Cases reported "Duodenal Obstruction"

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1/225. superior mesenteric artery syndrome simulating acute pancreatitis: a case report.

    A case of infrapapillary duodenal obstruction secondary to the superior mesenteric artery syndrome is reported. The clinical picture and laboratory data simulated acute pancreatitis but no evidence of pancreatic disease was noted at surgical exploration. A review of the causative factors and treatment of the superior mesenteric artery syndrome is presented along with the differential diagnosis of infrapapillary duodenal obstruction.
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keywords = obstruction
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2/225. An unusual clinical presentation of pancreatic carcinoma: duodenal obstruction in the absence of jaundice.

    A case of pancreatic carcinoma, presenting with the uncommon initial manifestation of vomiting secondary to duodenal obstruction without jaundice, is reported. A review of 72 consecutive biopsy-proven cases of pancreatic carcinoma admitted to our institution in the past five years revealed an 8.3% incidence of this unusual primary complaint. Although infrequently reported previously, pancreatic carcinoma should be considered in the differential diagnosis of gastric outlet obstruction in the absence of jaundice. The classic triad of progressive jaundice, weight loss and abdominal pain suggests carcinoma of the head of the pancreas. Emesis, secondary to high grade duodenal obstruction in the absence of jaundice, is an infrequent clinical presentation. The case described is illustrative of widespread pancreatic carcinoma that remained silent until obstruction developed.
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ranking = 4
keywords = obstruction
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3/225. Superior mesenteric artery (Wilkie's) syndrome: report of three cases and review of the literature.

    Of the three cases of superior mesenteric artery (Wilkie's) syndrome presented, one was associated with anorexia nervosa; this association has not been reported before. Two patients were treated surgically with a duodenojejunostomy, and one was treated medically. Vascular compression of the duodenum is a controversial subject. The syndrome probably is more common than generally recognized and is underdiagnosed due to its exclusion from the differential diagnosis of small-bowel obstruction. Its recognition is important because early diagnosis of a partial obstruction may allow for medical rather than surgical intervention, as exemplified by our third case.
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4/225. Intestinal blind pouch- and blind loop- syndrome in children operated previously for congenital duodenal obstruction.

    A follow-up study of 27 children operated for congenital duodenal obstruction (CDO) in the years 1953--71 is presented. Nine children belonged to the intrinsic and 18 children to the extrinsic group of CDO. A total of 7 retrocolic, isoperistaltic, side-to-side duodeno-jejunostomy, 7 Ladd's operation, 8 duodenolysis, 2 reduction of midgut volvulus, 2 duodenostomy a.m. Morton and one gastro-jejunostomy were performed at the age of 1 day--15 years. The clinical and radiological examinations were performed 3--21 years (mean 10 years 2 months) after these operations. In 3 cases there was a moderate duodenal dilatation, but reoperation was not necessary. During the follow-up period, one boy, now aged 8 years, developed a blind pouch-syndrome in the I portion of the duodenum containing a 5 x 5 cm phytobezoar 4 1/2 years after duodeno-jejunostomy. The frequency of blind pouch-syndrome after duodeno-jejunostomy was thus 1:7 or 14%. One girl, now aged 9 years, developed a blind loop-syndrome in the ileocaecal segment 3 months after side-to-side ileotransversostomy, which was performed from adhesion-obstruction after duodenolysis for malrotation I and CDO. Both the blind pouch- and the blind loop-deformation were resected and the children recovered well. To avoid blind-pouch- and blind loop-deformations in the intestines, the anastomosis must be made wide enough, and especially in the surgery of the jejuno-ileo-colic region an end-to-end anastomosis is preferable.
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ranking = 3
keywords = obstruction
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5/225. duodenal obstruction by gallstone: case report of Bouveret's syndrome.

    Bouveret's syndrome involves gastric outlet obstruction by gallstone. Herein we describe an unusual case of duodenal bulb obstruction by gallstone. An 80-year-old woman was hospitalized with a fifteen-day history of vomiting. Computed tomography (CT) showed pneumobilia and a round calcified mass in the second portion of the duodenum. upper gastrointestinal tract series demonstrated the same sized oval radiolucency between the bulbus and the second portion of the duodenum. Endoscopic examination revealed a round black mass in the second portion of the duodenum, totally occupying the lumen. Endoscopic removal and destruction of the gallstone was attempted using a dye-laser, but the stone was too hard to crush. Eventually surgical enterolithotomy was successfully performed without cholecystectomy or closure of the fistula. Improved preoperative systemic management and prompt examination allowed earlier surgical intervention and reduced the morbidity. Surgical approach whether fistula closure should be performed remains controversial.
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ranking = 3
keywords = obstruction
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6/225. Palliative transhepatic biliary drainage and enteral nutrition.

    Simultaneous intestinal and biliary obstruction is a rare but agonizing complication of metastatic abdominal cancer. Although endoscopic procedures exist that relieve jaundice or restore enteral nutrition, they can be impossible to perform for technical or anatomical reasons. We propose a palliative approach for these patients that includes transcutaneous common bile duct drainage, progressive dilation of the transhepatic channel over 1 wk, and, finally, insertion of a permanent silicon catheter that drains bile into the duodenum and is combined with an enteral feeding line. We report three patients whose metastatic abdominal tumors had led to simultaneous jaundice and gastric outlet obstruction, neither of which could be treated endoscopically. In all patients, the transcutaneous bile drainage catheter combined with the enteral feeding line was inserted and tumor symptoms resolved rapidly. As a result, the patients chose to return to home care with enteral nutrition and pain medication. The creation of a transhepatic access for simultaneous enteral bile drainage and nutrition is a technically simple procedure that causes little discomfort to a terminally ill patient. It relieves the symptoms of tumor obstruction, and the option of enteral nutrition and medication can obviate the need for intravenous infusions.
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ranking = 1.5
keywords = obstruction
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7/225. Electrohydraulic lithotripsy treatment of gallstone after disimpaction of the stone from the duodenal bulb (Bouveret's syndrome).

    A 75-year-old man with right upper quadrant abdominal pain was diagnosed by gastroscopy to have an impacted gallstone in the duodenal bulb. Using the polypectomy loop, the stone was extracted from the bulbus and mobilized into the stomach. After failure to remove the stone from the stomach as well as fragmentation by mechanical lithotripsy, electrohydraulic lithotripsy was used to break up the stone, parts of which passed spontaneously through the bowel. Thus, it was unnecessary to proceed with surgical enterolithotomy to remove, from the duodenal bulb, the impacted gallstone responsible for the gastric outlet obstruction.
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ranking = 0.5
keywords = obstruction
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8/225. Metallic stents in the treatment of duodenal obstruction: technical issues and results.

    OBJECTIVE: To evaluate the efficacy of duodenal stenting procedures and to review technical issues with these procedures in a series of cases over a 1-year period. methods: Expandable metallic stents (Wallstents) of varying sizes were introduced and deployed in 4 patients (1 man and 3 women 42 to 81 years of age). Each patient underwent a separate method of stent introduction with either fluoroscopic or endoscopic guidance, either perorally, transgastrically and transhepatically. RESULTS: All procedures were technically successful, allowing patients to continue eating normally. In 1 patient, stent foreshortening necessitated the introduction of a second stent. Another patient experienced transient stent obstruction by food; this resolved spontaneously and required no additional intervention. Based on the patients' continuing ability to tolerate food, it was believed that the stents remained patent until the time of death (from 3 days to 9 weeks with a mean of 5.25 weeks). CONCLUSIONS: Duodenal stenting procedures provide a relatively new, technically feasible and efficacious method of managing duodenal obstructions, especially in patients who are poor candidates for surgery.
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ranking = 3
keywords = obstruction
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9/225. An antenatally-diagnosed solitary, non-parasitic hepatic cyst with duodenal obstruction.

    Congenital solitary, non-parasitic liver cysts are uncommon lesions that are rarely diagnosed antenatally. The cystic nature of the antenatally-diagnosed abdominal cyst in our case was confirmed postnatally by ultrasound. Partial excision with marsupialisation and release of extrinsic bands on the second part of the duodenum was done.
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ranking = 2
keywords = obstruction
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10/225. Bouveret's syndrome complicated by acute pancreatitis.

    BACKGROUND/AIM: This study evaluated a case of Bouveret's syndrome due to a cholecystoduodenal fistula and gallstone obstruction of the duodenum, complicated by acute pancreatitis and cholecystitis. methods: The presenting features, special investigations, radiological findings, operative and endoscopic procedures were reviewed. RESULTS: Symptoms persisted after laparotomy and removal of a gallstone in the duodenum. Intra-operative endoscopy identified a second previously undetected stone impacted in the distal duodenum. CONCLUSION: The importance of excluding more than one stone causing Bouveret's syndrome is emphasized.
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ranking = 0.5
keywords = obstruction
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