Cases reported "Duodenal Obstruction"

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1/5. Successful laserlithotripsy in Bouveret's syndrome using a new frequency doubled doublepulse Nd:YAG laser (FREDDY).

    gastric outlet obstruction as a result of gallstone (Bouveret syndrome) is a rare but serious complication of cholelithiasis. In many cases, surgery has been conducted for treatment. In recent years, minimal invasive treatment modalities (e.g. shockwave lithotripsy) have been shown to be effective in some of those patients. Laserlithotripsy has so far been described in two cases with a Rhodamine-6G dye laser. We present the case of a 90-year-old woman with duodenal obstruction due to a huge gallstone. The patient was referred to our hospital because attempts at endoscopic extraction and extracorporeal shockwave lithotripsy had failed. The man was treated successfully in just one session with a new cost-efficient frequency doubled doublepulse Nd:YAG laser (FREDDY) using a total of 5726 laser pulses (120 mJ pulse energy, 10 Hz pulse repetition rate) and recovered rapidly. Laserlithotripsy can be considered an effective non-invasive therapeutic alternative to surgical treatment in Bouveret's syndrome, especially in old or high-risk patients.
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2/5. Management of upper gastrointestinal obstruction in advanced ovarian cancer with intraluminal stents.

    BACKGROUND: The course of many patients with end-stage gynecologic malignancy will be complicated by malignant bowel obstruction. Intraluminal stents are a novel alternative to standard surgical intervention which can involve considerable patient risk. CASES: Two cases are presented of patients with upper gastrointestinal obstruction due to recurrent ovarian cancer. In the first case, a stent was utilised to provide relief from nocturnal vomiting secondary to duodenal obstruction. In the second case, stent insertion for subtotal gastric outlet obstruction provided initial relief from vomiting. However, recurrence of symptoms occurred due to stent occlusion from tumour ingrowth. CONCLUSIONS: In patients with upper gastrointestinal obstruction due to recurrent gynecologic malignancy, intraluminal stents can provide useful palliation.
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3/5. shock-wave therapy of gastric outlet syndrome caused by a gallstone.

    A patient with gastric outlet syndrome (Bouveret's syndrome) caused by a large gallstone impacted in the duodenal bulb was successfully treated by extracorporeal shock-wave lithotripsy. Thus, open abdominal surgery could be avoided. For disintegration of the stone, three consecutive lithotripsy procedures were necessary. Thereafter, stone fragments could be extracted endoscopically. Extracorporeal shock-wave lithotripsy could become a non-surgical alternative in patients with obstruction of the duodenum caused by a gallstone.
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4/5. Recurrent superior mesenteric artery syndrome complicating staged reconstructive spinal surgery: alternative methods of conservative treatment.

    Recurrent superior mesenteric artery syndrome is an infrequent complication following reconstructive spinal surgery. However, if diagnosis and treatment are delayed, life-threatening dehydration and electrolyte abnormalities may occur. Recent advances in oral and parenteral alimentation have simplified the treatment of superior mesenteric artery syndrome following the early recognition of the characteristic clinical and radiographic presentation. This case report describes the early diagnosis and various methods of conservative treatment of recurrent superior mesenteric artery syndrome following staged reconstructive spinal surgery.
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5/5. Groove pancreatitis with recurrent duodenal obstruction. Report of a case successfully treated with pylorus-preserving pancreaticoduodenectomy.

    Groove pancreatitis is a rare subtype of chronic pancreatitis that is difficult to distinguish from pancreatic carcinoma. Most reported patients have undergone a Whipple procedure because pancreatic cancer was not ruled out. We report a case of groove pancreatitis in a patient who presented with recurrent duodenal obstruction without biliary stricture. The diagnosis of groove pancreatitis was based on characteristic episodes of repeated duodenal obstruction and the absence of radiographic evidence of cancer. Subsequently, our patient underwent a successful pylorus-preserving pancreaticoduodenectomy (PPPD). PPPD is a favorable alternative to the Whipple operation for duodenal obstruction resulting from this disease.
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