Blunt Traumatic Transection of the Duodenal Bulb Reconstructed with Gastroduodenostomy Using an Automatic Anastomotic Device in a Child

The patient was a 66-year-old woman who had undergone laparoscopic cholecystectomy (Lap-C) secondary to chronic cholecystitis status post endoscopic choledocholithotomy 13 months previously. During surgery, Hem-o-Lok clips were used to control the cystic duct and the cystic artery. Due to the presence of extensive adhesions of the cystic duct and surrounding tissue, the surgeons had difficulty in debriding the area. Thirteen months after Lap-C, the patient underwent a screening esophagogastroduodenoscopy (EGD), which demonstrated clip appearance at the inferior wall of the first part of the duodenum. In the EGD, duodenal erosions and edema were observed around the clip. We appreciated that endoscopic clip removal would be difficult because of the presence of severe adhesions and inflammation of the duodenal bulb. On clinical examination of the patient, no major abnormalities or physical findings were noted. Therefore, we decided not to attempt to remove the clip. The patient was treated with an oral proton pump inhibitor to prevent extensive duodenal mucosal injury. Two months later, we repeated the EGD, which revealed that the clip was no longer present, and the duodenum was covered with normal mucosa surrounding the scar. Abbreviations: EGD: esophagogastroduodenoscopy; Lap-C: laparoscopic cholecystectomy; PPI: proton pump inhibitor.

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Observational study on Barium Meal X-Ray in clinically diagnosed cases of Parinama Shoola

Journal of Ayurveda and Integrated Medical Sciences (JAIMS) ◽

10.21760/jaims.v1i2.3659 ◽

2016 ◽

Vol 1 (2) ◽

Author(s):

Dr. Mahamad Yunus ◽

KM Shailaja Singh ◽

Suvarna Bhagavat ◽

Arun Kumar Singh ◽

Manish Kumar

Keyword(s):

Medical Science ◽

Duodenal Bulb ◽

Barium Meal ◽

Vital Role ◽

Question Mark ◽

X Ray ◽

System Disease ◽

Mucosal Erosion ◽

Meal Time ◽

The Mind

Parinama Shoola is a disease of Annavaha Srotas (GIT) characterized by pain during digestion of food which tormates the process after every meal time and source of constant discomfort. It is a Pitta Pradhana Tridoshaja Vyadhi. Based on subjective features most of the Ayurvedic scholars considered as peptic ulcer, one of the most common digestive system disease rise due to the faulty diet and habits. Hence in the field of gastroenterology diagnosis and management of shoola plays a vital role. The present era is an era of new inventions and the modern medical science has stuck the mind of all by its day to day developments. It is true that modern medical science has grown up considerably; still it has to face a big question mark in so far as some miserable problems are concerned. The problem selected for this work is one among them. Considering the solemnity and incidence of the disease, the present study was aimed to observe barium meal X-ray findings in clinically diagnosed cases of Parinama Shoola to evaluate objective features for Parinama Shoola. It was observed that among 60 patients of Parinama Shoola, 30% were having deformed duodenal bulb, in 25% duodenal cap is deformed with mucosal erosion and 13.3% had duodenal ulcer found with ulcer crater in upper GI barium meal X-ray.

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A case of gastric and duodenal mucosa-associated lymphoid tissue lymphoma with multiple gastric cancers: a case report

Surgical Case Reports ◽

10.1186/s40792-020-01081-8 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Takashi Yokoyama ◽

Tetsuya Tanaka ◽

Suzuka Harada ◽

Takeshi Ueda ◽

Goki Ejiri ◽

...

Keyword(s):

Gastric Cancer ◽

Malt Lymphoma ◽

Lymphoid Tissue ◽

Regional Lymph Node ◽

Duodenal Bulb ◽

Duodenal Mucosa ◽

Upper Endoscopy ◽

Gastric Cancers ◽

Regional Lymph Node Dissection ◽

H Pylori

Abstract Background Gastric mucosa-associated lymphoid tissue (MALT) lymphoma is often caused by Helicobacter pylori and has a good prognosis. Rarely, patients with MALT lymphoma may have gastric cancer and have a poor prognosis. Case presentation We herein report a case in which surgical treatment was achieved for a 72-year-old male patient with gastric and duodenal MALT lymphoma coexisting multiple gastric cancers. He underwent upper endoscopy for epigastric discomfort, which revealed mucosal erosion on the posterior wall of the middle body of the stomach, an elevated lesion on the duodenal bulb, and a raised tumor on the antrum of the stomach. He was diagnosed with gastric and duodenal MALT lymphoma with early gastric cancer. One month after H. pylori eradication, a second upper endoscopy revealed no improvement in the gastric or duodenal mucosa, and areas of strong redness with a shallow recess just below the cardia of the stomach. As a result, a diagnosis of gastric and duodenal MALT lymphoma with two gastric cancers was made. Total gastrectomy with proximal duodenum resection using intraoperative upper endoscopy and regional lymph node dissection was performed. Pathologically, gastric and duodenal MALT lymphoma and three gastric cancers were detected. Since one of them was an advanced cancer, he started taking S-1 after his general condition improved. Conclusion For early detection of gastric and duodenal MALT lymphoma or gastric cancer, appropriate upper endoscopy and a biopsy are important. It is necessary to select a suitable treatment, such as H. pylori eradication, endoscopic treatment, surgery, chemotherapy, and irradiation, according to the disease state.

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Underwater endoscopic mucosal resection for en bloc resection of a neuroendocrine tumor in the duodenal bulb

Endoscopy ◽

10.1055/a-1512-8954 ◽

2021 ◽

Author(s):

Hugo Uchima ◽

Alberto Diez-Caballero ◽

Jaume Capdevila ◽

Mercé Rosinach ◽

Alfredo Mata ◽

...

Keyword(s):

Neuroendocrine Tumor ◽

Endoscopic Mucosal Resection ◽

Duodenal Bulb ◽

En Bloc Resection ◽

Bloc Resection ◽

En Bloc ◽

Mucosal Resection

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Confocal laser endomicroscopy reveals alterations in duodenal permeability in patients with acute pancreatitis

Journal of International Medical Research ◽

10.1177/0300060518820430 ◽

2019 ◽

Vol 47 (3) ◽

pp. 1279-1287

Author(s):

Lingjia Sun ◽

Min Yue ◽

Yining Dai ◽

Chaohui Yu ◽

Chunxiao Chen

Keyword(s):

Acute Pancreatitis ◽

Large Scale ◽

Duodenal Bulb ◽

Severity Index ◽

Duodenal Mucosa ◽

Confocal Laser Endomicroscopy ◽

Confocal Laser ◽

Mucosal Permeability ◽

Reactive Protein ◽

Severity Index Score

Objective Intestinal permeability increases during the course of acute pancreatitis (AP). We assessed duodenal permeability alterations in patients with AP by confocal laser endomicroscopy (CLE). Methods Thirty patients with AP underwent CLE evaluation of the antral and duodenal mucosa. Images were graded based on the appearance of capillaries and the degree of fluorescein leakage. Results Patients with AP had increased duodenal mucosal permeability that could be detected by CLE. The mucosal permeability progressively increased in the gastric antrum, duodenal bulb, and descending duodenum. The CLE parameters in the antrum and duodenal bulb were not significantly different between patients with mild and severe AP. The CLE grades in the descending duodenum were higher in patients with severe than mild AP. The C-reactive protein level in AP was positively correlated with the permeability in the duodenal bulb and descending duodenum, while the computed tomography severity index score was positively correlated with the mucosal permeability in the duodenal bulb and descending duodenum. Conclusion CLE revealed increased duodenal permeability in patients with AP. Higher permeability in the descending duodenum was observed in severe than mild AP. Further large-scale studies are needed to confirm the relationship between altered duodenal permeability and the severity of AP.

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Endoscopic Diagnosis of Bouveret Syndrome

Case Reports in Gastroenterology ◽

10.1159/000510162 ◽

2020 ◽

Vol 14 (3) ◽

pp. 683-686

Author(s):

Felix Hesse ◽

Mohamed Abdelhafez ◽

Christoph Schlag ◽

Roland M. Schmid ◽

Tobias Lahmer

Keyword(s):

Computed Tomography ◽

Female Patient ◽

Gastric Outlet Obstruction ◽

Rare Complication ◽

Gallstone Ileus ◽

Duodenal Bulb ◽

Outlet Obstruction ◽

Endoscopic Diagnosis ◽

Endoscopic Imaging ◽

Bouveret Syndrome

Bouveret syndrome is a form of gallstone ileus and a rare complication of chole(cysto)lithiasis. It describes gastric outlet obstruction secondary to an impacted gallstone. Here, we report a case of an 82-year-old female patient with gastric outlet obstruction and penetration of gallstones into the duodenal bulb on endoscopic imaging. Based on these findings Bouveret syndrome was diagnosed and confirmed by computed tomography.

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Double Pylorus in Upper Gastrointestinal Bleeding

Case Reports in Gastroenterology ◽

10.1159/000513804 ◽

2021 ◽

pp. 332-337

Author(s):

Heasty Oktaricha ◽

Muhammad Miftahussurur

Keyword(s):

Duodenal Bulb ◽

Rare Condition ◽

High Dose ◽

Protective Agent ◽

Gastrointestinal Fistula ◽

Double Pylorus ◽

History Of ◽

Inflammatory Drugs ◽

H Pylori ◽

Upper Gastrointestinal

Double pylorus, also known as acquired double pylorus, is a rare condition defined as a gastrointestinal fistula connecting stomach antrum and duodenal bulb. The prevalence of double pylorus ranges from 0.001 to 0.4% by esophagogastroduodenoscopy (EGD). Although the etiology is unknown, the formation of double pylorus is related to Helicobacter pylori infection and the use of non-steroidal anti-inflammatory drugs (NSAID). The development of the occurrence of double pylorus is still unknown, but many systemic diseases play a role. We present the case of a 59-year-old man who was admitted to Dr. Soetomo General Hospital with hematemesis and melena. The patient had a history of diabetes mellitus since 3 years and consumption of medicinal herbs for myalgia, which was suspected of NSAIDs for the past 5 months. The patient had anemia with hemoglobin at 8.3 g/dL, enterogenous azotemia with blood urea nitrogen 28 mg/dL and serum creatinine 1.14 mg/dL. At EGD, double pylorus was found and accompanied by gastric ulcer, a giant white base ulcer, part of it covered by clotting without any sign of active bleeding. Biopsy revealed chronic inactive gastritis, and no H. pylori was found. Treatment mainly depends on gastrointestinal acid suppression through a proton pump inhibitor (PPI). The patient was given a high-dose PPI and a mucosal protective agent. He was treated for 1 week and had improved complaints.

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Duodenal Bulb Adenocarcinoma Benefitted from Neoadjuvant Chemotherapy: A Case Report

Chemotherapy ◽

10.1159/000469700 ◽

2017 ◽

Vol 62 (5) ◽

pp. 290-294 ◽

Cited By ~ 1

Author(s):

Geng-Yuan Zhang ◽

Jie Mao ◽

Bin Zhao ◽

Bo Long ◽

Hao Zhan ◽

...

Keyword(s):

Neoadjuvant Chemotherapy ◽

Comprehensive Evaluation ◽

Duodenal Bulb ◽

Treatment Modalities ◽

Pathological Examination ◽

Upper Gastrointestinal Endoscopy ◽

Tumor Type ◽

Low Incidence ◽

Rare Malignancy ◽

Upper Gastrointestinal

Duodenal bulb adenocarcinoma is an extremely rare malignancy in the alimentary tract which has a low incidence rate and nonspecific symptoms. It is difficult to diagnose early, and the misdiagnosis rate is high. CT, MRI, upper gastrointestinal endoscopy, and other advanced imaging modalities should be combined to make a comprehensive evaluation. The diagnostic confirmation of this tumor type mainly depends on the pathological examination. The combination of surgery with other treatment modalities is effective. A review of reports on duodenal bulb adenocarcinoma with chemotherapy revealed 6 cases since 1990. However, there are few reports on neoadjuvant chemotherapy for the disease. In this report, preoperative S-1 in combination with oxaliplatin neoadjuvant chemotherapy achieved a complete pathological response in the treatment of duodenal bulb adenocarcinoma. Neoadjuvant chemotherapy shows a better clinical efficacy in the treatment of duodenal bulb adenocarcinoma, but its value needs to be further verified.

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An Incomplete Congenital Septum of the Duodenal Bulb

Digestive Surgery ◽

10.1159/000094175 ◽

2006 ◽

Vol 23 (3) ◽

pp. 154-154

Author(s):

Mehmet İbiş ◽

Engin Uçar ◽

Bülent Ödemiş ◽

Erkan Parlak

Keyword(s):

Duodenal Bulb

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