OBJECTIVE: To assess the value of chromosomal microarray analysis (CMA) for fetal duodenal obstruction (DO). METHODS: Fifty-one fetuses with DO identified by prenatal ultrasound were divided into DO only group and DO with other anomaly group. CMA was carried out on amniotic fluid or umbilical blood samples, and the outcome of pregnancy of all cases were followed up. RESULTS: Eight fetuses (15.7%) were found with genomic abnormalities, which included 3 chromosomal aneuploidies and 5 copy number variations (CNVs), including one 17q12 microduplication syndrome, one 13q21.33q31.1 microdeletion, one 13q21.32q22.3 deletion, one 13q21.2q31.1 deletion and one 1q43q44 duplication. EDNRB from 13q and HNF1B from 17q12 are candidate genes for fetal DO. No significant difference was found in the detection rate of pathogenic CNVs between the DO only and DO with other anomaly groups (9.5% vs.11.1%, P> 0.05). There were 39 live borns, 1 stillbirth, and 11 artificial abortions (8 with abnormal CMA results). CONCLUSION There is a correlation between fetal DO and abnormal copy number of the genome, for which prenatal diagnosis is necessary. CMA not only can detect microdeletions/microduplications, but also identify pathogenic genes, which can facilitate prenatal diagnosis, genetic counseling and prognosis for the fetus.
Chromosome Aberrations ; DNA Copy Number Variations ; Duodenal Obstruction/genetics* ; Female ; Fetus ; Humans ; Microarray Analysis ; Pregnancy ; Prenatal Diagnosis

Duodenal leiomyosarcoma is a rare condition with a poor prognosis. Early diagnosis of duodenal leiomyosarcoma is challenging because it presents with nonspecific symptoms and endoscopic biopsies usually do not enable a definitive diagnosis. Duodenal leiomyosarcomas are diagnosed on the basis of the histopathological identification of a mesenchymal lesion composed of malignant tumor cells that on immunohistochemical examination is positive for smooth muscle actin and desmin. We report the case of a 38-year-old man who presented with gastrointestinal bleeding and obstruction who was diagnosed with duodenal leiomyosarcoma after surgical resection.
Actins ; Adult ; Biopsy ; Desmin ; Diagnosis ; Duodenal Obstruction ; Early Diagnosis ; Gastrointestinal Hemorrhage ; Hemorrhage ; Humans ; Leiomyosarcoma ; Muscle, Smooth ; Prognosis

Afferent loop syndrome (ALS) is a rare cause of recurrent pancreatitis. Recurrent pancreatitis in association with ALS can develop due to impaired outflow of pancreatic juice or reflux of enteric secretions caused by increased intraluminal duodenal pressure. Here, we report a case of ALS presenting as recurrent acute pancreatitis due to chronic intermittent partial obstruction of the third portion of the duodenum caused by postoperative adhesion. Interestingly, pancreatic histology showed a granulocytic epithelial lesion, which is a diagnostic feature of type 2 autoimmune pancreatitis (AIP, idiopathic duct centric chronic pancreatitis [IDCP]). From this case we learned that the diagnosis of type 2 AIP should be made in the appropriate clinical setting.
Afferent Loop Syndrome ; Diagnosis ; Duodenal Obstruction ; Duodenum ; Pancreatic Juice ; Pancreatitis ; Pancreatitis, Chronic

BACKGROUND: Endoscopic self-expandable metal stent (SEMS) insertions for palliation of malignant biliary and duodenal obstructions have been revealed to be an effective treatment. We present our clinical experience with the use of SEMS for malignant biliary and duodenal obstructions caused by periampullary cancer. METHODS: We performed a retrospective review of all patients who underwent endoscopic biliary and duodenal SEMS insertion for palliation of malignant biliary and duodenal obstruction caused by periampullary cancer between July 2007 and October 2016. The patients received simultaneous or sequential endoscopic biliary stenting and duodenal stenting with COMVITM stents (partially covered; Taewoong, Seoul, Korea). RESULTS: The final diagnoses of our enrolled patients were 15 pancreas head cancer, and 3 distal common bile duct (CBD) cancer. The main stricture site in the duodenum was bulb (n = 4, 22.2%), 2nd portion (n = 9, 50.0%), and 3rd portion (n = 5, 27.8%). The technical success rates of CBD and duodenal stenting were 100% (18/18), and 100% (18/18), respectively. The clinical success rates of CBD and duodenal stenting were 100% (18/18), and 88.9% (16/18), respectively. Median actuarial stent patency for biliary and duodenal SEMS were 6.5 months (range, 1-2 months) and 4.5 months (range, 1-14 months), respectively. Three patients (16.7%) had recurrent biliary obstruction and all of them underwent percutaneous trans-hepatic biliary drainage (PTBD) with biliary SEMS reinsertion. Three other patients (16.7%, totally different from patients with CBD restenosis) had recurrent duodenal obstruction and all of them underwent upper gastrointestinal endoscopy with duodenal SEMS reinsertion. CONCLUSION: Endoscopic SEMS insertions for simultaneous palliation of malignant biliary and duodenal obstruction in patients with periampullary cancer may provide a safe, and less invasive alternative to surgical palliation with a successful clinical outcome.
Common Bile Duct ; Constriction, Pathologic ; Diagnosis ; Drainage ; Duodenal Obstruction ; Duodenum ; Endoscopy, Gastrointestinal ; Head and Neck Neoplasms ; Humans ; Palliative Care* ; Pancreas ; Retrospective Studies ; Self Expandable Metallic Stents ; Seoul ; Stents*

Pancreatic cancer tends to be delayed in diagnosis because of the lack of early symptom and less than 20% of patients present with resectable masses. A 95-year-old male visited due to recurrent abdominal pain and vomiting. About 2 years ago, a polypoid lesion was detected at the post-bulbar area on esophagogastroduodenoscopy for medical check-up. Endoscopic biopsy noted chronic inflammation with glandular atypia. On the CT scan, there was an intraluminal polypoid mass lesion with mixed hypodensity at the duodenal second portion. Ultrasound guided biopsy targeting the hypodense lesion was performed and revealed chronic pancreatitis. The vomiting persisted and the patient received a palliative gastrojejunostomy. Twenty-five days after gastrojejunostomy, jaundice occurred and an ill-defined mass at the pancreas head was noted on the CT. Pylorus preserving pancreatoduodenectomy was performed and a 3.5 cm sized, moderate to poorly differentiated ductal adenocarcinoma of pancreas head was diagnosed. Nineteen days after operation, the patient was discharged in good condition.
Abdominal Pain ; Adenocarcinoma ; Biopsy ; Diagnosis ; Duodenal Obstruction* ; Endoscopy, Digestive System ; Gastric Bypass ; Head ; Humans ; Inflammation ; Jaundice ; Male ; Pancreas ; Pancreatic Neoplasms* ; Pancreaticoduodenectomy ; Pancreatitis ; Pancreatitis, Chronic ; Pylorus ; Tomography, X-Ray Computed ; Ultrasonography ; Vomiting

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

No abstract available.
Aged, 80 and over ; Aortic Aneurysm, Abdominal/*complications/diagnosis ; Aortography/methods ; Duodenal Obstruction/diagnosis/drug therapy/*etiology ; Gastrointestinal Agents/therapeutic use ; Humans ; Male ; Risk Factors ; Syndrome ; Tomography, X-Ray Computed

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.
Child ; Constriction, Pathologic* ; Diagnosis* ; Diagnosis, Differential ; Down Syndrome ; Duodenal Obstruction ; Hematemesis ; Humans ; Infant* ; Male ; Vomiting

Midgut malrotation includes a range of developmental abnormalities that occur during fetal intestinal rotation. Manifestations of intestinal malrotation are generally seen in the paediatric population and are uncommon in adults. Symptomatic patients may present with either acute abdominal pain due to midgut volvulus, or chronic abdominal pain due to proximal midgut partial obstruction in the presence of congenital bands. A limited number of paediatric cases of duodenal occlusion due to duodenal malrotation has been previously reported in the medical literature. We herein report the case of a 57-year-old woman who presented with duodenal obstruction due to organoaxial partial rotation of the distal duodenum associated with midgut malrotation. This is probably the first of such a case diagnosed in adulthood reported in the medical literature. Our patient underwent Roux-en-Y duodenojejunostomy and had symptomatic relief following the successful surgery.
Duodenal Obstruction ; congenital ; diagnosis ; surgery ; Duodenostomy ; Duodenum ; abnormalities ; Female ; Humans ; Middle Aged ; Sri Lanka ; Treatment Outcome

Superior mesenteric artery (SMA) syndrome is an uncommon cause of duodenal outlet obstruction. Symptoms and signs suggestive of this condition are nonspecific, and a high index of suspicion coupled with appropriate imaging studies are necessary for diagnosis. We present the case of a 70-year-old man who developed SMA syndrome following prolonged hospitalisation for a surgically treated bleeding duodenal ulcer. His SMA syndrome resolved after successful nonoperative management based on accepted guidelines for nutritional therapy, thus avoiding the need for reoperation and its attendant risks in a malnourished patient.
Aged ; Duodenal Obstruction ; drug therapy ; Duodenal Ulcer ; complications ; surgery ; Endoscopy ; Hospitalization ; Humans ; Male ; Malnutrition ; Nutrition Therapy ; methods ; Refeeding Syndrome ; diagnosis ; Superior Mesenteric Artery Syndrome ; diet therapy ; Treatment Outcome