Cases reported "Duodenal Obstruction"

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11/225. duodenal obstruction due to a swallowed nasogastric tube.

    Nasogastric tubes are commonly used, not only in surgical practice but in all disciplines. Their use, however, is not without complications. We present the first reported case of duodenal obstruction due to a swallowed nasogastric tube, and recommend that nasogastric tubes be used in their entirety (uncut) with the splayed distal end intact. This simple procedure will prevent a rare but distressing complication that might be amenable only to laparotomy.
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12/225. gastric outlet obstruction by a gallstone (Bouveret's syndrome).

    gastric outlet obstruction caused by a gallstone in the duodenum or pylorus(Bouveret's syndrome) is a very rare complication of gallstone disease. Presenting symptoms include epigastric pain, nausea, and vomiting. Preoperative diagnosis is not easy. Oral endoscopy is one of the diagnostic procedures. We present a case in which the diagnosis was made by endoscopic examination. Multiple attempts at endoscopic extraction of the gallstone from the duodenum were unsuccessful. A one-stage surgical procedure consisting of the removal of the impacted stone, fistula repair, and cholecystectomy was performed in this case. The postoperative course was uneventful.
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13/225. Extended-release nifedipine bezoar identified one year after discontinuation.

    OBJECTIVE: To report a case of tablet impaction of nifedipine extended-release tablets (Procardia XL) discovered one year after discontinuation of the drug in a patient with peptic stricture. DATA SOURCES: English-language references identified via a medline search from 1966 through September 1998 and bibliographic review of pertinent articles. DATA SYNTHESIS: Extended-release nifedipine has been associated with the formation of medication bezoars in case reports. bezoars are concretions of undigested material within the gastrointestinal (GI) tract. Although they can occur throughout the GI tract, bezoars are most frequently located in the stomach and, rarely, in the duodenum. We report an unusual case of tablet impaction with a gastric outlet obstruction in the duodenal area discovered one year after the patient stopped taking extended-release nifedipine. CONCLUSIONS: Extended-release nifedipine is associated with tablet impaction, even long after discontinuing administration. Although rare, clinicians should be aware of this potential problem when prescribing extended-release medications to patients at risk, and should consider this possible etiology when refractory epigastric pain and weight loss occur.
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14/225. choledochal cyst associated with duodenal obstruction.

    The association between congenital duodenal obstruction and concomitant choledochal cyst has not been reported, although duodenal obstruction is known to be associated with many other anomalies. The authors describe 2 patients with choledochal cyst with duodenal obstruction. In 1 patient, a diverticulum type of choledochal cyst was found within an annular pancreas. Cyst excision, choledochojejunostomy, and side-to-side duodeno-duodenostomy were performed. The other patient showed separated duodenal atresia and other multiple anomalies including imperforate anus. A choledochal cyst was noted at the time of duodeno-duodenostomy and sigmoid colostomy. Cyst-enterostomy was performed at the age of 8 months, but the patient died of multiple anomalies. Intraoperative cholangiography indicated an anomalous pancreatobiliary ductal junction (APBDJ). In both patients the bile in the cyst contained high levels of amylase, suggesting the presence of an APBDJ. An APBDJ is considered to play an etiologic role in the development of the choledochal cysts associated with duodenal obstruction.
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15/225. Congenital duodenal diaphragms in adults: a delayed cause of intestinal obstruction.

    Congenital duodenal diaphragms in the adult are uncommon, unsuspected lesions that infrequently cause intestinal obstruction. The diaphragms may be single or multiple and are usually located near the ampulla of vater. Three cases are summarized and the recent literature reviewed. At least 35 cases have been reported. Treatment most often consisted of duodenotomy,excision of the web and duodenal closure.
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16/225. The transhepatic route for the placement of a duodenojejunal stent: application in a postoperative closed loop obstruction of the duodenum.

    A patient who had undergone gastric resection for carcinoma, had closed loop obstruction of the duodenum due to neoplasia at the duodenojejunal junction. The obstruction was relieved successfully by transhepatic placement of a duodenojejunal stent. We were compelled to use the transhepatic route because a Roux-Y reconstruction had been performed. Transhepatic placement may be the only chance of palliation in a small subset of patients with malignant intestinal obstruction.
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17/225. Endoscopic palliation for pancreatic cancer with expandable metal stents.

    Pancreatic cancer is generally not amenable to curative resection. Consequently, therapeutic efforts for these patients are most commonly directed at palliation of symptoms. Historically, surgery has been considered the most effective method of providing relief for biliary and/or enteric obstruction. However, less invasive methods have become available that can provide effective relief of jaundice and duodenal obstruction. Surgeons should still play an integral role in the management of these patients. We present a case report in which self-expanding metallic stents were used to relieve obstruction of the bile duct and duodenum in a patient with unresectable pancreatic cancer.
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18/225. Annular duodenal stricture due to Brunner's gland hyperplasia.

    A patient with obstructive Brunner's gland hyperplasia presenting as an annular duodenal stricture is reported. Surgical biopsy was required to obtain a tissue specific diagnosis and obstruction was relieved by performing a Roux-en-Y duodenojejunostomy. Brunner's gland hyperplasia poses a diagnostic challenge. Conservative management is usually adequate after a histological diagnosis has been firmly established.
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19/225. Duodenal atresia with an anomalous common bile duct masquerading as a midgut volvulus.

    In a patient with duodenal atresia, a "double bubble" is classically present on plain radiographs. When bowel gas exists distal to the duodenum, duodenal atresia often is excluded from the differential diagnosis. The authors present a case in which contrast can be seen in the small bowel and biliary system on upper gastrointestinal series in a patient with duodenal atresia and an anomalous common bile duct. One always must consider duodenal atresia with an anomalous biliary system as a possible cause of bilious vomiting with a high grade proximal bowel obstruction in a neonate. J Pediatr Surg 36:956-957.
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20/225. diagnosis and management of duodenal obstruction due to renal cell carcinoma.

    Two cases of duodenal obstruction secondary to renal cell carcinoma are described. One case had delayed metastasis to duodenum four years after right radical nephrectomy and the second case had a large right renal cell carcinoma with duodenal involvement. The possibility of duodenal involvement or metastasis should be kept in mind in any patient presenting with upper gastrointestinal obstructive symptoms and with right sided renal tumour or radical nephrectomy in the past. Whenever suspected, radiography and if required endoscopic assessment should be supplemented to diagnose this condition. Extensive local disease or presence of concurrent metastasis usually rules out the possibility of cure. We describe the clinico-radiological features of this condition along with a review of the literature.
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