Duodenal Malignancies

2018 ◽  
Author(s):  
Emily R Newton ◽  
Benjamin H Schmidt ◽  
Michael O Meyers
Keyword(s):  
Small Bowel ◽  
Primary Treatment ◽  
Carcinoid Tumors ◽  
Adjunctive Treatment ◽  
Small Bowel Tumors ◽  
Cross Sectional ◽  
Carcinoid Crisis ◽  
Cross Sectional Imaging ◽  
Duodenal Carcinoma ◽  
Duodenal Resection

Although malignancies involving the small bowel are rare, one-third of these are located in the duodenum. The majority of duodenal tumors are adenocarcinoma but also may include gastrointestinal stromal tumors (GIST), carcinoid or neuroendocrine tumors, sarcomas, and lymphoma. These commonly present with nonspecific symptoms, but obstructive patterns predominate when symptoms are present. Preoperative diagnosis is made via endoscopy and/or cross-sectional imaging. This section focuses on treatment and surgical management for adenocarcinoma, carcinoid tumors, and GISTs of the duodenum. Surgical resection is the primary treatment of for all three of these, but all have significant nuances in surgical planning and decision-making as well as variability in the role of adjunctive treatment in their management. Functional carcinoid tumors can have hormone-driven symptoms and are associated with an increase in risk of carcinoid crisis, which may be prophylactically treated with intravenous octreotide. Resection of these tumors relies heavily on tumor relationship to the ampulla. Key anatomic distinctions and clinical tips to identify the ampulla to ensure an appropriate duodenal resection are discussed in this review. This review contains 12 figures, 5 tables, and 54 references. Key Words: carcinoid, duodenal carcinoma, duodenal adenocarcinoma, duodenal resection, duodenal tumors, neuroendocrine tumor, gastrointestinal stromal tumor, small bowel tumors

Duodenal Malignancies

2018 ◽  
Author(s):  
Emily R Newton ◽  
Benjamin H Schmidt ◽  
Michael O Meyers
Keyword(s):  
Small Bowel ◽  
Primary Treatment ◽  
Carcinoid Tumors ◽  
Adjunctive Treatment ◽  
Small Bowel Tumors ◽  
Cross Sectional ◽  
Carcinoid Crisis ◽  
Cross Sectional Imaging ◽  
Duodenal Carcinoma ◽  
Duodenal Resection

Although malignancies involving the small bowel are rare, one-third of these are located in the duodenum. The majority of duodenal tumors are adenocarcinoma but also may include gastrointestinal stromal tumors (GIST), carcinoid or neuroendocrine tumors, sarcomas, and lymphoma. These commonly present with nonspecific symptoms, but obstructive patterns predominate when symptoms are present. Preoperative diagnosis is made via endoscopy and/or cross-sectional imaging. This section focuses on treatment and surgical management for adenocarcinoma, carcinoid tumors, and GISTs of the duodenum. Surgical resection is the primary treatment of for all three of these, but all have significant nuances in surgical planning and decision-making as well as variability in the role of adjunctive treatment in their management. Functional carcinoid tumors can have hormone-driven symptoms and are associated with an increase in risk of carcinoid crisis, which may be prophylactically treated with intravenous octreotide. Resection of these tumors relies heavily on tumor relationship to the ampulla. Key anatomic distinctions and clinical tips to identify the ampulla to ensure an appropriate duodenal resection are discussed in this review. This review contains 12 figures, 5 tables, and 54 references. Key Words: carcinoid, duodenal carcinoma, duodenal adenocarcinoma, duodenal resection, duodenal tumors, neuroendocrine tumor, gastrointestinal stromal tumor, small bowel tumors

Cross-Sectional Imaging of Small Bowel Malignancies

2012 ◽  
Vol 63 (3) ◽  
pp. 215-221 ◽  
Author(s):  
Dellano D. Fernandes ◽  
Ram Prakash Galwa ◽  
Najla Fasih ◽  
Margaret Fraser-Hill
Keyword(s):  
Small Bowel ◽  
Accurate Diagnosis ◽  
Imaging Features ◽  
Cross Sectional ◽  
Conventional Endoscopy ◽  
Cross Sectional Imaging ◽  
Pretreatment Staging ◽  
Sectional Imaging ◽  
Histologic Subtypes

Small bowel malignancies are rare neoplasms, usually inaccessible to conventional endoscopy but detectable in many cases by cross-sectional imaging. Modern multidetector computed tomographies permit accurate diagnosis, complete pretreatment staging, and follow-up of these lesions. In this review, we describe the cross-sectional imaging features of the most frequent histologic subtypes of the small bowel malignancies.

Case 9.28

2014 ◽  
pp. 476-477
Author(s):  
Christine U. Lee ◽  
James F. Glockner
Keyword(s):  
Small Bowel ◽  
Cross Sectional ◽  
New Era ◽  
True Incidence ◽  
Live Births ◽  
Cross Sectional Imaging ◽  
Sectional Imaging ◽  
The Right ◽  
Left Abdomen

11-year-old boy with suspected IBD Coronal SSFSE images (Figure 9.28.1) demonstrate abnormal orientation of large and small bowel, with small bowel in the right abdomen and colon in the left abdomen. Malrotation Classic thinking regarding malrotation holds that most cases are detected within the first few months of life. However, in the new era of cross-sectional imaging for everyone, more and more adults with asymptomatic malrotations are noted and the true incidence is not entirely certain. Estimates in the literature range from 1 in 6,000 to 1 in 200 live births. Autopsy studies suggest that some form of malrotation exists in 0.5% to 1% of the population....

Luminal narrowing alone allows an accurate diagnosis of Crohn’s disease small bowel strictures at cross-sectional imaging

2020 ◽  
Author(s):  
Daniel Stocker ◽  
Michael J King ◽  
Maria El Homsi ◽  
Guillermo Carbonell ◽  
Octavia Bane ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Small Bowel ◽  
Crohn's Disease ◽  
Diagnostic Performance ◽  
Mr Enterography ◽  
Cross Sectional ◽  
Luminal Narrowing ◽  
Cross Sectional Imaging ◽  
Sectional Imaging ◽  
Sensitivity Specificity

Abstract Background and Aims Current consensus recommendations define small bowel strictures (SBS) in Crohn’s disease (CD) on imaging as luminal narrowing with unequivocal upstream bowel dilation. The aim of this study was to 1) evaluate the performance of cross-sectional imaging for SBS diagnosis in CD using luminal narrowing with upstream SB dilation and luminal narrowing with or without upstream dilation, and 2) compare the diagnostic performance of CT and MR enterography (MRE) for SBS diagnosis. Methods One hundred and eleven CD patients (81 with pathologically confirmed SBS, 30 controls) who underwent CT and/or MRE were assessed. Two radiologists (R1, R2) blinded to pathology findings independently assessed the presence of luminal narrowing and upstream SB dilation. Statistical analysis was performed for a) luminal narrowing with or without SB upstream dilation (“possible SBS”), b) luminal narrowing with upstream SB dilation ≥3cm (“definite SBS”). Results Sensitivity for detecting SBS was significantly higher using “possible SBS” (R1, 82.1%; R2, 77.9%) compared to “definite SBS” (R1, 62.1%; R2, 65.3%; p<0.0001) with equivalent specificity (R1, 96.7%; R2, 93.3%; p>0.9). Using criterion “possible SBS”, sensitivity/specificity were equivalent between CT (R1, 87.3%/93.3%; R2, 83.6%/86.7%) and MRE (R1, 75.0%/100%; R2: 70.0%/100%). Using criterion “definite SBS”, CT showed significantly higher sensitivity (78.2%) compared to MRE (40.0%) for R1 but not R2 with similar specificities (CT, 86.7%-93.3%; MRE, 100%). Conclusion SBS can be diagnosed using luminal narrowing alone without the need for upstream dilation. CT and MRE show similar diagnostic performance for SBS diagnosis using luminal narrowing with or without upstream dilation.

scholarly journals Inflammatory bowel disease—the role of cross-sectional imaging techniques in the investigation of the small bowel

2014 ◽  
Vol 6 (1) ◽  
pp. 73-83 ◽  
Author(s):  
Athanasios Athanasakos ◽  
Argyro Mazioti ◽  
Nikolaos Economopoulos ◽  
Christina Kontopoulou ◽  
Georgios Stathis ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Small Bowel ◽  
Bowel Disease ◽  
Imaging Techniques ◽  
Cross Sectional ◽  
Cross Sectional Imaging ◽  
Inflammatory Bowel ◽  
Sectional Imaging

scholarly journals Masquerading in the midgut: a rare diagnosis in a patient with recurrent abdominal pain

2019 ◽  
Vol 11 (5) ◽  
pp. 420-422
Author(s):  
Philip J Smith ◽  
Trusha Patel ◽  
Nicholas Reading ◽  
Konstantinos Giaslakiotis ◽  
Sami Hoque
Keyword(s):  
Abdominal Pain ◽  
Small Bowel ◽  
Recurrent Abdominal Pain ◽  
Filling Defect ◽  
Watery Diarrhoea ◽  
Laboratory Findings ◽  
Cross Sectional ◽  
Microscopic Evaluation ◽  
Cross Sectional Imaging ◽  
Sectional Imaging

A 38-year-old woman who had been previously diagnosed with irritable bowel syndrome was seen in the outpatient clinic with a 2-year history of intermittent cramp-like abdominal pain which was often followed by watery diarrhoea. She had presented several times previously to the emergency department with episodes of severe pain and collapse although on arrival examination findings were mostly unremarkable other than some mild lower abdominal tenderness. On each occasion, the symptoms resolved spontaneously with conservative management. She had been extensively investigated by her general practitioner to establish the cause of her symptoms but all laboratory findings, cross-sectional imaging, ultrasound and oesophagogastroduodenoscopy to date were unremarkable. After being seen in gastroenterology outpatients’ clinic, a colonoscopy was performed and was described as being macroscopically normal but microscopic evaluation of colonic biopsies suggested a possible ‘resolving infection’. She was treated symptomatically, but within 6 months she represented to hospital with progressively worsening symptoms of severe abdominal pain, now associated with vomiting, followed by watery diarrhoea and then resolution of the symptoms. An abdominal CT scan was performed which showed a small intraluminal-filling defect in the mid-terminal ileum. A wireless capsule endoscopy was organised to further characterise the lesion although this was reported as showing no abnormality. Prior to any further outpatient investigations, she represented as an emergency to hospital in small bowel obstruction, underwent further cross-sectional imaging followed by surgical resection of the lesion. Histological characterisation revealed a small bowel inflammatory fibroid polyp.

scholarly journals The accuracy of intestinal ultrasound compared with small bowel capsule endoscopy in assessment of suspected Crohn’s disease in patients with negative ileocolonoscopy

2018 ◽  
Vol 11 ◽  
pp. 175628481876590 ◽  
Author(s):  
Dan Carter ◽  
Lior H. Katz ◽  
Eytan Bardan ◽  
Eti Salomon ◽  
Shulamit Goldstein ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Small Bowel ◽  
Capsule Endoscopy ◽  
Diagnostic Yield ◽  
Inflammatory Biomarkers ◽  
Cross Sectional ◽  
Imaging Results ◽  
Cross Sectional Imaging ◽  
Sectional Imaging

Background: Small bowel involvement in Crohn’s disease (CD) is frequently proximal to the ileocecal valve and inaccessible by conventional ileocolonoscopy (IC). Small bowel capsule endoscopy (SBCE) is among the prime modalities for assessment of small bowel disease in these patients. Intestinal ultrasound (IUS) is an accurate bedside fast and low-cost diagnostic modality utilized in CD for both diagnosis and monitoring. The aim of this study was to examine the accuracy of IUS in patients with suspected CD after a negative IC, and to evaluate the correlation of IUS with SBCE, inflammatory biomarkers and other cross-sectional imaging techniques. Methods: Prospective single center study in which patients with suspected CD underwent IUS and SBCE examinations within 3 days. IUS results were blindly compared with SBCE that served as the gold standard. A post hoc comparison was performed of IUS and SBCE results and available cross-sectional imaging results (computed tomography or magnetic resonance enterography) as well as inflammatory biomarkers if measured. The study cohort was followed for 1 year. In case of discordance between the IUS and SBCE results, the diagnosis at 1 year was reported. Results: Fifty patients were included in the study. The diagnostic yield of both IUS and SBCE for the diagnosis of small bowel CD was 38%. The IUS findings significantly correlated to small bowel inflammation detected by SBCE ( r = 0.532, p < 0.001), with fair sensitivity and specificity (72% and 84%). Cross-sectional imaging results significantly correlated to IUS as well ( r = 0.46, p = 0.018). Follow up was available in 8 of the 10 cases of discordance between IUS and SBCE. In all of these cases, diagnosis of CD was not fully established at the end of the follow up. Conclusions: The diagnostic yield of CE and IUS for detection of CD in patients with negative ileocolonoscopy was similar. IUS can be a useful diagnostic tool in suspected CD when IC is negative.

scholarly journals Performance of Capsule Endoscopy and Cross-Sectional Techniques in Detecting Small Bowel Lesions in Patients with Crohn’s Disease

2020 ◽  
Vol 2 (2) ◽  
Author(s):  
Carlo Calabrese ◽  
Margherita Diegoli ◽  
Nikolas Dussias ◽  
Marco Salice ◽  
Fernando Rizzello ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Small Bowel ◽  
Crohn's Disease ◽  
Capsule Endoscopy ◽  
Imaging Techniques ◽  
Cross Sectional ◽  
Imaging Characteristics ◽  
Cross Sectional Imaging ◽  
Sectional Imaging

Abstract Background Crohn’s disease (CD) can be classified according to endoscopic and cross-sectional imaging characteristics. Information regarding disease extent and phenotype may be provided by advanced endoscopic and imaging techniques. In this study, we compare the ability of capsule endoscopy (CE) and cross-sectional imaging techniques (CST) (MRE/Computer Tomography Enteroscopy [CTE]) in detecting small bowel (SB) lesions. Methods We retrospectively analyzed 102 patients with a diagnosis of CD who underwent both CE and CST. Only patients with at least a 12-month follow-up after CE were included. Results Sensitivity and specificity for the detection of SB lesions were, respectively, 100% and 83.3% for CE, 55.1% and 80% for CTE, and 60% and 82.3% for MRE. CE detected proximal CD lesions in 73% of patients, whereas MRE and CTE detected proximal lesions in 41% and 16% of patients, respectively (P &lt; 0.001). Positive findings on CE led to management changes in all patients, in a median follow-up period of 58.7 months. During the follow-up period, 26.5% of patients underwent surgery. Multivariate analysis revealed that moderate-to-severe disease at CE was independently correlated with surgery (P = 0.03). Conclusions CE has a superior sensitivity for detecting CD lesions in the proximal and medium SB compared with CST. In the terminal ileum, MRE and CTE displayed similar performance to CE.

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