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Duodenal Stenosis

Duodenum Steis


Presentation

  • The case of a 66-year-old female patient is presented. The patient was admitted to hospital presenting anorexia, repeated alimentary vomiting, epigastric pain, and weight loss.[ncbi.nlm.nih.gov]
  • We present a case of incomplete duodenal obstruction having a delayed presentation, making diagnosis and early intervention more challenging.[ncbi.nlm.nih.gov]
  • Diagnostic methods, endoscopic procedures and long-term outcomes of the endoscopic treatment were presented.[ncbi.nlm.nih.gov]
  • Our patient presented at the age of 5 months, outside of the immediate neonatal period, and with the atypical presenting sign of hematemesis.[ncbi.nlm.nih.gov]
  • The presenting symptom leading to diagnosis was, in all but one case, non-bile-stained vomiting. Associated malformations were found in all but four patients, mostly morbus Down.[ncbi.nlm.nih.gov]
Short Stature
  • It is primarily a clinical diagnosis with manifestations that include poikiloderma, short stature, sparse hair, juvenile cataracts, small hands and feet, bone defects, photosensitivity, hypogonadism, defective dentition, onychodystrophy, and hyperkeratosis[ncbi.nlm.nih.gov]
Soft Tissue Mass
  • Abdominal CT scan revealed the periaortic soft tissue mass encircling grafted aorta and stenosis of duodenal third portion. Retroperitoneal fibrosis with duodenal stenosis was diagnosed and prednisolone therapy was initiated.[ncbi.nlm.nih.gov]
Juvenile Cataract
  • It is primarily a clinical diagnosis with manifestations that include poikiloderma, short stature, sparse hair, juvenile cataracts, small hands and feet, bone defects, photosensitivity, hypogonadism, defective dentition, onychodystrophy, and hyperkeratosis[ncbi.nlm.nih.gov]
Vomiting
  • He was initially treated for acute gastroenteritis, but vomiting resumed after starting oral ingestion.[ncbi.nlm.nih.gov]
  • A 10-month-old child affected by CRS with congenital hearth disease, perceptive deafness and microcephaly, was admitted because of vomiting and failure to thrive.[ncbi.nlm.nih.gov]
  • DISCUSSION Duodenal stenosis frequently presents with recurrent vomiting and failure to thrive. Owing to its chronic and variable presentation, the diagnosis is often delayed.[ncbi.nlm.nih.gov]
  • A 17-year-old boy who developed a symptomatic duodenal ulcer at 10 years of age with melena, and was then treated continuously for 6 years with ranitidine therapy that only partially controlled symptoms and peptic lesions, came to us with vomiting due[ncbi.nlm.nih.gov]
  • The presenting symptom leading to diagnosis was, in all but one case, non-bile-stained vomiting. Associated malformations were found in all but four patients, mostly morbus Down.[ncbi.nlm.nih.gov]
Bilious Vomiting
  • If the defect is located proximal to the major duodenal papilla, nonbilious vomiting occurs, whereas a defect occurring distal to the papilla causes bilious vomiting.[amboss.com]
  • Preampullary lesions with non-bilious vomiting simulating gastric outlet obstruction has been reported recently [1].[jpss.eu]
  • Case report – The patient is 2 year old aged girl with persistent non-bilious vomiting. She was vomiting several times a week, and over the ten days prior to presentation as many as several times a day.[cejpaediatrics.com]
  • CASE REPORT A full-term male newborn infant was admitted on the 2nd day of life to the neonatal intensive care unit with intermittent bilious vomiting, abnormal weight loss, and upper abdominal distension.[journals.lww.com]
  • […] bowel distal to the obstruction No oral or rectal contrast is usually needed to diagnose duodenal atresia Double bubble may also be seen on prenatal ultrasounds Differential Diagnosis Malrotation with Ladd’s bands Bilious vomiting within 24 hours of[learningradiology.com]
Nausea
  • A 61-year-old woman was admitted to our hospital complaining of abdominal fullness, epigastralgia, nausea, and vomiting.[ncbi.nlm.nih.gov]
  • Although clinical presentations should vary among causes, symptoms of duodenal stenosis due to periduodenal hematoma commonly include abdominal pain, nausea, or vomiting.[ncbi.nlm.nih.gov]
  • A 63-year-old man was admitted to the hospital presenting with nausea and vomiting of 2 days' duration. Laboratory examinations showed an elevation in both the serum amylase level (275 IU/l) and white blood cell count (13 600/microl).[ncbi.nlm.nih.gov]
  • Nausea and Vomiting Obstruction of the duodenum can also cause patients to become nauseated and vomit.[livestrong.com]
  • Vomiting with intense nausea and dull stomach pain is more likely with gastroenteritis.[telefot.eu]
Recurrent Vomiting
  • Most patients are diagnosed during the neonatal period based on recurrent vomiting, but some cases develop symptoms at an older age.[ncbi.nlm.nih.gov]
  • DISCUSSION Duodenal stenosis frequently presents with recurrent vomiting and failure to thrive. Owing to its chronic and variable presentation, the diagnosis is often delayed.[ncbi.nlm.nih.gov]
Dyspepsia
  • […] colon or intestine Torsion of colon or intestine Twist of colon or intestine Type 2 Excludes volvulus of duodenum ( K31.5 ) duodenum K31.5 ICD-10-CM Codes Adjacent To K31.5 K29.9 Gastroduodenitis, unspecified K29.90 …… without bleeding K30 Functional dyspepsia[icd10data.com]
Low Set Ears
  • Clinical examination revealed microcephaly, hypotelorism, microphthalmia, a flat rudimentary nose with a single nasal cavity, high palate, thick dysplastic low-set ears, a short neck, postaxial polydactyly of the upper limbs, and single palmar creases[ncbi.nlm.nih.gov]
Small Hand
  • It is primarily a clinical diagnosis with manifestations that include poikiloderma, short stature, sparse hair, juvenile cataracts, small hands and feet, bone defects, photosensitivity, hypogonadism, defective dentition, onychodystrophy, and hyperkeratosis[ncbi.nlm.nih.gov]
Sparse Hair
  • It is primarily a clinical diagnosis with manifestations that include poikiloderma, short stature, sparse hair, juvenile cataracts, small hands and feet, bone defects, photosensitivity, hypogonadism, defective dentition, onychodystrophy, and hyperkeratosis[ncbi.nlm.nih.gov]
Hyperkeratosis
  • It is primarily a clinical diagnosis with manifestations that include poikiloderma, short stature, sparse hair, juvenile cataracts, small hands and feet, bone defects, photosensitivity, hypogonadism, defective dentition, onychodystrophy, and hyperkeratosis[ncbi.nlm.nih.gov]
Photosensitivity
  • It is primarily a clinical diagnosis with manifestations that include poikiloderma, short stature, sparse hair, juvenile cataracts, small hands and feet, bone defects, photosensitivity, hypogonadism, defective dentition, onychodystrophy, and hyperkeratosis[ncbi.nlm.nih.gov]
Spastic Quadriplegia
  • Our results suggest that congenital duodenal stenosis/atresia is a potential risk factor for spastic quadriplegia in patients with Down syndrome.[ncbi.nlm.nih.gov]
Ataxia
  • It is characterized by acute or subacute ataxia, altered consciousness, and ophthalmoparesis. Gastroenterological surgery, total parenteral nutrition for short bowel syndrome, and alcoholism are common risk factors for Wernicke encephalopathy.[ncbi.nlm.nih.gov]

Workup

  • The diagnostic preoperative workup should include a plain abdominal radiograph, upper and/or lower gastrointestinal contrast studies, and ultrasonography (1).[journals.lww.com]
Multilocular Cyst
  • It appeared as an irregularly shaped, multilocular cyst with no contrast effect. Abdominal magnetic resonance imaging (MRI) showed low mass intensity on T1-weighted images and high intensity on T2-weighted images ( Fig. 2 A and B).[ncbi.nlm.nih.gov]
Foam Cell
  • cells are present containing lipoid material in varying amounts. 5 Such masses are also called hamartomas. 1,7 Our patient's tumor was classified as a cystic lymphangioma.[ncbi.nlm.nih.gov]

Treatment

  • Endoscopic treatment is feasible in these patients. The long-term outcomes of endoscopic therapy need to be compared with surgical treatment.[ncbi.nlm.nih.gov]
  • To investigate the efficacy of gastroscopic treatment in the treatment of membranous duodenal stenosis.[ncbi.nlm.nih.gov]
  • PURPOSE: To evaluate the clinical effectiveness of a newly designed stent for the treatment of malignant distal duodenal stenosis.[ncbi.nlm.nih.gov]
  • BACKGROUND: Image-guided balloon dilatation has been used in adults as an alternative to standard surgical treatment of intestinal stricture. The experience in children is limited.[ncbi.nlm.nih.gov]
  • At that time it was Germany's first medical institution specializing in the treatment of diabetes.[bookinghealth.com]

Prognosis

  • This classification generally guides prognosis and therapy (see the image below). Classification of jejunoileal atresias.[emedicine.medscape.com]
  • , Prevention, and Complications Prognosis full recovery is expected after surgical correction Prevention no preventive measures are available at this time Complications without treatment, condition is lethal Please rate topic.[medbullets.com]
  • If left untreated, it is fatal Prognosis will depend on the presence of associated cardiac, tracheo-esophageal, anal, renal, or skeletal abnormalities (VATER) Double Bubble Sign.[learningradiology.com]
  • With surgical correction, prognosis is excellent (especially with isolated cases), and the outlook is therefore largely determined by other associated abnormalities.[radiopaedia.org]

Etiology

  • Necrotizing enterocolitis was the most common (6/9) etiology of stricture. Ten of 11 patients did not require subsequent operative management although 3 children required further dilatations.[ncbi.nlm.nih.gov]
  • Etiology Multiple theories regarding the etiology of jejunoileal atresia have been studied in many animal models (eg, puppies, ewes, rabbits, and chick embryos). [22, 23, 24, 25, 26] Murine studies suggest that some forms of atresia may be hereditary[emedicine.medscape.com]
  • […] called also Brunner's glands. duodenal reflux retrograde movement of duodenal contents, either into the stomach where it has been incriminated as a cause of vomiting and gastric hyposecretion, or into the pancreatic duct and parenchyma as a factor in the etiology[medical-dictionary.thefreedictionary.com]
  • Early postoperative survival rates of greater than 90% should be expected. 7 – 11 Etiology Congenital duodenal obstruction can occur due to an intrinsic or extrinsic lesion. 12 The most common cause of duodenal obstruction is atresia. 7 This intrinsic[clinicalgate.com]
  • To date, none of the theories proposed offers a definitive answer to the question of the etiology of HPS.[basicmedicalkey.com]

Epidemiology

  • References: [1] [2] Epidemiological data refers to the US, unless otherwise specified.[amboss.com]
  • After an overview of pathogenesis, classification, and epidemiology of AIDS, chapters cover early cutaneous signs and symptoms, superficial and disseminated fungal and protozoal infections, bacterial and complex infections, venereal disease, cutaneous[books.google.es]
  • […] during weeks 8-10 of development Results in stenosis of the duodenal passageway between the stomach and intestinal tract leads to gastric outlet syndrome Associated with Down syndrome (20-30% of DS cases) and other birth defects as with biliary atresia Epidemiology[medbullets.com]
  • […] intravenously. [1] The definitive treatment for duodenal atresia is surgery (duodenoduodenostomy), which may be performed openly or laparoscopically. [6] The surgery is not urgent. [1] The initial repair has a 5 percent morbidity and mortality rate. [2] Epidemiology[en.wikipedia.org]
  • Further, a prospective study of 1146 older candidates (mean age, 77 5 years: 70% female) participating in the Established Populations for Epidemiologic Study of the Elderly (EPESE) reported that older men and women with anemia experienced clinically significant[benthamopen.com]
Sex distribution
Age distribution

Pathophysiology

  • Pathophysiology Duodenal atresia occurs when recanalization of the closed duodenum fails to occur or occurs only partially during the embryonic period (usually between the 8 th –10 th week of gestation).[amboss.com]
  • Likewise, our understanding of the etiology and pathophysiology of duodenal obstruction and malrotation has been largely stagnant.[basicmedicalkey.com]
  • Etiology/Pathophysiology: The ratio of duodenal atresia to duodenal stenosis is 4:1. The point of atresia is distal to the ampulla of Vater in 75-80% of patients.[virtualpediatrichospital.org]

Prevention

  • A loose overbridging duodenoduodenostomy was performed to prevent compression of the vessel. The cardiac anomalies were corrected, and he could eat unrestricted diets.[ncbi.nlm.nih.gov]
  • , and Complications Prognosis full recovery is expected after surgical correction Prevention no preventive measures are available at this time Complications without treatment, condition is lethal Please rate topic.[medbullets.com]
  • […] life-threatening complications such as secondary infection, rupture with hemorrhage, and volvulus or intestinal obstruction. 8,13,14 Few methods are available for the treatment of mesenteric lymphangioma, surgical management being the most effective to prevent[ncbi.nlm.nih.gov]
  • Food is blocked from passing through the intestine, which prevents normal feeding and intestinal function. Intestinal atresia and stenosis usually involve the small intestine, but can affect any part of the gastrointestinal tract.[chp.edu]
  • Duodenal obstruction prevents the stomach from passing foodstuffs into the duodenum, disrupting the digestive process and blocking the gall bladder and pancreas from adding their digestive secretions.[wisegeek.com]

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