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1.
BMJ Case Rep ; 14(2)2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-33526527

RESUMO

A 57-year-old woman presented with a 5-day history of worsening right upper quadrant pain, bilious emesis and approximately 20 pounds of weight loss. The patient was afebrile, without jaundice and had mild tenderness in her right upper quadrant. She noted an incidental finding of asymptomatic cholelithiasis on imaging 4 years earlier. An abdominal radiograph revealed pneumobilia and a large ectopic calculus. An abdominal CT scan confirmed pneumobilia, a large concretion completely obstructing the third portion of the duodenum and a soft tissue communication between the gallbladder and proximal duodenum. She was brought to the operating room for definitive treatment and had the obstructing gallstone removed via a transverse duodenotomy. Bouveret syndrome is a rare cause of small bowel obstruction that requires a high index of suspicion for diagnosis. It should be considered in older patients with clinical evidence of gastric or duodenal obstruction, particularly with a history of cholelithiasis.


Assuntos
Obstrução Duodenal/diagnóstico por imagem , Cálculos Biliares/diagnóstico por imagem , Fístula Intestinal/diagnóstico por imagem , Duodenopatias/complicações , Duodenopatias/diagnóstico por imagem , Obstrução Duodenal/etiologia , Obstrução Duodenal/cirurgia , Feminino , Doenças da Vesícula Biliar/complicações , Doenças da Vesícula Biliar/diagnóstico por imagem , Cálculos Biliares/complicações , Cálculos Biliares/cirurgia , Humanos , Fístula Intestinal/complicações , Pessoa de Meia-Idade , Radiografia Abdominal , Tomografia Computadorizada por Raios X
2.
BMJ Case Rep ; 13(12)2020 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-33370983

RESUMO

One of the causes of congenital incomplete duodenal obstruction is the presence of congenital duodenal web with fenestration. This condition requires a high index of suspicion for an early and accurate diagnosis. We present an unusual presentation of duodenal web in a 6-year-old girl who presented with a 3-year history of cyclical and seasonal vomiting and abdominal pain. The diagnosis of congenital duodenal web with fenestration was made on contrast study and endoscopy and was treated surgically by incision of the web.


Assuntos
Dor Abdominal/etiologia , Obstrução Duodenal/diagnóstico , Duodeno/anormalidades , Vômito/etiologia , Dor Abdominal/cirurgia , Criança , Obstrução Duodenal/congênito , Obstrução Duodenal/cirurgia , Duodeno/cirurgia , Endoscopia , Feminino , Humanos , Fatores de Tempo , Resultado do Tratamento , Vômito/cirurgia
3.
BMJ Case Rep ; 13(12)2020 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-33370996

RESUMO

An 87-year-old woman presented to us with a 5-day history of worsening epigastric pain and vomiting. Her medical history included known gallstones and a previous episode of acute cholecystitis complicated by a perforated gallbladder for which she had declined surgery 5 years prior. Radiological imaging confirmed a large gallstone impacted in the first part of the duodenum with gross gastric outlet obstruction and pneumobilia, confirming the diagnosis of Bouveret syndrome, an often overlooked and rare variant of gallstone ileus. Following an unsuccessful oesophagogastroduodenoscopy for stone retrieval, she underwent a laparotomy and gastrotomy with a successful outcome and discharged from hospital 4 weeks following the procedure.


Assuntos
Obstrução Duodenal/diagnóstico , Cálculos Biliares/complicações , Obstrução da Saída Gástrica/diagnóstico , Íleus/diagnóstico , Idoso de 80 Anos ou mais , Obstrução Duodenal/etiologia , Obstrução Duodenal/cirurgia , Duodeno/diagnóstico por imagem , Duodeno/cirurgia , Endoscopia do Sistema Digestório , Feminino , Vesícula Biliar/diagnóstico por imagem , Cálculos Biliares/diagnóstico , Cálculos Biliares/cirurgia , Obstrução da Saída Gástrica/etiologia , Obstrução da Saída Gástrica/cirurgia , Humanos , Íleus/etiologia , Íleus/cirurgia , Estômago/diagnóstico por imagem , Estômago/cirurgia , Síndrome , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Ultrassonografia
4.
Medicine (Baltimore) ; 99(31): e21439, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756156

RESUMO

RATIONALE: Duodenal atresia in association with situs inversus abdominus is extremely rare. Care should be taken when selecting appropriate surgical methods, and caution should be exercised during the surgery to avoid misdiagnosis and mistreatment. With prompt recognition of the condition, the surgical procedure should be performed in a timely manner to achieve positive results. PATIENT CONCERNS: A newborn affected by situs inversus abdominus associated with duodenal atresia, midgut malrotation, and volvulus. DIAGNOSIS: Congenital duodenal atresia with situs inversus abdominis. INTERVENTIONS: Diamond-shaped duodenoduodenostomy with appendectomy was performed, with the release of Ladd band and correction of the malrotation. OUTCOMES: The baby boy is thriving well with no abdominal complaints at 4 years of surgical follow-up. LESSONS: Although several theories are put forward to clarify this matter, the proper cause of duodenal atresia is not well defined. Clinical symptoms and examinations can assist diagnosis, the definitive cause should be ascertained by surgical approach. And the operating surgeon must be aware of the "mirror anatomy" to prevent unnecessary injuries. Additionally, long-term prognosis for duodenal atresia are very good, therefore, careful attention in postoperative management are important in such a case.


Assuntos
Obstrução Duodenal/congênito , Obstrução Duodenal/complicações , Obstrução Duodenal/cirurgia , Duodeno/cirurgia , Atresia Intestinal/complicações , Atresia Intestinal/cirurgia , Situs Inversus/complicações , Assistência ao Convalescente , Anastomose Cirúrgica/métodos , Apendicectomia/métodos , Anormalidades do Sistema Digestório/complicações , Anormalidades do Sistema Digestório/diagnóstico , Obstrução Duodenal/diagnóstico , Humanos , Recém-Nascido , Atresia Intestinal/diagnóstico , Volvo Intestinal/complicações , Volvo Intestinal/diagnóstico , Masculino , Situs Inversus/diagnóstico , Resultado do Tratamento
5.
Ann R Coll Surg Engl ; 102(8): e209-e212, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32538127

RESUMO

Idiopathic retroperitoneal haematoma is a rare clinical entity; resulting duodenal obstruction is even more occult. It can pose a diagnostic challenge due to variable presentations. Timely management requires a high index of suspicion and a multidisciplinary approach. Surgery is indicated in patients refractory to conservative treatment and failure of endoscopic or interventional radiology options. We report an interesting case illustrating the rarity and severity of this condition, with a review of the literature.


Assuntos
Obstrução Duodenal , Hematoma , Espaço Retroperitoneal , Obstrução Duodenal/diagnóstico por imagem , Obstrução Duodenal/etiologia , Obstrução Duodenal/cirurgia , Hematoma/complicações , Hematoma/diagnóstico por imagem , Hematoma/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Espaço Retroperitoneal/diagnóstico por imagem , Espaço Retroperitoneal/patologia , Espaço Retroperitoneal/cirurgia
8.
Niger J Clin Pract ; 23(4): 586-588, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32246671

RESUMO

A peptic ulcer is a rare cause of distal common bile duct stricture, Obstructive jaundice as a complication of ulcerative duodenal stenosis is quite difficult to differentiate from malignant disease, especially in those in which esophagogastroduodenoscopy examination does not reveal an ulcer. In this case report, a 61-year-old male suffered from right upper quadrant pain, chills and fever caused by duodenal and distal common bile duct stenosis originating from ulcer and was treated surgically.


Assuntos
Obstrução Duodenal , Atresia Intestinal , Icterícia Obstrutiva , Obstrução Duodenal/complicações , Obstrução Duodenal/diagnóstico , Obstrução Duodenal/cirurgia , Dor no Flanco/etiologia , Humanos , Atresia Intestinal/complicações , Atresia Intestinal/diagnóstico , Atresia Intestinal/cirurgia , Icterícia Obstrutiva/diagnóstico , Icterícia Obstrutiva/etiologia , Icterícia Obstrutiva/cirurgia , Masculino , Pessoa de Meia-Idade
9.
Pediatr Surg Int ; 36(4): 477-483, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32114651

RESUMO

PURPOSE: Congenital duodenal obstruction (CDO) is associated with trisomy 21 (T21), or Down's syndrome, in around a third of infants. The aim of this study was to explore the impact of T21 on the epidemiology, management, and outcomes of infants with CDO. METHODS: Data were prospectively collected from specialist neonatal surgical centres in the United Kingdom over a 12 month period from March 2016 using established population-based methodology for all babies with CDO. Infants with T21 were compared to those without any chromosomal anomaly. RESULTS: Of 102 infants with CDO that underwent operative repair, T21 was present in 33 [32% (95% CI 23-41%)] babies. Cardiac anomalies were more common in those with T21 compared to those without a chromosomal anomaly (91 vs 17%, p < 0.001), whereas associated gastrointestinal anomalies were less common in infants with T21 (3 vs 12%, p = 0.03). Surgical management was not influenced by T21. Time to achieve full enteral feed, need for repeat related surgery, and mortality were similar between groups. Infants with T21 had a longer median initial inpatient stay (23 vs 16.5 days, p = 0.02). CONCLUSIONS: Infants with T21 have a higher incidence of cardiac anomalies and a longer initial inpatient stay; however, it does not change CDO management or outcomes. This information is important for prenatal and postnatal counselling of parents of infants with CDO and T21.


Assuntos
Anormalidades Múltiplas , Anormalidades do Sistema Digestório/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório , Síndrome de Down/diagnóstico , Obstrução Duodenal/congênito , Anormalidades do Sistema Digestório/diagnóstico , Anormalidades do Sistema Digestório/epidemiologia , Obstrução Duodenal/epidemiologia , Obstrução Duodenal/cirurgia , Feminino , Humanos , Incidência , Recém-Nascido , Masculino , Reoperação , Estudos Retrospectivos , Reino Unido/epidemiologia
10.
Cir Cir ; 88(1): 95-99, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31967610

RESUMO

Bouveret´s syndrome refers to the condition of gastric outlet obstruction caused by the impaction of a large gallstone into the duodenum after passage through a cholecystoduodenal fistula. Many endoscopic and surgical techniques have been described in the management of this syndrome, however the morbidity and mortality are still very high. We present the case of a 67-year-old female patient with Bouveret´s syndrome, with successful resolution with surgical treatment after two failed endoscopic treatments.


Assuntos
Obstrução Duodenal/complicações , Cálculos Biliares/complicações , Obstrução da Saída Gástrica/etiologia , Doenças Raras/etiologia , Idoso , Fístula Biliar/complicações , Obstrução Duodenal/cirurgia , Feminino , Cálculos Biliares/cirurgia , Obstrução da Saída Gástrica/cirurgia , Humanos , Fístula Intestinal/complicações , Doenças Raras/cirurgia , Síndrome
11.
J Pediatr Surg ; 55(2): 282-285, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31839373

RESUMO

PURPOSE: Congenital Partial Duodenal Obstruction (CPDO) caused by membranes/webs/diaphragms has traditionally been managed by open or laparoscopic duodenoduodenostomy or duodenojejunostomy. We report a two center case series where Natural Orifice Endoluminal technique (NOEL) was used to treat children with CPDO. METHODS: A retrospective case series was evaluated. Data collected included the duration of procedure, postoperative complications, length of stay, and need for further procedures. RESULTS: Fifteen patients were treated over a 10 year period by NOEL technique for late presenting CPDO. Four patients were managed at Sheffield Children's Hospital (Center A, UK), and 11 patients were managed in Bambino Gesù Hospital of Rome (Center B, Italy). 20% of the patients had more than one duodenal obstructing membrane. Both balloon dilatation and membrane incision techniques were used. Median follow up was 23 months (range 2-69) in Center A and 18 months (range 7-58) in Center B. 60% of patients were successfully treated with 1 NOEL procedure. 20% required 2 or 3 procedures to achieve long term luminal patency. 20% required surgery after NOEL failed to treat the partial obstruction definitively. One patient in Center A required radiological drainage of a retroperitoneal collection following perforation during NOEL. CONCLUSION: NOEL technique is feasible and effective in selected children with CPDO. Both balloon dilatation and incision techniques can be used. Care must be taken to rule out a second distal obstruction. We would recommend that all infants and children with CPDO owing to a fenestrated membrane should be considered for NOEL. TYPE OF STUDY: Case series. LEVEL OF EVIDENCE: Level IV.


Assuntos
Obstrução Duodenal , Duodeno , Cirurgia Endoscópica por Orifício Natural/métodos , Adolescente , Adulto , Criança , Pré-Escolar , Obstrução Duodenal/patologia , Obstrução Duodenal/cirurgia , Duodeno/anormalidades , Duodeno/patologia , Duodeno/cirurgia , Humanos , Lactente , Estudos Retrospectivos , Adulto Jovem
13.
Arch Dis Child Fetal Neonatal Ed ; 105(2): 178-183, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31229958

RESUMO

OBJECTIVE: Congenital duodenal obstruction (CDO) comprising duodenal atresia or stenosis is a rare congenital anomaly requiring surgical correction in early life. Identification of variation in surgical and postoperative practice in previous studies has been limited by small sample sizes. This study aimed to prospectively estimate the incidence of CDO in the UK, and report current management strategies and short-term outcomes. DESIGN: Prospective population-based, observational study for 12 months from March 2016. SETTING: Specialist neonatal surgical units in the UK. MAIN OUTCOME MEASURES: Incidence of CDO, associated anomalies and short-term outcomes. RESULTS: In total, 110 cases were identified and data forms were returned for 103 infants giving an estimated incidence of 1.22 cases per 10 000 (95% CI 1.01 to 1.49) live births. Overall, 59% of cases were suspected antenatally and associated anomalies were seen in 69%. Operative repair was carried out mostly by duodenoduodenostomy (76%) followed by duodenojejunostomy (15%). Postoperative feeding practice varied with 42% having a trans-anastomotic tube placed and 88% receiving parenteral nutrition. Re-operation rate related to the initial procedure was 3% within 28 days. Two infants died within 28 days of operation from unrelated causes. CONCLUSION: This population-based study of CDO has shown that the majority of infants have associated anomalies. There is variation in postoperative feeding strategies which represent opportunities to explore the effects of these on outcome and potentially standardise approach. Short-term outcomes are generally good.


Assuntos
Obstrução Duodenal/cirurgia , Duodeno/anormalidades , Duodeno/cirurgia , Atresia Intestinal/cirurgia , Obstrução Duodenal/mortalidade , Feminino , Humanos , Lactente , Recém-Nascido , Atresia Intestinal/mortalidade , Masculino , Nutrição Parenteral/métodos , Cuidados Pós-Operatórios/métodos , Reoperação , Índice de Gravidade de Doença , Reino Unido
14.
Surg Innov ; 26(6): 738-743, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31603039

RESUMO

Duodenal atresia is a congenital defect that requires advanced surgical skills. The objective of this study is to present an anatomical defect of duodenal atresia using a rabbit model and evaluate the preliminary experience for the training of surgical skills with pediatric surgeons. Adult white New Zealand male rabbits weighing 3.0 to 4.5 kg were used to create the defect. To simulate the bottom of the dilated blind pouch, the gastric antrum of the rabbit was obliterated using a 2-0 Prolene suture, and the cecal appendix was dissected to simulate the continuation of the duodenum. Participants performed laparoscopic duodenal atresia repair in this animal model using the iPhone trainer. Thirteen pediatric surgeons with experience in laparoscopic duodenal atresia repair assessed this model with a questionnaire on 5-point Likert-type scale. Overall, the simulated model of duodenal atresia obtained a general average score of 4.39. The highest observed average was for its physical realism, whereas the lowest score was in surgical experience. The global opinion of the model obtained a score of 4.40. In addition, all surgeons answered that this rabbit model showed the same complexity as newborns and young children in the repair of this type of defect. The inclusion of new models through rabbits in pediatric surgery programs will allow the development of advanced skills of pediatric residents and surgeons.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/educação , Obstrução Duodenal/cirurgia , Atresia Intestinal/cirurgia , Pediatria/educação , Cirurgiões/educação , Adulto , Animais , Competência Clínica , Modelos Animais de Doenças , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Coelhos , Reprodutibilidade dos Testes
15.
World J Gastroenterol ; 25(28): 3787-3797, 2019 Jul 28.
Artigo em Inglês | MEDLINE | ID: mdl-31391773

RESUMO

BACKGROUND: Congenital duodenal obstruction (CDO) can be complete (CCDO) or incomplete (ICDO). To date there is no outcome analysis available that compares both subtypes. AIM: To quantify and compare the association between CCDO and ICDO with outcome parameters. METHODS: We retrospectively reviewed all patients who underwent operative repair of CCDO or ICDO in our tertiary care institution between January 2004 and January 2017. The demographics, clinical presentation, preoperative diagnostics and postoperative outcomes of 50 patients were compared between CCDO (n = 27; atresia type 1-3, annular pancreas) and ICDO (n = 23; annular pancreas, web, Ladd´s bands). RESULTS: In total, 50 patients who underwent CDO repair were enrolled and followed for a median of 5.2 and 3.9 years (CCDO and ICDO, resp.). CCDO was associated with a significantly higher prenatal ultrasonographic detection rate (88% versus 4%; CCDO vs ICDO, P < 0.01), lower gestational age at birth, lower age and weight at operation, higher rate of associated congenital heart disease (CHD), more extensive preoperative radiologic diagnostics, higher morbidity according to Clavien-Dindo classification and comprehensive complication index (all P ≤ 0.01). The subgroup analysis of patients without CHD and prematurity showed a longer time from operation to the initiation of enteral feeds in the CCDO group (P < 0.01). CONCLUSION: CCDO and ICDO differ with regard to prenatal detection rate, gestational age, age and weight at operation, rate of associated CHD, preoperative diagnostics and morbidity. The degree of CDO in mature patients without CHD influences the postoperative initiation of enteral feeding.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/métodos , Obstrução Duodenal/cirurgia , Duodeno/anormalidades , Nutrição Enteral/estatística & dados numéricos , Laparoscopia/métodos , Fatores Etários , Criança , Pré-Escolar , Obstrução Duodenal/congênito , Obstrução Duodenal/diagnóstico , Duodeno/diagnóstico por imagem , Duodeno/cirurgia , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Período Pós-Operatório , Estudos Retrospectivos , Resultado do Tratamento
16.
BMJ Case Rep ; 12(8)2019 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-31466956

RESUMO

A 55-day-old boy was transferred to our unit with intestinal obstruction and obstructive jaundice after two neonatal operations for duodenal atresia and intestinal malrotation. Abdominal ultrasound showed dilated intrahepatic and extrahepatic ducts with cut-off at the distal common bile duct (CBD). He underwent emergency laparotomy for adhesive intestinal obstruction with a contained abscess from mid-jejunal perforation. Biliary dissection was not attempted due to poor preoperative nutritional status. Tube cholecystostomy was created for biliary decompression. Postoperative magnetic resonance cholangiopancreatography showed dilated CBD with cut-off at the ampulla but did not demonstrate pancreaticobiliary maljunction (PBMJ). The diagnostic dilemma was whether our patient had congenital PBMJ or had developed biliary stricture from perioperative ischaemic scarring. He underwent definitive surgery at 7 months: excision of dilated CBD with Roux-en-Y hepaticojejeunal reconstruction, excisional tapering duodenoplasty and jejunostomy creation. Intraoperative finding was type I choledochal cyst and subsequently confirmed on histology. Postoperative recovery was uneventful and bilirubin levels normalised.


Assuntos
Ducto Colédoco/diagnóstico por imagem , Obstrução Duodenal/cirurgia , Atresia Intestinal/cirurgia , Obstrução Intestinal/cirurgia , Icterícia Obstrutiva/cirurgia , Colangiopancreatografia por Ressonância Magnética , Ducto Colédoco/cirurgia , Diagnóstico Diferencial , Humanos , Lactente , Obstrução Intestinal/diagnóstico por imagem , Icterícia Obstrutiva/diagnóstico por imagem , Laparotomia , Masculino , Má Junção Pancreaticobiliar/diagnóstico por imagem , Má Junção Pancreaticobiliar/cirurgia , Reoperação/efeitos adversos , Resultado do Tratamento , Ultrassonografia
17.
BMJ Case Rep ; 12(8)2019 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-31451461

RESUMO

This is a case report of a neonate who was antenatally diagnosed with jejunal atresia which turned out to be duodenal atresia with apple peel syndrome. A previous sibling, who also had apple peel but with jejunal atresia, succumbed to sepsis after surgery. The first sibling had jejunal stenosis and had died of sepsis following surgery. Combination of duodenal atresia with apple peel is extremely rare. This coupled with a familial condition is rarer still. This case was challenging due to the short length of the gut and prolonged need for total parenteral nutrition and sepsis in postoperative period.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/métodos , Obstrução Duodenal , Atresia Intestinal , Jejunostomia/métodos , Sepse Neonatal , Adulto , Diagnóstico Diferencial , Obstrução Duodenal/diagnóstico , Obstrução Duodenal/etiologia , Obstrução Duodenal/fisiopatologia , Obstrução Duodenal/cirurgia , Duodeno/anormalidades , Duodeno/diagnóstico por imagem , Duodeno/cirurgia , Feminino , Humanos , Recém-Nascido , Atresia Intestinal/diagnóstico , Atresia Intestinal/genética , Atresia Intestinal/fisiopatologia , Atresia Intestinal/cirurgia , Jejuno/anormalidades , Jejuno/diagnóstico por imagem , Jejuno/cirurgia , Anamnese , Sepse Neonatal/diagnóstico , Sepse Neonatal/etiologia , Sepse Neonatal/terapia , Nutrição Parenteral Total/métodos , Gravidez , Diagnóstico Pré-Natal/métodos , Doenças Raras/diagnóstico , Irmãos , Resultado do Tratamento
18.
Am J Case Rep ; 20: 1108-1113, 2019 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-31350383

RESUMO

BACKGROUND Duodenal compression between the superior mesenteric vessels and aorta or its branches is a rare disease in which the angle between the superior mesenteric vessels and aorta becomes acute, resulting in duodenal obstruction. Reduction in retroperitoneal fat due to several debilitating conditions is considered to be the cause of the decreased angle between the 2 vessels. Nutcracker phenomenon is the asymptomatic compression of the left renal vein (LRV) between the aorta and the superior mesenteric artery. CASE REPORT We report the case of a 33-year-old man who presented with postprandial abdominal pain, mainly at the epigastric region, colicky in nature, without radiation, accompanied by nausea, postprandial vomiting, and loss of weight. Computed tomography (CT) of the abdomen showed duodenal compression between the SMV and the right common iliac artery, which has never been reported before. Laparoscopic duodenojejunostomy was performed. CONCLUSIONS Vascular compression of the duodenum presents with manifestations of proximal small bowel obstruction, which may have chronic, intermittent, or acute symptoms. Diagnosis is difficult due to the lack of knowledge of this rare disorder. Most of these symptoms can be present in other diseases, and symptoms sometimes do not correspond with imaging findings. Therefore, for a better outcome, the clinician should have a high index of suspicion and should be able to exclude other causes with similar manifestations.


Assuntos
Obstrução Duodenal/cirurgia , Duodenostomia , Jejunostomia , Laparoscopia , Veias Mesentéricas/cirurgia , Síndrome do Quebra-Nozes/diagnóstico por imagem , Adulto , Obstrução Duodenal/diagnóstico por imagem , Obstrução Duodenal/etiologia , Humanos , Masculino , Veias Mesentéricas/diagnóstico por imagem , Síndrome do Quebra-Nozes/complicações , Tomografia Computadorizada por Raios X
20.
Medicine (Baltimore) ; 98(27): e15856, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31277088

RESUMO

RATIONALE: Duodenal obstruction (DO) sometimes induces the groove pancreatitis. However, the case of DO due to chronic pancreatitis in pancreas tail (CPPT) is extremely rare. Therefore, the managements of DO caused by CPPT have not been established yet. PATIENT CONCERNS: A 68-year-old man, who was under the treatment of chronic pancreatitis, presented to our hospital with nausea and abdominal pain. He was diagnosed as DO caused by CPPT. The Conservative treatment, including the nasogastric aspiration and intravenous infusion under the absence of food, was performed. The drainage fluid from naso-gastric tube had been more than 2000 ml per a day although continuing treatment for 14 days. Hence, we decided that the conservative therapy was failed and the surgical intervention was required. DIAGNOSIS: Computed tomography showed gastroduodenal expansion due to stenosis at the horizontal portion of the duodenum with increasing pancreatic pseudocyst. The contrast radiography of the duodenum showed severe stenosis around Treitz ligament. His pre-surgical diagnosis was DO due to CPPT through exclusion of other etiologies for DO such as annular pancreas, SMA syndrome, duodenal diaphragm and Crohn disease. INTERVENTION: Spleen preserving distal pancreatectomy (Warshaw operation) was performed with gastrojejunostomy. During surgery, marked redness and thickness of the mesenteric serosa around Treiz ligament were observed. His surgical findings were supported our preoperative prediction. OUTCOMES: The patient was successfully treated and discharged uneventfully after postoperative day 14. At the 9 months follow-up visit, the patient is still doing well without any symptoms. CONCLUSION: Combination of gastrojejunostomy and Warshaw operation is one of the ideal surgical procedures for patients of DO due to CPPT.


Assuntos
Obstrução Duodenal/cirurgia , Derivação Gástrica/métodos , Pancreatectomia/métodos , Pseudocisto Pancreático/cirurgia , Pancreatite Crônica/complicações , Idoso , Obstrução Duodenal/etiologia , Humanos , Masculino , Tratamentos com Preservação do Órgão , Pseudocisto Pancreático/diagnóstico por imagem , Pseudocisto Pancreático/etiologia , Tomografia Computadorizada por Raios X
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