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Velmishi V, Alushani D, Dervishi E, Heta S, Sila S, Cullufi P. Delayed Diagnosis of Congenital Duodenal Stenosis in a 16-Year-Old Girl. Case Rep Med 2024; 2024:1070253. [PMID: 38736458 PMCID: PMC11088463 DOI: 10.1155/2024/1070253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/21/2024] [Accepted: 04/22/2024] [Indexed: 05/14/2024] Open
Abstract
Background Duodenal atresia or stenosis are different degrees of the same abnormality. They usually occur at the level of the ampulla of Vater and are thought to be an embryologic defect during the development of the foregut, leading to abnormal recanalization. Complete duodenal atresia is usually symptomatic in the early neonatal period, while partial obstruction (web, stenosis) may have a late presentation and a more challenging diagnosis such as in our case. Case Presentation. The patient, a 16-year-old girl, presented with abdominal pain, recurrent vomiting, and growth failure. An upper GI study with barium showed an image compatible with gastroptosis. Further diagnostic procedures confirmed a rare finding such as congenital duodenal stenosis. She underwent surgical intervention, and the recovery period was uneventful. Conclusion Gastroptosis is not diagnostic for a particular disease. This rare radiological finding in children may obscure uncommon diagnosis, such as congenital duodenal stenosis, which can present a diagnostic challenge beyond early childhood.
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Affiliation(s)
- Virtut Velmishi
- Service of Pediatric Gastroenterology “Mother Teresa” University Hospital Center, Tirana, Albania
| | - Dritan Alushani
- Service of pediatric Surgery “Mother Teresa” University Hospital Center, Tirana, Albania
| | - Ermira Dervishi
- Service of Pediatric Gastroenterology “Mother Teresa” University Hospital Center, Tirana, Albania
| | - Saimir Heta
- Service of pediatric Surgery “Mother Teresa” University Hospital Center, Tirana, Albania
| | - Spiro Sila
- Service of pediatric Surgery “Mother Teresa” University Hospital Center, Tirana, Albania
| | - Paskal Cullufi
- Service of Pediatric Gastroenterology “Mother Teresa” University Hospital Center, Tirana, Albania
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Alimadadi M, Ghanbari R, Yousefi M, Sadani S. Duodenal Web in an Elderly Patient with Abdominal Discomfort and Vomiting: A Rare Case. ARCHIVES OF IRANIAN MEDICINE 2023; 26:455-458. [PMID: 38301108 PMCID: PMC10685735 DOI: 10.34172/aim.2023.69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 04/25/2023] [Indexed: 02/03/2024]
Abstract
Duodenal web is complete or incomplete obstruction of the duodenum due to a membranous web or intraluminal diverticulum. This abnormality is one of the main causes of intestinal obstruction in children. The symptoms of this disease may rarely appear in older age and cause gastric outlet obstruction in adults. In the present paper, we report a 69-year-old male patient with heartburn, abdominal discomfort, frequent non-bilious, non-bloody vomiting for the past 6 months. Furthermore, the patient had experienced a weight loss of 12 kg during this period. He had been taking aspirin daily for years due to his ischemic heart disease. After performing contrast-enhanced CT imaging, esophagogastroduodenoscopy and barium meal examination, the patient was diagnosed to suffer from duodenal web. Since surgery is currently the mainstay of treatment in the management of this disease, the patient finally underwent a gastrojejunostomy.
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Affiliation(s)
- Mehdi Alimadadi
- Clinical Research Development Unit (CRDU), Sayad Shirazi Hospital, Golestan University of Medical Sciences, Gorgan, Iran
| | - Reza Ghanbari
- Gene Therapy Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohanna Yousefi
- Clinical Research Development Unit (CRDU), Sayad Shirazi Hospital, Golestan University of Medical Sciences, Gorgan, Iran
| | - Somayeh Sadani
- Clinical Research Development Unit (CRDU), Sayad Shirazi Hospital, Golestan University of Medical Sciences, Gorgan, Iran
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Grinlinton M, Welsh F, Phillips L, Chang WK. Surgical management of duodenal web in an adult presenting with melaena; Case report and literature review. Int J Surg Case Rep 2021; 88:106488. [PMID: 34637991 PMCID: PMC8506959 DOI: 10.1016/j.ijscr.2021.106488] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/02/2021] [Accepted: 10/03/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction Duodenal web is a rare pathology presenting infrequently in adults. Diagnosis is challenging and definitive management is commonly delayed. We present a case of a patient with a late diagnosis of duodenal web, who underwent laparotomy, intraoperative gastroscopy and surgical removal of the web performed by two general surgeons. Case presentation A 32-year-old woman with a previous diagnosis of irritable bowel syndrome presented with a three day history of abdominal pain, nausea and anorexia, and a one day history of melaena and haematemesis. Investigations including a magnetic resonance enterography, barium swallow study and gastroscopy revealed the diagnosis. The patient underwent laparotomy and excision of duodenal web. Intraoperative gastroscopy assisted with identification of the web's anatomical location. A longitudinal duodenotomy was performed and this was closed in a transverse fashion using the Heineke-Mikulicz technique. Discussion This case reports successful application of intraoperative gastroscopy during laparotomy and duodenotomy. Longitudinal duodenotomy with excision of the web and transverse closure of the duodenum appears to be the best approach. There are no previous publications detailing gastroscopy at the time of laparotomy with duodenal web. This technique may be utilised in appropriate situations to improve operative accuracy. Conclusion Duodenal web is a rare entity in adults, and delayed diagnosis may lead to significant patient morbidity. Incorporating intraoperative endoscopy ensures accurate anatomical visualisation. This technique avoids duodenectomy, organ damage, bypass, or an unnecessarily large incision. Duodenal web is a rare diagnostic dilemma found infrequently in adults. Duodenal web is frequently misdiagnosed and may not be visible on gastroscopy. Investigations such as magnetic resonance enterography and barium swallow studies may be useful adjuncts for diagnosis. Surgical management via laparotomy and duodenotomy are the best agreed cure for duodenal web. Intraoperative gastroscopy is a novel technique that may improve patient outcomes by enhancing anatomical accuracy.
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Affiliation(s)
- Megan Grinlinton
- Department of General Surgery, Northland District Health Board, Whangārei, New Zealand.
| | - Fraser Welsh
- Department of General Surgery, Waikato District Health Board, Hamilton, New Zealand
| | - Liz Phillips
- Department of Gastroenterology, Waikato District Health Board, Hamilton, New Zealand
| | - Wai Keat Chang
- Department of General Surgery, Waikato District Health Board, Hamilton, New Zealand
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Abstract
Duodenal stenosis is a type of congenital intestinal atresia syndrome. Most patients are diagnosed during the neonatal period based on recurrent vomiting, but some cases develop symptoms at an older age. We report a case with an unusual pathogenic mechanism: sudden ileus due to food impaction.A 15-month-old boy was admitted to our institution with a history of recurrent vomiting and diarrhea for 7 days and fever for 2 days. Abdominal distention was found upon physical examination but other congenital anomalies were not. He was initially treated for acute gastroenteritis, but vomiting resumed after starting oral ingestion. Congenital membranous duodenal stenosis and impaction of a shimeji mushroom into the narrow section of the duodenum was recognized upon endoscopy. Dilatation was successful and restenosis was not seen. Food impaction is a rare (but important) initial event in congenital duodenal stenosis, and this disorder should be included in the differential diagnosis, especially for infants/toddlers with recurrent vomiting that develops at the time of eating solid and more diverse types of food.
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Nicholson MR, Acra SA, Chung DH, Rosen MJ. Endoscopic diagnosis of duodenal stenosis in a 5-month-old male infant. Clin Endosc 2014; 47:568-70. [PMID: 25505725 PMCID: PMC4260107 DOI: 10.5946/ce.2014.47.6.568] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 12/05/2013] [Accepted: 12/09/2013] [Indexed: 11/17/2022] Open
Abstract
Duodenal stenosis and duodenal atresia are well-known gastrointestinal anomalies in patients with Down syndrome. Although duodenal atresia presents early and classically with vomiting in the immediate neonatal period, the presentation of duodenal stenosis can be significantly more subtle and the diagnosis delayed. Here, we describe the case of a 5-month-old male infant with Down syndrome and delayed presentation of high-grade duodenal stenosis diagnosed endoscopically. Pediatric gastroenterologists should include duodenal stenosis in the differential diagnosis of older infants and children with vomiting and should be familiar with the endoscopic appearance of this lesion.
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Affiliation(s)
- Maribeth R Nicholson
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Sari A Acra
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Dai H Chung
- Department of Pediatric Surgery, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Michael J Rosen
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA. ; Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Schoppel K, Durkin ET, Kim HB, Chen C. Delayed presentation of bowel obstruction in a patient with Trisomy 21: A novel method for addressing intestinal webs. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2014. [DOI: 10.1016/j.epsc.2014.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Lee SS, Hwang ST, Jang NG, Tchah H, Choi DY, Kim HY, Ryoo E. A case of congenital duodenal web causing duodenal stenosis in a down syndrome child: endoscopic resection with an insulated-tip knife. Gut Liver 2011; 5:105-9. [PMID: 21461083 DOI: 10.5009/gnl.2011.5.1.105] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Accepted: 04/06/2010] [Indexed: 11/04/2022] Open
Abstract
A 35-month-old girl visited our hospital with repetitive vomiting and abdominal distention; this was especially aggravated after the introduction of solid and semisolid foods. At 5 months of age, the patient, who had Down's syndrome, had undergone surgery for ventricular septal defect, atrial septal defect, and patent ductus arteriosus, and had subsequently been frequently hospitalized for respiratory infections and other viral infectious diseases. After her admission, the abdominal distension improved with fasting and intravenous fl uid therapy. Radiograph from a small-bowel series revealed a thin fi lling defect with a dilated duodenal bulb in the distal region of the second portion of the duodenum, suggesting a duodenal web, and endoscopy revealed duodenal stenosis. We therefore performed endoscopic resection with an insulated-tip knife because of the history of prior operations, fasting problems after operations, and respiratory infections. Seven days later, scar formation was noted on the second portion of the duodenum, the scope passed well at the excision site, and no retained food material was noted on the follow-up endoscopy. After the procedure, the patient's abdominal distention and repetitive vomiting subsided, and she was discharged with the ability to eat eat an age-appropriate normal diet. There were no specifi c symptoms or other complications for 1 year after the procedure.
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Affiliation(s)
- Sang Seon Lee
- Department of Pediatrics, Gachon University of Medicine and Science Graduate School of Medicine, Incheon, Korea
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Dierssen M, Herault Y, Estivill X. Aneuploidy: from a physiological mechanism of variance to Down syndrome. Physiol Rev 2009; 89:887-920. [PMID: 19584316 DOI: 10.1152/physrev.00032.2007] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Quantitative differences in gene expression emerge as a significant source of variation in natural populations, representing an important substrate for evolution and accounting for a considerable fraction of phenotypic diversity. However, perturbation of gene expression is also the main factor in determining the molecular pathogenesis of numerous aneuploid disorders. In this review, we focus on Down syndrome (DS) as the prototype of "genomic disorder" induced by copy number change. The understanding of the pathogenicity of the extra genomic material in trisomy 21 has accelerated in the last years due to the recent advances in genome sequencing, comparative genome analysis, functional genome exploration, and the use of model organisms. We present recent data on the role of genome-altering processes in the generation of diversity in DS neural phenotypes focusing on the impact of trisomy on brain structure and mental retardation and on biological pathways and cell types in target brain regions (including prefrontal cortex, hippocampus, cerebellum, and basal ganglia). We also review the potential that genetically engineered mouse models of DS bring into the understanding of the molecular biology of human learning disorders.
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Affiliation(s)
- Mara Dierssen
- Genes and Disease Program, Genomic Regulation Center-CRG, Pompeu Fabra University, Barcelona Biomedical Research Park, Dr Aiguader 88, PRBB building E, Barcelona 08003, Catalonia, Spain.
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Dankovcik R, Jirasek JE, Kucera E, Feyereisl J, Radonak J, Dudas M. Prenatal diagnosis of annular pancreas: reliability of the double bubble sign with periduodenal hyperechogenic band. Fetal Diagn Ther 2008; 24:483-90. [PMID: 19047797 DOI: 10.1159/000178759] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2007] [Accepted: 12/05/2007] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To evaluate the power of prenatal 2-D ultrasound examination in the 2nd trimester as a method of choice for accurate diagnosis of annular pancreas. METHODS Co-incidence of the double bubble sign (often accompanying gastroduodenal dilatation) together with a hyperechogenic band around the duodenum (corresponding with the tissue of annular pancreas) was used as a diagnostic criterion. Findings from postnatal surgery served for verification. RESULTS From 7,897 screened pregnancies, annular pancreas was proven in the cases where both signs were present, but never without the hyperechogenic band (N(1) = 3, N(2) = 3, p < or = 0.05). Sensitivity and specificity were 100%. CONCLUSIONS More multicentric studies are required to test this approach. The following diagnostic strategy is reasonable at the present time: when the double bubble sign is discovered, always suspect annular pancreas and look for the second sign: hyperechogenic bands around the duodenum. Also look for known associated anomalies, and vice versa, if any of associated anomalies are noted, also search specifically for the signs of annular pancreas.
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