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Das S, Sunil J, Prakash S, Shaikh OH, Reddy A, Kumbhar US. Duodeno-duodenal intussusception presenting as upper gastrointestinal bleed. BMJ Case Rep 2023; 16:e250003. [PMID: 37607766 PMCID: PMC10445347 DOI: 10.1136/bcr-2022-250003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023] Open
Abstract
Duodeno-duodenal intussusception (DDI) is the type of intestinal intussusception in which a segment of the duodenum invaginates into the next part of the duodenum. We present a case of a male patient in his 50s presenting with right upper abdominal pain with multiple episodes of vomiting and a history of melena for 1 month. Imaging studies showed the presence of DDI without apparent growth. The patient underwent upper gastrointestinal endoscopy, which showed a doubtful growth in the duodenum, and the biopsy, was suggestive of adenocarcinoma. The patient underwent Whipple's procedure, and postoperative histology was diagnostic of Brunner's gland adenoma. The patient improved well without any complications.
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Affiliation(s)
- Snehasis Das
- Surgery, Jawaharlal Institute of Postgraduate Medical Education, Puducherry, India
| | - Julia Sunil
- Surgery, Jawaharlal Institute of Postgraduate Medical Education, Puducherry, India
| | - Sagar Prakash
- Surgery, Jawaharlal Institute of Postgraduate Medical Education, Puducherry, India
| | - Oseen Hajilal Shaikh
- Surgery, Jawaharlal Institute of Postgraduate Medical Education, Puducherry, India
| | - Abhinaya Reddy
- Surgery, Jawaharlal Institute of Postgraduate Medical Education, Puducherry, India
| | - Uday Shamrao Kumbhar
- Surgery, Jawaharlal Institute of Postgraduate Medical Education, Puducherry, India
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Yi GY, Lee JK, Lee H, Yi SY, Park S. Imaging Findings of an Intraluminal Duodenal Diverticulum Associated with Adult Duodeno-Duodenal Intussusception and Recurrent Pancreatitis: A Case Report. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2022; 83:680-686. [PMID: 36238501 PMCID: PMC9514536 DOI: 10.3348/jksr.2021.0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/22/2021] [Accepted: 07/17/2021] [Indexed: 02/05/2023]
Abstract
Intraluminal duodenal diverticulum (IDD) is a rare congenital abnormality, consisting of a sac-like mucosal lesion in the duodenum. Cases of IDD can present with gastrointestinal bleeding, duodenal obstruction, or pancreatitis. Here, we report a rare case of a 25-year-old female presenting with IDD complicated by duodeno-duodenal intussusception and recurrent pancreatitis. The diagnosis was based on findings from radiologic examinations (CT and MRI), upper gastrointestinal series (barium swallow), and gastroduodenofiberscopy. Laparoscopic excision of the presumed duodenal duplication was performed. The subsequent histopathologic evaluation of the excised sac revealed normal mucosa on both sides, but the absence of a proper muscle layer confirmed the diagnosis of IDD. Radiologic detection of a saccular structure in the second portion of the duodenum can indicate IDD with duodeno-duodenal intussusception as the lead point.
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Affiliation(s)
- Ga Young Yi
- Department of Radiology, College of Medicine, Ewha Womans University, Mokdong Hospital, Seoul, Korea
| | - Jeong Kyong Lee
- Department of Radiology, College of Medicine, Ewha Womans University, Mokdong Hospital, Seoul, Korea
| | - Huisong Lee
- Department of Surgery, College of Medicine, Ewha Womans University, Mokdong Hospital, Seoul, Korea
| | - Sun Young Yi
- Department of Gastroenterology, College of Medicine, Ewha Womans University, Mokdong Hospital, Seoul, Korea
| | - SangHui Park
- Department of Pathology, College of Medicine, Ewha Womans University, Mokdong Hospital, Seoul, Korea
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Fontana F, Piacentino F, Ossola C, Pascarella RD, Franchi C, Curti M, Coppola A, Basile A, Saverio SD, Carcano G, Venturini M. Gangliocytic paraganglioma leading to duodeno-jejunal intussusception: A case report. Radiol Case Rep 2021; 16:3977-3981. [PMID: 34729128 PMCID: PMC8545659 DOI: 10.1016/j.radcr.2021.09.056] [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: 09/05/2021] [Revised: 09/19/2021] [Accepted: 09/20/2021] [Indexed: 02/07/2023] Open
Abstract
The intussusception of the small bowel is rarely encountered in adult patients and is frequently associated with a lead point that is often malignant. In a 69-year-old female patient with an episode of gastrointestinal (GI) bleeding, computed tomography (CT) showed a duodenal-jejunal intussusception caused by an intraluminal mass. Open polypectomy and reduction of intussusception were performed and the diagnosis of gangliocytic paraganglioma was made at pathological evaluation. It would be important to consider neoplasms like gangliocytic paraganglioma in the setting of adult small bowel intussusception.
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Affiliation(s)
- Federico Fontana
- Diagnostic and Interventional Radiology Department, Ospedale di Circolo, ASST dei Sette Laghi, Varese 21100, Italy
- School of Medicine and Surgery, Università degli Studi dell'Insubria, Varese 21100, Italy
| | - Filippo Piacentino
- Diagnostic and Interventional Radiology Department, Ospedale di Circolo, ASST dei Sette Laghi, Varese 21100, Italy
| | - Christian Ossola
- School of Medicine and Surgery, Università degli Studi dell'Insubria, Varese 21100, Italy
| | | | - Caterina Franchi
- School of Medicine and Surgery, Università degli Studi dell'Insubria, Varese 21100, Italy
| | - Marco Curti
- School of Medicine and Surgery, Università degli Studi dell'Insubria, Varese 21100, Italy
| | - Andrea Coppola
- Diagnostic and Interventional Radiology Department, Ospedale di Circolo, ASST dei Sette Laghi, Varese 21100, Italy
| | - Antonio Basile
- Department of Medical and Surgical Sciences and Advanced Technologies, Radiodiagnostic and Radiotherapy Unit, University Hospital "Policlinico-Vittorio Emanuele", Catania 95123, Italy
| | - Salomone Di Saverio
- School of Medicine and Surgery, Università degli Studi dell'Insubria, Varese 21100, Italy
- Department of General Surgery, ASUR Marche, AV5, Hospital of San Benedetto del Tronto, San Benedetto del Tronto 63074, Italy
| | - Giulio Carcano
- School of Medicine and Surgery, Università degli Studi dell'Insubria, Varese 21100, Italy
- Surgery Department, Ospedale di Circolo, ASST dei Sette Laghi, Varese 21100, Italy
| | - Massimo Venturini
- Diagnostic and Interventional Radiology Department, Ospedale di Circolo, ASST dei Sette Laghi, Varese 21100, Italy
- School of Medicine and Surgery, Università degli Studi dell'Insubria, Varese 21100, Italy
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Neville JJ, Gallagher J, Mitra A, Sheth H. Adult Presentations of Congenital Midgut Malrotation: A Systematic Review. World J Surg 2021; 44:1771-1778. [PMID: 32030442 DOI: 10.1007/s00268-020-05403-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Adult midgut malrotation is a rare cause of an acute abdomen requiring urgent intervention. It may also present in the non-acute setting with chronic, non-specific symptoms. The objective of this study is to identify the clinical features, appropriate investigations and current surgical management associated with adult malrotation. METHODS A systematic review was conducted according to PRISMA guidelines, identifying confirmed cases of adult malrotation. Patient demographics, clinical features, investigation findings and operative details were analysed. RESULTS Forty-five reports met the inclusion criteria, totalling 194 cases. Mean age was 38.9 years (n = 92), and 52.3% were male (n = 130). The commonest presenting complaints were abdominal pain (76.8%), vomiting (35.1%) and food intolerance (21.6%). At least one chronic symptom was reported in 87.6% and included intermittent abdominal pain (41.2%), vomiting (12.4%) and obstipation (11.9%). Computerised tomography scanning was the most frequent imaging modality (81.4%), with a sensitivity of 97.5%. The whirlpool sign was observed in 30.9%; abnormalities of the superior mesenteric axis were the commonest finding (58.0%). Ladd's procedure was the most common surgical intervention (74.5%). There was no significant difference in resolution rates between emergency and elective procedures (p = 0.46), but length of stay was significantly shorter for elective cases. (p = 0.009). There was no significant difference in risk of mortality, or symptom resolution, between operative and conservative management (p = 0.14 and p = 0.44, respectively). CONCLUSION Malrotation in the adult manifests with chronic symptoms and should be considered as a differential diagnosis in patients with abdominal pain, vomiting and food intolerance.
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Affiliation(s)
- Jonathan J Neville
- Ealing Hospital, London North West University Healthcare NHS Trust, Uxbridge Road, London, UB1 3HW, UK. .,Imperial College Healthcare NHS Trust, Paddington, London, W2 1NY, UK.
| | - Jack Gallagher
- Ealing Hospital, London North West University Healthcare NHS Trust, Uxbridge Road, London, UB1 3HW, UK.,Imperial College Healthcare NHS Trust, Paddington, London, W2 1NY, UK
| | - Anuja Mitra
- Ealing Hospital, London North West University Healthcare NHS Trust, Uxbridge Road, London, UB1 3HW, UK.,Imperial College Healthcare NHS Trust, Paddington, London, W2 1NY, UK
| | - Hemant Sheth
- Ealing Hospital, London North West University Healthcare NHS Trust, Uxbridge Road, London, UB1 3HW, UK
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A. N. Alzerwi N. Duodenoduodenal and duodenojejunal intussusceptions in adults: A systematic review with a focus on demographics, diagnosis, and etiology. AIMS MEDICAL SCIENCE 2020. [DOI: 10.3934/medsci.2020012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Loo GH, Mohamad Abu Zeid WM, Lim SL, Ismail AM. Rare presentation of idiopathic duodenoduodenal intussusception. Ann R Coll Surg Engl 2017; 99:e188-e190. [PMID: 28660832 DOI: 10.1308/rcsann.2017.0104] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Enteroenteric intussusception is a condition in which the full-thickness bowel wall becomes telescoped into the lumen of distal bowel. Intussusception in adult occurs infrequently and varies from childhood intussusception, particularly in its presentation, aetiology and treatment. Duodenoduodenal intussusception is rare because the duodenum is fixed in the retroperitoneal position. It usually occurs secondary to tumour, lipoma, Brunner's gland hamartomatous polyp or adenoma. The diagnosis in adults is usually made at laparotomy, where presentation is with intestinal obstruction. In non-emergency presentation, it may be difficult to arrive at an accurate diagnosis as symptoms may be vague, self-limiting intermittent abdominal pain. Clinical examinations and investigations may not be conclusive and another working diagnosis such as irritable bowel syndrome would be made. We describe a case where a patient initially presented with symptoms mimicking pancreatitis but his symptoms persisted over the course of 2 weeks. When a laparotomy was performed, duodenoduodenal intussusception was discovered and confirmed with histopathology. In this case, a discernible leading point could not be identified.
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Affiliation(s)
- G H Loo
- General Surgery, Bintulu Hospital, Bintulu City , Bintulu , Malaysia
| | | | - S L Lim
- General Surgery, Bintulu Hospital, Bintulu City , Bintulu , Malaysia
| | - A M Ismail
- Pathology Department, Hospital Umum Sarawak , Kuching, Sarawak , Malaysia
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Chai LF, Batista PM, Lavu H. Taking the Lead: A Case Report of a Leiomyoma Causing Duodeno-Duodenal Intussusception and Review of Literature. Case Rep Pancreat Cancer 2016; 2:19-22. [PMID: 30631810 PMCID: PMC6319677 DOI: 10.1089/crpc.2016.0001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background: Duodenal masses are rare entities and symptomatic presentation generally is due to abdominal pain or the presence of gastrointestinal bleeding. A number of published case reports in the literature have detailed various neoplasms that have caused an intussusception isolated to the duodenum. This is a particularly unusual phenomenon due to the location and fixation of this portion of the proximal small bowel to the retroperitoneum. We present here a case of duodeno-duodenal intussusception secondary to a leiomyoma. Case: A 65-year-old Caucasian male presented with intermittent bloody stools and syncope over a 9-month period secondary to a duodenal leiomyoma causing intussusception, which was treated through a pancreaticoduodenectomy. Conclusion: Intussusception of the duodenum is an uncommon entity and the diagnosis of a leiomyoma should be considered in the setting of a potential mass in the small intestine.
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Affiliation(s)
- Louis F. Chai
- Rutgers-Robert Wood Johnson Medical School, Piscataway, New Jersey
| | - Philip M. Batista
- Department of Surgery, Jefferson Pancreas, Biliary, and Related Cancer Center, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Harish Lavu
- Department of Surgery, Jefferson Pancreas, Biliary, and Related Cancer Center, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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