Duodenal Duplication Cyst in adult male; An Extremely Rare Entity and a Diagnostic Pitfall leading to Whipple procedure

Abstract Introduction/Objective Whipple procedure is a complex, invasive operation and has high morbidity and mortality. It is the most commonly indicated treatment for treating malignant tumors, however, it can be also used for benign entities as well including biliary stricture, chronic pancreatitis, choledochal cyst, inflammatory pseudotumour, and duodenal angiodysplasia. Methods/Case Report We report a case of a 50-year-old man who presented with symptoms of gastric outlet obstruction. Esophagogastroduodenoscopy and CT scan showed an obstruction at the level of the second part of the duodenum with proximal dilation. Subsequently, a Whipple procedure was performed based on high clinical suspicion of duodenal cancer. Gross examination revealed a unilocular thick walled cyst (4.2 cm) in the duodenum. Histopathologic examination showed a cyst lined by duodenal mucosa with thick smooth muscle wall and focal ectopic gastric tissue. This was finally diagnosed as a duodenal cyst consistent with duplication cyst. Results (if a Case Study enter NA) NA Conclusion Duplication cysts are rare congenital abnormality predominantly diagnosed in infancy and childhood. They are most commonly located in the distal ileum, followed by the esophagus and ileocecal region, and are extremely rare in duodenum. Differential diagnosis includes choledochocele, pancreatic pseudocyst, and cystic tumors of the pancreas, mesenteric cysts, and duodenal diverticulums. Treatment options include total excision, cystojejunostomy, and endoscopic marsupialization but occasionally may lead to more invasive measures such as the Whipple procedure. Although duodenal duplication cysts can have variable clinical presentation and radiological findings, making preoperative diagnosis very challenging, it is still pertinent to be aware of this entity for the optimal patient care.

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Endoscopic stenting for malignant tumors in the area of the bauginium fl ap

Experimental and Clinical Gastroenterology ◽

10.31146/1682-8658-ecg-177-5-78-81 ◽

2020 ◽

Vol 174 (5) ◽

pp. 78-81

Author(s):

A. S. Vodoleev ◽

M. S. Burdyukov ◽

S. S. Pirogov ◽

E. S. Karpova ◽

D. G. Sukhin ◽

...

Keyword(s):

Emergency Surgery ◽

Malignant Tumors ◽

Clinical Success ◽

Colonic Obstruction ◽

Stent Migration ◽

Endoscopic Stenting ◽

High Morbidity ◽

Right Colon ◽

Long Distance ◽

Ileocecal Region

Introduction. Stenting in the ileocecal region is not a routine procedure. Proximal colonic obstruction is generally managed with primary surgery, although there are no RCTs to support this assumption. Recent reports have shown that emergency right colon resection can be associated with high morbidity and mortality rates. We report about 8 cases of obstructive ileocecal cancer for palliative treatment. Case report. Four men and 4 women (mean age, 69 years; range, 62–82 years) were stenting for obstructive ileocecal cancer between September 2014 and December 2019. Emergency SEMS placement was attempted in the remaining 5 cases. An uncovered colonic stent (S&G Biotech; Boston Scientifi c) 22, 24, 25 mm in diameter, 6, 8or 9cm in length, was used. Clinical success is achieved in all cases. One patient was diagnosed with stent migration 4 weeks after stenting, and repeated stenting was performed. Five patients received chemotherapy after stenting, two patients refused further treatment. Discussion. Placing SEMS for ileocecal obstruction is technically challenging for the following reasons. The long distance from the anus, tortuosity of the bowel and angled anatomy of stricture make an ileocecal lesion difficult to reach endoscopically. SEMS can be an alternative to emergency surgery for obstruction due to right colon cancer. In our study, we had migration in 1 case, no perforations or stent ingrown were detected. Conclusion. Stenting for malignant tumors of the ileocecal region, complicated by intestinal obstruction is an eff ective and safe minimally invasive intervention, and can be used as an alternative to emergency surgery.

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Duodenal duplication cyst presenting with gastric outlet obstruction in an adult male

Endoscopy ◽

10.1055/s-0030-1256857 ◽

2011 ◽

Vol 43 (S 02) ◽

pp. E352-E353 ◽

Cited By ~ 3

Author(s):

A. McArdle ◽

J. Conneely ◽

N. Ravi ◽

J. Reynolds

Keyword(s):

Gastric Outlet Obstruction ◽

Adult Male ◽

Outlet Obstruction ◽

Duplication Cyst ◽

Duodenal Duplication ◽

Duodenal Duplication Cyst

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Duplication Cyst in the Third Part of the Duodenum Presenting with Gastric Outlet Obstruction and Severe Weight Loss

Case Reports in Surgery ◽

10.1155/2015/749085 ◽

2015 ◽

Vol 2015 ◽

pp. 1-4

Author(s):

Osama Shaheen ◽

Samer Sara ◽

Mhd Firas Safadi ◽

Bayan Alsaid

Keyword(s):

Weight Loss ◽

Gastric Outlet Obstruction ◽

Outlet Obstruction ◽

Duplication Cyst ◽

Upper Endoscopy ◽

Developmental Abnormality ◽

The Third ◽

Duodenal Duplication ◽

Adjacent Structures ◽

Infancy And Childhood

Duodenal duplication is a rare developmental abnormality which is usually diagnosed in infancy and childhood, but less frequently in adulthood. We report a case of a 16-year-old female with a duplication cyst in the third part of the duodenum. The patient presented with symptoms of gastric outlet obstruction, including severe anorexia and weight loss. The diagnosis was made preoperatively by CT scan and upper endoscopy. The cyst was successfully treated by marsupialization on the duodenum using a GIA stapler. Duodenal duplication presents with a wide variety of symptoms. Although illusive, many cases can be properly diagnosed preoperatively by using the appropriate imaging modalities. Treatment choices are tailored according to the size and location of the cyst, in addition to its relation to adjacent structures. The outcomes are favorable in the majority of patients.

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Vertebroplasty as a palliative treatment option for intractable pain in pediatric patients with spinal tumors

10.22541/au.161646246.61643461/v1 ◽

2021 ◽

Author(s):

Leandro Cardarelli Leite ◽

Shahrad Rassekh ◽

Robert D'Ortenzio ◽

Manraj Heran

Keyword(s):

Palliative Treatment ◽

Wilms Tumor ◽

Malignant Tumors ◽

Pediatric Population ◽

Treatment Options ◽

Growth Potential ◽

Spinal Tumors ◽

High Morbidity ◽

Intractable Pain

Background: Primary and secondary malignant tumors of the spine are relatively uncommon in the pediatric population but are associated with high morbidity and significantly decreased quality of life due to pain. Local management of these tumors is often challenging due to the importance of maintaining vertebral mechanical integrity as well as the spinal growth potential. Typically, surgery and/or radiation therapy have been used in the primary management of these tumors. However, treatment options become more limited when there is relapse or refractory disease, with re-resection or additional radiotherapy often not being viable therapies. The purpose of this study was to assess the feasibility of percutaneous vertebroplasty as a palliative treatment for intractable pain secondary to malignant tumors affecting the spine. Procedure: A retrospective review of all cases of vertebroplasty performed at a single institution between 2003 and 2020. Results: A total of 11 vertebral levels were treated in 3 children with relapsed cancers (two with alveolar rhabdomyosarcoma, and one with Wilms tumor). All three had clinical benefit with sustained significant improvement in their pain. Conclusions: Vertebroplasty is a currently underutilized modality that might provide excellent pain palliation in cases of relapsed cancer in the spine. Future prospective studies of its use in pediatric oncology are needed.

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Duodenal Duplication Cysts in Children: Clinical Features and Current Treatment Choices

Biomedicine Hub ◽

10.1159/000508489 ◽

2020 ◽

Vol 5 (2) ◽

pp. 1-13 ◽

Cited By ~ 1

Author(s):

Valeria Dipasquale ◽

Paolo Barraco ◽

Simona Faraci ◽

Valerio Balassone ◽

Paola De Angelis ◽

...

Keyword(s):

Clinical Symptoms ◽

Early Recognition ◽

Treatment Options ◽

Management Strategies ◽

Delayed Diagnosis ◽

Signs And Symptoms ◽

Current Treatment ◽

Duplication Cyst ◽

Duodenal Duplication ◽

Pubmed Search

Background: Duodenal duplication cysts are rare gastrointestinal tract malformations. Most patients experience symptom onset in the first decade of life. This review aims to examine clinical presentation, management strategies and outcomes of duodenal duplication cysts in childhood. Methods: A Pubmed/Medline (http://www.ncbi.nlm.nih.gov/pubmed/) search in October 2019 for articles published since 1999 using the keywords “duodenal duplication cyst,” “child” and “newborn” was carried out. Clinical symptoms, complications, diagnostic examinations, treatment options and outcomes were analyzed and tabulated. Results: There were 41 citations in the literature providing adequate descriptions of 45 cases of duodenal duplication cysts. The age of presentation ranged from newborn to 18 years. The median interval between initial presentation and definitive diagnosis and treatment was 17 months (range: 2 months to 12 years). Overall, 67% of cases presented with abdominal pain, and 43% were complicated with pancreatitis. Different surgical and endoscopic therapeutic strategies were reported. Conclusions: Duodenal duplication cysts may be associated with life-threatening complications and/or recurrent symptoms, impairing quality of life. Early recognition of patients who demonstrate suggestive signs and symptoms is important to ensure success of treatment. This review may be useful to highlight the main diagnostic aspects and limit the risk of a delayed diagnosis.

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Overview of Treatment Options for Critical Limb Ischaemia Patients

European Cardiology Review ◽

10.15420/ecr.2011.7.1.51 ◽

2011 ◽

Vol 7 (1) ◽

pp. 51 ◽

Cited By ~ 1

Author(s):

Frederic Baumann ◽

Nicolas Diehm ◽

◽

Keyword(s):

Treatment Options ◽

Critical Limb Ischaemia ◽

Treatment Modalities ◽

High Morbidity ◽

Limb Ischaemia ◽

Arterial Revascularisation ◽

Planning Treatment ◽

Treatment Concepts ◽

Peripheral Arterial ◽

Renal Origin

Patients with critical limb ischaemia (CLI) constitute a subgroup of patients with particularly severe peripheral arterial occlusive disease (PAD). Treatment modalities for these patients that often exhibit multilevel lesions and severe vascular calcifications are complicated due to multiple comorbidities, i.e. of cardiac and vascular but also of renal origin. These need to be taken into consideration while planning treatment options. Although CLI is associated with considerably high morbidity and mortality rates, the clinical outcome of patients being subjected to revascularisation has improved substantially in recent years. This is mainly due to improved secondary prevention strategies as well as dedicated endovascular innovations for this most challenging patient cohort. The aim of this article is to provide a discussion of the contemporary treatment concepts for CLI patients with a focus on arterial revascularisation.

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Ultrasonic differential diagnostics of cyst and cystic tumors of the spleen

Medical Visualization ◽

10.24835/1607-0763-2020-3-63-75 ◽

2020 ◽

Vol 24 (3) ◽

pp. 63-75

Author(s):

Yu. A. Stepanova ◽

M. Z. Alimurzaeva ◽

D. A. Ionkin

Keyword(s):

Differential Diagnosis ◽

Cancer Metastasis ◽

Malignant Tumors ◽

Dynamic Control ◽

Differential Diagnostics ◽

Epithelial Lining ◽

Focal Lesions ◽

Morphological Form ◽

Cystic Tumors ◽

Number Of Patients

The incidence of focal lesions in the spleen is 3.2–4.2% per 100,000 population. Spleen cysts are rare (incidence 0.75 per 100,000). These are single or multiple, thin- and smooth-walled cavities filled with a transparent liquid. Distinguish between primary (or true) cysts, lined with epithelium, and secondary (or false), devoid of epithelial lining. Among the primary cysts, there are congenital cysts formed in the embryonic period due to the migration of peritoneal cells into the spleen tissue, dermoid and epidermoid cysts. A special group of primary cysts are parasitic cysts. Cystic tumors of the spleen include lymphangioma and lymphoma.The main difficulties in the diagnosis and differential diagnosis of cysts and cystic tumors of the spleen are associated with the rarity of this pathology and, as a consequence, a small number of works, including a significant number of the cases. However, in those works where a large number of the cases are described, most often this is one morphological form and an analysis of its various characteristics.Purpose. Based on the analysis of our own examination data of a significant number of patients with cysts and cystic tumors of the spleen, to assess the possibility of differential diagnosis of individual morphological forms according to ultrasound data.Materials and methods. 323 patients with cysts and cystic tumors of the spleen from 15 to 77 years old (men – 105 (32.5%); women – 218 (67.5%) were treated at A.V. Vishnevsky National Medical Research Center of Surgery for the period from 1980 to 2020. All patients underwent ultrasound during examination. Surgical treatment was carried out in various ways – (85.1%), when making a preoperative diagnosis of an uncomplicated spleen cyst of small size, dynamic observation was carried out (verification by puncture biopsy data).Results. Morphological verification of cysts and cystic tumors of the spleen was presented as follows (taking into account possible difficulties in identifying the epithelial lining): true cyst – 182 (56.4%); dermoid cyst – 3 (0.9%) (malignant – in 1 case); pseudocyst – 16 (5.0%); pancreatogenic – 34 (10.5%); echinococcus – 52 (16.1%); lymphangioma – 24 (7.4%); lymphoma – 10 (3.1%); ovarian cancer metastasis – 2 (0.6%). The article describes the ultrasound signs of the above forms of the lesions with an emphasis on the complexity of diagnosis.Conclusions. Primary and parasitic spleen cysts are well differentiated according to ultrasound; false cysts of the spleen, depending on the cause of their occurrence, can create difficulties in their identification and differentiation (they require careful dynamic control); cystic tumors of the spleen should be differentiated from malignant tumors and metastases of a cystic structure, as a result of which such vigilance should always be present when they are detected.

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Neglected femoral neck fractures in cerebral palsy: a narrative review

EFORT Open Reviews ◽

10.1302/2058-5241.5.190019 ◽

2020 ◽

Vol 5 (1) ◽

pp. 58-64

Author(s):

Giuseppe Toro ◽

Antimo Moretti ◽

Marco Paoletta ◽

Annalisa De Cicco ◽

Adriano Braile ◽

...

Keyword(s):

Cerebral Palsy ◽

Femoral Neck ◽

Motor Function ◽

Treatment Options ◽

High Morbidity ◽

Fibular Graft ◽

Motor Impairments ◽

High Prevalence ◽

Neck Fracture

Hip fractures are severe conditions with a high morbidity and mortality, especially when the diagnosis is delayed, and if formulated over 30 days after the injury, is termed a ‘neglected femoral neck fracture’ (NFNF). Cerebral palsy (CP) is probably one of the major risk factors for NFNF in Western countries, mainly because of both cognitive and motor impairments. However, considering the high prevalence of fractures in these patients, the incidence of NFNF in this population is probably underestimated, and this condition might result in persistent hip or abdominal pain. Several techniques are available for the treatment of NFNF (i.e. muscle pedicle bone graft, fixation with fibular graft, valgisation osteotomy), but most of them could affect motor function. Motor function must be preserved for as long as possible, in order to enhance the quality of life of CP patients. After discussing published NFNF cases in CP patients and available treatment options, a practical approach is proposed to facilitate the orthopaedic surgeon to both early identify and appropriately manage these challenging fractures. Cite this article: EFORT Open Rev 2020;5:58-64. DOI: 10.1302/2058-5241.5.190019

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A metabolomic endotype of bioenergetic dysfunction predicts mortality in critically ill patients with acute respiratory failure

Scientific Reports ◽

10.1038/s41598-021-89716-0 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Raymond J. Langley ◽

Marie E. Migaud ◽

Lori Flores ◽

J. Will Thompson ◽

Elizabeth A. Kean ◽

...

Keyword(s):

Respiratory Failure ◽

Acute Respiratory Failure ◽

Patient Outcomes ◽

Medical Intensive Care Unit ◽

Close Association ◽

Treatment Options ◽

Feature Model ◽

High Morbidity ◽

Medical Intensive Care ◽

Poor Outcomes

AbstractAcute respiratory failure (ARF) requiring mechanical ventilation, a complicating factor in sepsis and other disorders, is associated with high morbidity and mortality. Despite its severity and prevalence, treatment options are limited. In light of accumulating evidence that mitochondrial abnormalities are common in ARF, here we applied broad spectrum quantitative and semiquantitative metabolomic analyses of serum from ARF patients to detect bioenergetic dysfunction and determine its association with survival. Plasma samples from surviving and non-surviving patients (N = 15/group) were taken at day 1 and day 3 after admission to the medical intensive care unit and, in survivors, at hospital discharge. Significant differences between survivors and non-survivors (ANOVA, 5% FDR) include bioenergetically relevant intermediates of redox cofactors nicotinamide adenine dinucleotide (NAD) and NAD phosphate (NADP), increased acyl-carnitines, bile acids, and decreased acyl-glycerophosphocholines. Many metabolites associated with poor outcomes are substrates of NAD(P)-dependent enzymatic processes, while alterations in NAD cofactors rely on bioavailability of dietary B-vitamins thiamine, riboflavin and pyridoxine. Changes in the efficiency of the nicotinamide-derived cofactors’ biosynthetic pathways also associate with alterations in glutathione-dependent drug metabolism characterized by substantial differences observed in the acetaminophen metabolome. Based on these findings, a four-feature model developed with semi-quantitative and quantitative metabolomic results predicted patient outcomes with high accuracy (AUROC = 0.91). Collectively, this metabolomic endotype points to a close association between mitochondrial and bioenergetic dysfunction and mortality in human ARF, thus pointing to new pharmacologic targets to reduce mortality in this condition.

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Rheumatic Immune-Related Adverse Events—A Consequence of Immune Checkpoint Inhibitor Therapy

Biology ◽

10.3390/biology10060561 ◽

2021 ◽

Vol 10 (6) ◽

pp. 561

Author(s):

Anca Bobircă ◽

Florin Bobircă ◽

Ioan Ancuta ◽

Alesandra Florescu ◽

Vlad Pădureanu ◽

...

Keyword(s):

Immune System ◽

Adverse Events ◽

Immune Checkpoint ◽

Multidisciplinary Approach ◽

Malignant Tumors ◽

Checkpoint Inhibitors ◽

Treatment Options ◽

Cancer Cell Growth ◽

Inhibitory Mechanisms ◽

Checkpoint Inhibitor Therapy

The advent of immunotherapy has changed the management and therapeutic methods for a variety of malignant tumors in the last decade. Unlike traditional cytotoxic chemotherapy, which works by interfering with cancer cell growth via various pathways and stages of the cell cycle, cancer immunotherapy uses the immune system to reduce malignant cells’ ability to escape the immune system and combat cell proliferation. The widespread use of immune checkpoint inhibitors (ICIs) over the past 10 years has presented valuable information on the profiles of toxic adverse effects. The attenuation of T-lymphocyte inhibitory mechanisms by ICIs results in immune system hyperactivation, which, as expected, is associated with various adverse events defined by inflammation. These adverse events, known as immune-related adverse events (ir-AEs), may affect any type of tissue throughout the human body, which includes the digestive tract, endocrine glands, liver and skin, with reports of cardiovascular, pulmonary and rheumatic ir-AEs as well. The adverse events that arise from ICI therapy are both novel and unique compared to those of the conventional treatment options. Thus, they require a multidisciplinary approach and continuous updates on the diagnostic approach and management.

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