medical institutions, state and private, who atttended the service of High Technology videoendoscopy Dionisio Hernando Amaya Benavides Tucupita in 2010-2013 Medical Center were reviewed. Demographic and clinical variables were studied. Results: Peptic ulcer morbidity was 9.83%, diagnosed in 105 patients, most often in men aged between 45 and 54 years. The main origin in the case of gastric ulcers is popular medical practices (CMP), present in 36 patients; in case of duodenal, those from government services. The most affected by gastric ulcers in stomach antrum portion was with 110 diahgnosticadas ulcers (94%) and in the duodenum, anterior bulb with 51 ulcers recorded in this portion (50%). Conclusions: Gastric ulcer is more frequent than duodenal, epigastric pain was the main symptom that motivated the study ulcer patients. The nursing work contributes to the effective realization of videoendoscopy service.

Dual-phase CT findings of groove pancreatitis.

PURPOSE: Groove pancreatitis is a rare focal form of chronic pancreatitis that occurs in the pancreaticoduodenal groove between the major and minor papillae, duodenum and pancreatic head. Radiologic appearance and clinical presentation can result in suspicion of malignancy rendering pancreaticoduodenectomy inevitable. This study reports dual phase CT findings in a series of 12 patients with pathology proven groove pancreatitis. MATERIALS AND METHODS: Retrospective review of preoperative CT findings in 12 patients with histologically proven groove pancreatitis after pancreaticoduodenectomy. Size, location, attenuation, presence of mass or cystic components in the pancreas, groove and duodenum, calcifications, duodenal stenosis and ductal changes were recorded. Clinical data, laboratory values, endoscopic ultrasonographic and histopathological findings were collected. RESULTS: Soft tissue thickening in the groove was seen in all patients. Pancreatic head, groove and duodenum were all involved in 75% patients. A discrete lesion in the pancreatic head was seen in half of the patients, most of which appeared hypodense on both arterial and venous phases. Cystic changes in pancreatic head were seen in 75% patients. Duodenal involvement was seen in 92% patients including wall thickening and cyst formation. The main pancreatic duct was dilated in 7 patients, with an abrupt cut off in 3 and a smooth tapering stricture in 4. Five patients had evidence of chronic pancreatitis with parenchymal calcifications. CONCLUSION: Presence of mass or soft tissue thickening in the groove with cystic duodenal thickening is highly suggestive of groove pancreatitis. Recognizing common radiological features may help in diagnosis and reduce suspicion of malignancy.

Adenocarcinoma de la cuarta porción delduodeno: reporte de caso / Duodenal adenocarcinoma in fourth duodenal portion: a case report

El carcinoma de duodeno constituye una patología infrecuente y por lo tanto no es tenida en cuenta en los diagnósticos diferenciales de los cuadros obstructivos altos. A continuación se presenta un caso correspondiente a este tipo de lesión manejado en el servicio de cirugía del Hospital Universitario de Santander...

The duodenal carcinoma constitutes an infrequent pathology and therefore it is not taken into account as a differential diagnosis of high obstructive symptoms. Subsequently it’s presented a case pertaining to this type of wound handled in the service of surgery of the Hospital Universitario de Santander...

Contribution to the manufacture of an antiacid complex for the treatment of gastric and duodenal diseases from aluminum and magnesium compounds:

Magaldrat, a chemical combination of aluminum and magnesium hydroxides was synthesized from aluminum compounds and magnesium sulfate. The factors, which influence the result, have been investigated. The quality of magaldrate has also been analyzed following the standards of USP XXIII. The product showed low acute and chronic toxicity in vivo.