No abstract available.
Adult ; Biopsy ; *Brunner Glands/pathology/surgery ; Duodenal Diseases/*complications/diagnosis/surgery ; Duodenal Obstruction/diagnosis/*etiology/surgery ; Duodenoscopy ; Gastric Outlet Obstruction/diagnosis/*etiology/surgery ; Hamartoma/*complications/diagnosis/surgery ; Humans ; Male ; Tomography, X-Ray Computed ; Treatment Outcome

Hepatocellular carcinoma (HCC) is one of the most common malignant neoplasms occuring worldwide. Surgical resection currently provides the best chance of long-term tumor free survival, but the most HCCs are not candidates for surgical excision due to poor liver function or poor medical background. Numerous noninvasive alternatives to surgical resection have been introduced to treat liver cancers. Radiofrequency thermal ablation has begun to receive much attention as an effective and minimally invasive technique for the local control of HCC. The biliary system related complications after radiofrequency ablation has rarely been reported. We report a case of biliary-duodenal fistula with liver abscess after radiofrequency ablation for HCC. The case was treated by abscess drainage and antibiotics.
Biliary Fistula/*diagnosis/etiology ; Carcinoma, Hepatocellular/diagnosis/*surgery ; Catheter Ablation/*adverse effects ; Duodenal Diseases/*diagnosis/etiology ; Duodenal Obstruction/diagnosis ; Female ; Humans ; Intestinal Fistula/*diagnosis/etiology ; Liver Neoplasms/diagnosis/*surgery ; Middle Aged ; Tomography, X-Ray Computed

Abdominal Pain ; diagnosis ; etiology ; surgery ; Adult ; Duodenal Obstruction ; complications ; diagnosis ; surgery ; Humans ; Male ; Pancreas ; abnormalities ; surgery ; Tomography, X-Ray Computed ; Treatment Outcome

Superior mesenteric artery (SMA) syndrome is a rare disease in which the third portion of the duodenum is compressed by SMA. There are many causes leading to the SMA syndrome, however it's extremely rare that aortic aneurysm causes a SMA syndrome. We report a case of a successfully treated SMA syndrome due to an abdominal aortic aneurysm in a renal transplant recipient. The patient was a 52-yr-old woman with a thin stature (weight 40 kg, height 164 cm). She received a renal transplant 8 yr before, and had hypertension and abdominal aortic aneurysm. Her SMA syndrome developed in a prolonged supine position for the accidental rib fractures and was diagnosed by clinical and radiological findings. After a surgical correction (resection of an aneurysm and aortobiiliac bypass with an inverted Y graft), her symptoms relieved without deterioration of the graft function.
Aortic Aneurysm, Abdominal/*complications/surgery ; Duodenal Obstruction ; Duodenum/radiography ; Female ; Humans ; *Kidney Transplantation ; Middle Aged ; Superior Mesenteric Artery Syndrome/*etiology/surgery ; Tomography, X-Ray Computed

Groove pancreatitis is a rare form of chronic pancreatitis in which scarring is found mainly in the groove between the head of the pancreas, duodenum, and common bile duct. The pathogenesis of groove pancreatitis is still unclear but seems to be caused by the disturbance of pancreatic outflow through Santorini duct. It is often difficult to differentiate preoperatively between groove pancreatitis and pancreatic head carcinoma. Whereas conservative management is effective, some patients with duodenal obstruction may undergo Whipple's operation. A few case of groove pancreatitis have been reported in Korea, and they were diagnosed only by clinical and radiological features. We experienced a case of groove pancreatitis who needed a surgical management because of severe duodenal obstruction. We report the case with a review of its characteristic pathologic findings.
Adult ; Diagnosis, Differential ; Duodenal Obstruction/etiology/*surgery ; Humans ; Magnetic Resonance Imaging ; Male ; Pancreaticoduodenectomy ; Pancreatitis, Chronic/*diagnosis/pathology/surgery ; Tomography, X-Ray Computed

Complications associated with an intramural hematoma of the bowel, is a relatively unusual condition. Most intramural hematomas resolve spontaneously with conservative treatment and the patient prognosis is good. However, if the symptoms are not resolved or the condition persists, surgical intervention may be necessary. Here we describe internal incision and drainage by endoscopy for the treatment of an intramural hematoma of the duodenum. A 63-yr-old woman was admitted to the hospital with hematemesis. The esophagogastroduodenoscopy (EGD) showed active ulcer bleeding at the distal portion of duodenal bulb. A total of 10 mL of 0.2% epinephrine and 2 mL of fibrin glue were injected locally. The patient developed diffuse abdominal pain and projectile vomiting three days after the endoscopic treatment. An abdominal computed tomography revealed a very large hematoma at the lateral duodenal wall, approximately 10X5 cm in diameter. Follow-up EGD was performed showing complete luminal obstruction at the second portion of the duodenum caused by an intramural hematoma. The patient's condition was not improved with conservative treatment. Therefore, 21 days after admission, endoscopic treatment of the hematoma was attempted. Puncture and incision were performed with an electrical needle knife. Two days after the procedure, the patient was tolerating a soft diet without complaints of abdominal pain or vomiting. The hematoma resolved completely on the follow-up studies.
Drainage ; Duodenal Diseases/*diagnosis/pathology/surgery ; Endoscopy, Digestive System ; Female ; Gastrointestinal Hemorrhage/*etiology/therapy ; Hematoma/*diagnosis/pathology/surgery ; Humans ; Intestinal Obstruction/*etiology/therapy ; Middle Aged ; Tomography, X-Ray Computed

OBJECTIVETo study the treatment of primary malignant duodenal tumor.

METHODThe data of 54 cases of primary malignant duodenal tumor during 1993 approximately 2003 were analyzed retrospectively.

RESULTSClinical manifestations were jaundice, abdominalgia, obstruction of digest tract and bleeding. Correct diagnosis rates of image examination were endoscopic retrograde cholangiopancreatography 92.8%, air barium double radiography 70.8%, gastroscopy 50.0%, CT 21.9%, MRI 21.4%. Tumor location was 1 in duodenal bulb, 45 in descending portion, 3 in horizontal part and none in ascending portion. 48 malignant tumors were operated, 31 pancreaticoduodenectomy, 1 pancreaticoduodenectomy and partial resection of superior mesenteric vein, 6 radical segmental duodenal resection, 1 palliative segmental duodenal resection, 3 duodenal wedge resection, 5 bypass operation (gastrojejunostomy and/or cholangiojejunostomy), 1 jejunostomy. Adjuvant chemotherapy was given in 13 cases. The survival rates were 5-year 45.4%, 3-year 45.4%, 1-year 63.2%. Median survival months were 24, 10, 38 and 16 respectively for radical operation group, palliative operation group, with postoperative adjuvant therapy group and without postoperative adjuvant therapy group. No significant survival time was found between radical operation group and palliative operation group, adjuvant therapy group and without postoperative adjuvant therapy group, pancreaticoduodenectomy group and radical segmental duodenal resection group in statistics. Among lymphyaden metastasis, tumor size, tumor depth, tumor thrombi, pathologic type and operative methods, only tumor thrombi had prognostic significance in multivariate analysis.

CONCLUSIONSPancreaticoduodenectomy and radical segmental duodenal resection should be selected for primary malignant duodenal tumor. Bypass operation can prolong survival and improve life-quality. Postoperative adjuvant treatment is advocated.

Abdominal Pain ; etiology ; Adenocarcinoma ; complications ; surgery ; therapy ; Adult ; Aged ; Aged, 80 and over ; Duodenal Neoplasms ; complications ; surgery ; therapy ; Duodenal Obstruction ; etiology ; Duodenostomy ; methods ; Female ; Follow-Up Studies ; Gastrointestinal Hemorrhage ; etiology ; Humans ; Male ; Middle Aged ; Pancreatectomy ; methods ; Postoperative Care ; Retrospective Studies ; Surgical Wound Infection ; Survival Analysis

INTRODUCTIONBladder cancer is a common malignancy but presentation with metastatic disease is rare. This is the fi rst reported case of duodenal obstruction as a presentation of metastatic bladder cancer.

CLINICAL PICTUREA middle-aged woman presented with nausea, vomiting, weight loss and intermittent haematuria. Radiology and histology confirmed metastatic bladder cancer to the retroperitoneum encasing the duodenum and causing obstruction.

TREATMENTInsertion of a duodenal stent relieved the obstruction and palliative chemoradiotherapy was initiated.

OUTCOMEThe patient died 15 months after diagnosis.

CONCLUSIONSClinicians and radiologists should be aware of atypical presentations of common malignancies.

Adult ; Carcinoma, Transitional Cell ; drug therapy ; secondary ; Diagnosis, Differential ; Duodenal Obstruction ; diagnosis ; etiology ; surgery ; Fatal Outcome ; Female ; Humans ; Palliative Care ; Retroperitoneal Neoplasms ; complications ; diagnosis ; secondary ; Stents ; Urinary Bladder Neoplasms ; drug therapy ; pathology