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PubMed1991

[Clinical features of delayed diagnosis in congenital duodenal obstruction].

Delayed diagnosis in two cases of congenital duodenal obstruction was discussed. Case 1. Ten-month-old baby girl with Down's syndrome was admitted to the hospital because of vomiting of milk. Wall-like obstruction was found in the second part of duodenum. Case 2. One-year-old boy infant with Down's syndrome showed a stack of coin in the duodenum on admission. Wall-like obstruction was found in the second part of duodenum. Diagnosis of duodenal obstruction is sometimes delayed in Down's syndrome. Symptom such as vomiting and growth retardation might be ignored in a child with Down's syndrome. A large hole was found in the center of the obstruction in both cases; 4 mm in diameter in case 1, 3 mm in case 2. Papilla of Vater opened at the anal side of the obstruction. These structural particularities played a role in making symptom of duodenal obstruction obscure. Mural obstruction of duodenum was observed in both cases. The obstructions were, in shape, similar to the membraneous stenosis of the duodenum. However, they were not membranes but walls as thick as 4-5 mm. Wall-like duodenal obstruction has not been reported in the literature. It can not be concluded whether mural obstruction in our cases is a new subtype of duodenal obstruction or not.

Down Syndrome↗
PubMed1997

Tuberculous duodenal obstruction--a case report.

Proximal duodenal obstruction due to tuberculosis can masquarade as duodenal ulcer. Although commonest cause of duodenal obstruction is ulcer, other causes must be considered, particularly tuberculosis which is common in tropics.

Adult↗
PubMed1980

Idiopathic retroperitoneal fibrosis with functional duodenal obstruction.

Idiopathic retroperitoneal fibrosis with duodenal obstruction is a rarely reported clinical entity. The presenting symptoms of nausea, vomiting, weight loss, and progressive fatigability can be easily overlooked if attention is focused on the more prominent symptoms of low back and flank pain. Duodenal obstruction can present several months after the initial diagnosis of retroperitoneal fibrosis. Nutritional support before surgical correction is imperative.

Duodenal Obstruction↗
PubMed2002

Role of self-expandable metal stents in the palliation of malignant duodenal obstruction.

BACKGROUND: Palliative surgical intervention for malignant duodenal obstruction is often associated with a significant morbidity. Endoscopic enteral stenting offers a suitable alternative, that is safe, effective, and less invasive. This study reports our experience with the use of self-expanding metal stents in the palliation of malignant gastric duodenal obstruction. METHODS: A retrospective review of all patients who underwent duodenal stenting from November 1998 to February 2001 was performed. All the patients had symptomatic gastric outlet and duodenal obstruction with nausea, vomiting, and decreased oral intake. All of them underwent enteral stenting with self-expandable metal Wallstents 20 or 22 mm in diameter and 6 or 9 cm long. RESULTS: For this study, 33 patients (19 men and 14 women) with a mean age of 62 years (range, 37-81 years) were identified, 32 of whom had successful duodenal stent placement (6 were performed as outpatient surgery). The malignancies were pancreatic 18 (54%), gastric 4 (12%), duodenal 3 (9%), metastatic 6 (18%), and cholangiocarcinoma 2 (6%) disorders. The site of obstruction was pyloric (n = 5; 15%), pyloroduodenal (n = 3; 9%), duodenal bulb (n = 11; 33%), second portion of duodenum (n = 9; 27%), second and third portion of duodenum (n = 3; 9%), C-loop (n = 1; 3%), and anastomotic (n = 1; 3%). A total of 29 patients (91%) had good clinical outcomes, with relief of obstructive symptoms, Two of three patients with no symptomatic relief underwent gastrojejunostomy. One patient refused further treatment. No immediate stent-related complications were noted. During the follow-up period, 20 patients died (none as a result stent-related causes) due to progression of cancer. Median survival was 102 days. Four patients had recurrent obstruction (2 tumor ingrowths, 1 overgrowth, and 1 distally migrated stent) at a mean interval of 82 days. All four had successful restenting without complications. CONCLUSION: Self-expandable metal stents placed endoscopically provide a safe, less invasive palliative treatment option with good clinical outcome in the management of malignant gastric outlet-duodenal obstruction.

Adult↗
PubMed2002

Laparoscopic duodenoduodenostomy for duodenal obstruction in infants and children.

BACKGROUND/PURPOSE: Duodenal obstruction, such as that resulting from atresia or web, routinely has been corrected by laparotomy and duodenoduodenostomy. Until recently, no one has reported on the use of minimally invasive techniques to correct this congenital anomaly. Over the last 6 months we have approached 4 patients, 3 with atresia and one with a web, laparoscopically. Three were newborns, and one was 8 months old. METHODS: All procedures were performed with 3-mm instruments and scopes. RESULTS: Operating time in all cases was less then 90 minutes. Visualization was excellent, and there were no intraoperative complications. Feedings were started on postoperative day 5 in all 3 neonates and day 3 in the infant. All 4 were on full feedings after 3 days. Follow-up upper gastrointestinal tests show no evidence of stricture or obstruction. CONCLUSION: Laparoscopy provides an excellent way to evaluate and treat congenital duodenal obstruction.

Duodenal Obstruction↗
PubMed2001

Surgical treatment for congenital duodenal obstruction.

Thirty-four congenital duodenal obstructions (19 duodenal atresia, 7 duodenal web, 7 annular pancreas and one duodenal stenosis) were surgically treated in Siriraj Hospital between 1990 and 1999. Eleven per cent of duodenal atresia had no bile-stained vomiting. Duodenal web which received web excision and duodenoplasty in 43 per cent of cases, also presented with bile-stained vomiting. Duodeno-duodenostomy, duodeno-jejunostomy and web excision with duodenoplasty were performed in 29, 2 and 3 patients respectively. Duodeno-duodenostomy and web excision with duodenoplasty had no difference in the feeding capability. There was no statistically significant difference in duration of TPN, ability to be early fed, post-operative onset of full feeding and hospital stay between diamond-shaped (n = 18) and side-to-side (n = 11) duodeno-duodenostomy. Although transanastomotic feeding tube (n = 4) decreased a percentage of TPN requirement and made early feeding possible, the onset of full feeding, duration of TPN and hospital stay were not different from those who had no transanastomotic tube (n = 30).

Duodenal Diseases↗
PubMed1996

[Chronic duodenal obstruction in children].

Chronic duodenal obstruction was observed in 18 children aged from 2 months to 14 years. The disease was caused by different malformations of the intestine. In children younger than 7 years of age the main clinical manifestation of the disease was the syndrome of vomiting. Older children were admitted for examination for the chronic abdominal pain syndrome. Roentgen-contrast methods of examination of the stomach and duodenum were of decisive significance. All the children were operated upon. The operative method was chosen according to the intestinal malformation.

Adolescent↗
PubMed1986

Blood, urine, and ruminal fluid changes associated with metabolic alkalosis induced by duodenal obstruction.

Two Holstein heifers and a steer fitted with ruminal and duodenal cannulas were used to determine acid-base and electrolyte changes associated with metabolic alkalosis induced by duodenal obstruction. Obstruction was induced distally to the pylorus, but proximally to the common bile duct entrance. Ruminal fluid, blood, and urine samples were obtained before and after obstruction was induced. Duodenal obstruction resulted in increased blood pH, bicarbonate concentration, and base-excess values. Severe hypochloremia and hypokalemia were evident in 48 hours. Serum sodium concentration decreased only slightly. Packed cell volume and serum concentrations of urea nitrogen, creatinine, glucose, and inorganic phosphate increased, whereas calcium concentration showed no change. Renal chloride excretion reached near zero in 24 hours, whereas sodium and potassium excretions decreased in the steer, but were unchanged in the heifers. Urine creatinine concentration increased markedly in the heifers and steers. Acid urine was not evident up to 96 hours. Ruminal fluid pH decreased and chloride concentration increased in the steer, but remained unaffected in the heifers. Duodenal obstruction had no effect on rumen sodium, calcium, and magnesium concentrations, but the potassium concentration increased in the heifers. The degrees of alkalosis and electrolyte changes were greater in the steer than in the heifers.

Alkalosis↗
PubMed2005

Analysis of postoperative reoperation for congenital duodenal obstruction.

OBJECTIVE: To analyse the risk factors for reoperation after initial surgical repair of congenital duodenal obstruction and demonstrate that they can be decreased with more careful attention and more advanced techniques during surgery. METHODS: The records of newborns and infants (aged 0-2 months) who had surgical therapy for congenital duodenal obstruction in the past 30 years were reviewed and analysed. Of the 298 patients, 132 (44%) were boys and 166 (56%) were girls. All patients who underwent repeat surgery postoperatively were evaluated by the reasons for surgery. The number of patients with various combination lesions of congenital duodenal obstruction was also calculated and the relationship to postoperative reoperation was analysed. RESULTS: Twenty patients (6.7%) had congenital duodenal obstruction with combination lesions including duodenal web, malrotation, annular pancreas and multiple duodenal web. Twelve patients required further operation 5 days to 2 years postoperatively for complications (n = 5) and other duodenal atresias that were not discovered initially (n = 7). CONCLUSION: More than half of reoperated patients (7/12) had multiple lesions of duodenal obstruction that were missed during the primary operation. The postoperative reoperation rate for congenital duodenal obstruction could be decreased with more careful attention to operative details and more preoperative and intraoperative evaluation of the gastrointestinal tract.

Case-Control Studies↗
PubMed1979

Neonatal duodenal obstruction.

The records of 40 infants with intrinsic duodenal obstruction have been reviewed. Of these more than half had no bile in the vomit. Persistent vomiting had been considered as the major factor of doubt regarding duodenal obstruction. The incidence of other associated congenital abnormalities was 70%. The over all mortality rate was 42.5%. The association of mongoloidism to the intrinsic duodenal obstruction was found approximately in every third infant. The low birth weight without other congenital abnormality has very little effect on the mortality rate.

Abnormalities, Multiple↗
PubMed1987

Duodenal obstruction following abdominal aortic reconstruction.

Four patients developed duodenal obstruction after 161 abdominal aortic reconstructions, an incidence (2.5%) rivaling that of graft infection and arterioenteric fistula. The diagnosis is easily confirmed by gastrointestinal contrast studies. Duodenal obstruction is usually caused by perigraft collagenous adhesions and is probably less likely to occur if the mobilized duodenum is not replaced directly over the aorta during resuture of the retroperitoneum. Undetected duodenal obstruction leads to rapid dehydration and electrolyte and caloric depletion.

Aged↗
PubMed1997

[The surgical treatment of chronic duodenal obstruction in combination with chronic pancreatitis and tumors of the pancreaticoduodenal area].

Results of 102 surgical interventions were analyzed. In 39 patients chronic duodenal obstruction was associated with benign diseases, 63 patients had malignant tumours. The chronic duodenal obstruction resulted from diseases in the pancreatoduodenal area in 80 patients, in 22 patients it proved to be the cause of chronic pancreatitis. The adequate surgical correction of the duodenal obstruction is believed to be sufficient for normalizing the pancreas functions in patients with primary chronic duodenal obstruction. Direct surgical interventions are preferable for secondary chronic duodenal obstruction. Prophylactic formation of gastroenterostomy during the biliodigestive surgery can relieve the symptoms of the developing duodenal obstruction and allows to avoid another operation at the advanced stage of chronic duodenal obstruction.

Adult↗
PubMed2003

Self-expandable metallic stents for malignant duodenal obstruction caused by biliary tract cancer.

BACKGROUND: Malignant duodenal obstruction is a common event in patients with advanced biliary tract cancer. Because bypass surgery is accompanied by significant morbidity, self-expandable metallic stents have emerged as a possible alternative for palliation. METHODS: Twenty patients with biliary tract cancer (7 gallbladder, 13 Klatskin tumors) and duodenal obstruction were treated with metallic stents at a single institution between 1999 and 2001. Survival, morbidity, and stent function were studied prospectively. The ability to eat was assessed by using a scoring system. RESULTS: Stent placement was technically successful in all patients. An additional stent was required in 6 cases (4 occlusions, 2 dislocations). Median survival was 20.5 weeks; there was no treatment-related death. Twenty-eight biliary stent exchanges were performed in 13 (65%) patients. Erosive reflux esophagitis improved in 11 of 12 (92%) cases. After 4 weeks, all 17 surviving patients tolerated soft or solid food, whereas 13 of 17 (77%) tolerated a more solid diet (p < 0.001, gastric outlet obstruction scoring system). Twelve of 17 (71%) patients gained a median of 1.5 kg of body weight (p = 0.001). The median Karnofsky scale increased from 50% to 60% in 13 of 17 (77%) patients. CONCLUSIONS: Self-expandable metallic stents are a safe, efficacious, and minimally invasive treatment option for palliation of patients with duodenal obstruction from biliary tract cancer. Technical complications can be managed endoscopically and the bile duct remains accessible for endoluminal treatment.

Aged↗
PubMed1992

Partial situs inversus: duodenal obstruction in a neonate with isolated levocardia.

An unusual case of duodenal obstruction in an infant with isolated levocardia is described. The following anatomic features were shown preoperatively: (1) duodenal obstruction; (2) right-sided stomach and spleen; (3) left-sided liver; (4) totally right-sided located colon in mirror image nonrotation; and (5) levocardia without any defect or dysfunction. The mentioned findings were verified intraoperatively and the cause of the duodenal obstruction was found to be an aberrant vessel. This case is a rare one regarding the lack of heart and spleen defects and the cause of duodenal obstruction. It also demonstrates the necessity of meticulous investigation and precise description of the anomaly and suggests individualization as far as the management of these cases is concerned.

Duodenal Obstruction↗
PubMedDate not supplied

Solid gastric emptying after highly selective vagotomy and pyloroplasty in patients with obstructing duodenal ulcer.

Before being superseded by medical management, highly selective vagotomy (HSV) without drainage was the procedure of choice for uncomplicated duodenal ulcer. It is also justified for complications, including perforation and bleeding in selected cases. This prospective study evaluated the effects of HSV plus drainage on solid gastric emptying in 20 patients with chronic duodenal ulcer and pyloric stenosis. Patients were treated with HSV plus pyloroplasty (Heineke-Mikulicz pyloroplasty in five patients, Finney pyloroplasty in six patients and Jaboulay gastroduodenostomy in nine patients) and underwent solid-phase gastric emptying scintigraphic studies pre-operatively and 2 months and 6 months post-operatively. Results were compared with those from 10 controls. No significant differences were observed between the different types of pyloroplasty, although emptying was slightly faster in the gastroduodenostomy group. Gastric emptying returned to normal by 6 months post-operatively. In conclusion, HSV plus pyloroplasty is effective and can be used for the relief of stenosis in selected cases of duodenal ulcer.

Adolescent↗