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Nojima H, Shimizu H, Hirota M, Murakami T, Yamazaki M, Yamazaki K, Shuto K, Kosugi C, Mori M, Usui A, Sazuka T, Koda K. An ampullary adenoma presenting with jaundice caused by duodenal intussusception: a case report. Surg Case Rep 2024; 10:25. [PMID: 38252200 PMCID: PMC10803710 DOI: 10.1186/s40792-024-01822-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 01/12/2024] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Ampullary adenomas are premalignant lesions. However, biliary obstruction causing jaundice is rare. Duodenal intussusception secondary to an ampullary adenoma rarely occurs because of the fixed position of the duodenum in the retroperitoneum. Herein, we have described a rare case of ampullary adenoma with jaundice caused by duodenal intussusception. CASE PRESENTATION A 40-year-old woman presenting with vomiting and yellowish discoloration of the skin was admitted to another hospital. The patient had experienced recurrent epigastric pain and vomiting for the past 18 months. Blood test results showed elevated levels of bilirubin (3.9 mg/dL), and abdominal computed tomography (CT) showed a 60-mm hypovascular mass in the third part of the duodenum and a left lateral shift of the dilated common bile duct. The patient was referred to our hospital for further evaluation. She recovered from hyperbilirubinemia spontaneously (levels of bilirubin, 1.0 mg/dL), and the CT showed a tumor shift from the third part of the duodenum to the second part and improvement of the dilated common bile duct. Hypotonic duodenography revealed a tumor that moved easily from the second to the third portion of the patient's position. Upper gastrointestinal endoscopy revealed a large papillary tumor occupying the second part of the duodenum, which was diagnosed as an adenoma through biopsy. The possibility of malignancy could not be negated owing to the presence of jaundice and an elevated carbohydrate antigen 19-9 level (76.0 U/mL). Pancreaticoduodenectomy was performed. The resected specimen showed a 60 × 40 × 40-mm pedunculated ampullary mass with submucosal elongation. The pathological examination indicated that the ampullary tumor was a high-grade intestinal adenoma. The postoperative course was uneventful, and the patient was discharged 26 days postoperatively. CONCLUSIONS This report describes a rare case of a patient with an ampullary adenoma presenting with jaundice resulting from duodenal intussusception. Owing to the possibility of a postoperative cancer diagnosis which may have caused the biliary obstruction and the difficulty in making an accurate preoperative diagnosis, it is imperative to choose the appropriate surgical procedure such as a pancreaticoduodenectomy.
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Affiliation(s)
- Hiroyuki Nojima
- Department of Surgery, Teikyo University Chiba Medical Center, Anesaki, Ichihara, Chiba, 3426-3299-0011, Japan
| | - Hiroaki Shimizu
- Department of Surgery, Teikyo University Chiba Medical Center, Anesaki, Ichihara, Chiba, 3426-3299-0011, Japan.
| | - Mihono Hirota
- Department of Surgery, Teikyo University Chiba Medical Center, Anesaki, Ichihara, Chiba, 3426-3299-0011, Japan
| | - Takashi Murakami
- Department of Surgery, Teikyo University Chiba Medical Center, Anesaki, Ichihara, Chiba, 3426-3299-0011, Japan
| | - Masato Yamazaki
- Department of Surgery, Teikyo University Chiba Medical Center, Anesaki, Ichihara, Chiba, 3426-3299-0011, Japan
| | - Kazuto Yamazaki
- Department of Pathology, Teikyo University Chiba Medical Center, Anesaki, Ichihara, Chiba, 3426-3299-0011, Japan
| | - Kiyohiko Shuto
- Department of Surgery, Teikyo University Chiba Medical Center, Anesaki, Ichihara, Chiba, 3426-3299-0011, Japan
| | - Chihiro Kosugi
- Department of Surgery, Teikyo University Chiba Medical Center, Anesaki, Ichihara, Chiba, 3426-3299-0011, Japan
| | - Mikihito Mori
- Department of Surgery, Teikyo University Chiba Medical Center, Anesaki, Ichihara, Chiba, 3426-3299-0011, Japan
| | - Akihiro Usui
- Department of Surgery, Teikyo University Chiba Medical Center, Anesaki, Ichihara, Chiba, 3426-3299-0011, Japan
| | - Tetsutaro Sazuka
- Department of Surgery, Teikyo University Chiba Medical Center, Anesaki, Ichihara, Chiba, 3426-3299-0011, Japan
| | - Keiji Koda
- Department of Surgery, Teikyo University Chiba Medical Center, Anesaki, Ichihara, Chiba, 3426-3299-0011, Japan
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Shenoy KG, Gadiyaram S, Ramesh BS. Novel laparo-endoscopic hybrid technique of management of a rare case of duodeno-duodenal intussusception. J Minim Access Surg 2023:386310. [PMID: 37843157 DOI: 10.4103/jmas.jmas_112_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023] Open
Abstract
We herein report a rare case of duodeno-duodenal intussusception (IS) presenting with obstruction caused by tubulovillous adenoma in an adult with malrotation that was managed by a novel laparoendoscopic hybrid technique. This was done by passing transjejunal nasogastric tube (NG) through one of the ports and manoeuvring it towards the IS. Two hundred and fifty millilitre of saline was flushed by aseptosyringe with pressure connected to the NG. This hydrostatic reduction technique resulted in distension of the jejunal and duodenal loop achieving reduction of IS. Intraoperative endoscopy was performed to exactly localise the mass lesion. The duodenum was kocherised and was delivered through a 4-cm transverse incision. Anterior duodenotomy was performed; the mass was excised; and duodenotomy was closed transversely. An extensive literature search did not show any case report of duodenoduodenal IS being managed by this technique. The combination of novel retrograde decompression and intraoperative endoscopy helped us to manage this rare case by this novel technique.
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Affiliation(s)
- K Ganesh Shenoy
- Department of Minimal Access, GI and Bariatric Surgery, Fortis Hospital, Bengaluru, Karnataka, India
| | - Srikanth Gadiyaram
- Department of Surgical Gastroenterology and Minimally Invasive Surgery, Sahasra Hospitals, Bengaluru, Karnataka, India
| | - B S Ramesh
- Department of Minimal Access, GI and Bariatric Surgery, Fortis Hospital, Bengaluru, Karnataka, India
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Das S, Sunil J, Prakash S, Shaikh OH, Reddy A, Kumbhar US. Duodeno-duodenal intussusception presenting as upper gastrointestinal bleed. BMJ Case Rep 2023; 16:e250003. [PMID: 37607766 PMCID: PMC10445347 DOI: 10.1136/bcr-2022-250003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023] Open
Abstract
Duodeno-duodenal intussusception (DDI) is the type of intestinal intussusception in which a segment of the duodenum invaginates into the next part of the duodenum. We present a case of a male patient in his 50s presenting with right upper abdominal pain with multiple episodes of vomiting and a history of melena for 1 month. Imaging studies showed the presence of DDI without apparent growth. The patient underwent upper gastrointestinal endoscopy, which showed a doubtful growth in the duodenum, and the biopsy, was suggestive of adenocarcinoma. The patient underwent Whipple's procedure, and postoperative histology was diagnostic of Brunner's gland adenoma. The patient improved well without any complications.
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Affiliation(s)
- Snehasis Das
- Surgery, Jawaharlal Institute of Postgraduate Medical Education, Puducherry, India
| | - Julia Sunil
- Surgery, Jawaharlal Institute of Postgraduate Medical Education, Puducherry, India
| | - Sagar Prakash
- Surgery, Jawaharlal Institute of Postgraduate Medical Education, Puducherry, India
| | - Oseen Hajilal Shaikh
- Surgery, Jawaharlal Institute of Postgraduate Medical Education, Puducherry, India
| | - Abhinaya Reddy
- Surgery, Jawaharlal Institute of Postgraduate Medical Education, Puducherry, India
| | - Uday Shamrao Kumbhar
- Surgery, Jawaharlal Institute of Postgraduate Medical Education, Puducherry, India
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Elghezewi A, Hammad M, Mohamed M, Chirico P, Frandah W. A Rare Case of Anterograde Gastroduodenal Intussusception Caused by Migrated Percutaneous Endoscopic Gastrostomy Feeding Tube. J Med Cases 2023; 14:169-173. [PMID: 37303971 PMCID: PMC10251706 DOI: 10.14740/jmc4101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 05/16/2023] [Indexed: 06/13/2023] Open
Abstract
Gastroduodenal intussusception is a critical condition in which stomach protrudes into the duodenum. It is a very rare condition in adults. Most common causes include intra luminal lesions in the stomach including benign or malignant tumors of the stomach. Most common tumors included are gastrointestinal stromal tumors (GISTs), gastric carcinoma, gastric lipoma, gastric leiomyoma, and gastric schwannoma. It is extremely rare to be caused by migration of percutaneous feeding tube. A 50-year-old woman with a past medical history (PMH) of dysphagia status post percutaneous endoscopic gastrostomy (PEG) tube, history of spastic quadriplegia, presented with acute nausea, vomiting and abdominal distention, and was found to have gastroduodenal intussusception in computed tomography (CT) scan. Condition resolved after retracting PEG tube. Endoscopy did not reveal any intra luminal lesions. External fixation using Avanos Saf-T-Pexy T-fasteners was performed to prevent recurrence of this condition. Most common of causes of gastroduodenal intussusception are GIST tumors of stomach. CT abdomen is the most accurate test and upper endoscopy is needed to rule out any intra luminal causes. Treatment of choice is either endoscopic or surgical resection. External fixation is essential to prevent recurrence.
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Affiliation(s)
- Abdelwahap Elghezewi
- Department of Medicine, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV 25701, USA
| | - Mohamed Hammad
- Department of Medicine, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV 25701, USA
| | - Mujtaba Mohamed
- Section of Gastroenterology and Hepatology, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV 25701, USA
| | - Peter Chirico
- Department of Radiology, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV 25701, USA
| | - Wesam Frandah
- Section of Gastroenterology and Hepatology, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV 25701, USA
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Matsuura H, Saito A, Amano Y, Morishima K, Sasanuma H, Lefor AK, Sata N. Intussusception of the third portion of the duodenum secondary to a primary duodenal malignancy: A case report. Int J Surg Case Rep 2022; 94:107085. [PMID: 35439730 PMCID: PMC9027327 DOI: 10.1016/j.ijscr.2022.107085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 04/11/2022] [Accepted: 04/11/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction and importance Intussusception is invagination of the bowel and is rare in adults, representing only 5% of all cases of intussusception. Duodenal intussusception is also very rare. To the best of our knowledge, there is only one previous report of a malignant tumor in the fourth portion of the duodenum as the lead point of intussusception (Vaibhav et al., 2021 [1]). This reports a duodenal-duodenal intussusception caused by a malignant tumor in the third portion of the duodenum. Case presentation A 36-year-old woman with abdominal pain was diagnosed with duodenal intussusception by abdominal ultrasonography and computed tomography scan. Double balloon endoscopy showed that the intussusception had spontaneously reduced, and a tumor was found in the third portion of the duodenum. Open resection was performed because of the tumor location. Pathologic examination revealed adenocarcinoma with an adenoma of the duodenum. The patient had no evidence of recurrence for 4 years after resection. Clinical discussion This patient had a primary duodenal malignancy and presented with intussusception, Duodenal intussusception is a rare condition requiring prompt intervention, usually requiring surgery. In this patient, since endoscopic resection was difficult, partial resection of duodenum was performed by open surgery assisted by double balloon enteroscopy. The pathological diagnosis of the resected specimen was primary duodenal malignancy. Conclusion This is a report of adult duodenal intussusception caused by a primary duodenal malignancy. This rare condition posed an intriguing challenge for the optimal operative approach. Duodenal intussusception caused by a primary tumor is extremely rare. Intussusception is rare in adults. A duodenal tumor was identified with double balloon endoscopy and resected.
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Duodeno-Duodenal Intussusception Presenting as Acute Pancreatitis due to Duodenal Adenocarcinomas: a Rare Case Report. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02360-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Sousa P, Ferreira A. Waugh's syndrome: a rare cause of bowel obstruction in adults. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2020; 112:950-951. [PMID: 33226259 DOI: 10.17235/reed.2020.6977/2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Waugh's syndrome is the association of intussusception and intestinal malrotation, almost always reported in the pediatric population. We present images of a middle-aged adult with a large ileocolic intussusception in association with intestinal malrotation, the latter was concluded to be the underlying cause.
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Affiliation(s)
- Pedro Sousa
- Radiology , Hospital Beatriz Ângelo , Portugal
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Wang KP, Jiang H, Kong C, Wang LZ, Wang GY, Mo JG, Jin C. Adult duodenal intussusception with horizontal adenoma: A rare case report. World J Clin Cases 2020; 8:3314-3319. [PMID: 32874987 PMCID: PMC7441246 DOI: 10.12998/wjcc.v8.i15.3314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/01/2020] [Accepted: 07/14/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Adult duodenal intussusception rarely occurs, and the majority of duodenal adenomas are located in the descending part of the duodenum. Therefore, adenomas in the horizontal part of the duodenum presenting as duodenal intussusception in adults are extremely rare.
CASE SUMMARY A 36-year-old man complained of abdominal pain for 13 d. Blood analysis showed anemia. Magnetic resonance cholangiopancreatography and computed tomography revealed a tumor in the horizontal part of the duodenum as the main finding, leading to duodeno-duodenal intussusception. No obvious abnormalities were found on endoscopy or upper gastrointestinal radiography. He was diagnosed with duodenal intussusception secondary to duodenal adenoma. Laparotomy showed duodeno-duodenal intussusception and a tumor in the horizontal part of the duodenum near the ascending part. Postoperative pathology revealed tubular-villous adenoma with low-grade glandular intraepithelial neoplasia (local high-grade intraepithelial neoplasia). He was discharged without complications.
CONCLUSION This case highlights that rational use of computed tomography, magnetic resonance cholangiopancreatography, endoscopy and upper gastrointestinal radiography for preoperative diagnosis and timely surgery is an effective strategy for the treatment of adult duodenal intussusception with duodenal masses.
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Affiliation(s)
- Kun-Peng Wang
- Department of General Surgery, Taizhou Central Hospital (Taizhou University Hospital), Taizhou 318000, Zhejiang Province, China
| | - Hao Jiang
- Department of General Surgery, Taizhou Central Hospital (Taizhou University Hospital), Taizhou 318000, Zhejiang Province, China
| | - Can Kong
- Department of General Surgery, Taizhou Central Hospital (Taizhou University Hospital), Taizhou 318000, Zhejiang Province, China
| | - Lie-Zhi Wang
- Department of General Surgery, Taizhou Central Hospital (Taizhou University Hospital), Taizhou 318000, Zhejiang Province, China
| | - Guo-Yu Wang
- Department of Radiology, Taizhou Central Hospital (Taizhou University Hospital), Taizhou 318000, Zhejiang Province, China
| | - Jing-Gang Mo
- Department of General Surgery, Taizhou Central Hospital (Taizhou University Hospital), Taizhou 318000, Zhejiang Province, China
| | - Chong Jin
- Department of General Surgery, Taizhou Central Hospital (Taizhou University Hospital), Taizhou 318000, Zhejiang Province, China
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Guo Y, Liu B, Pan Z, Zhang Y. Acute duodenal obstruction secondary to intussusception caused by the duodenal diverticulum: a case report. BMC Gastroenterol 2020; 20:234. [PMID: 32698796 PMCID: PMC7376838 DOI: 10.1186/s12876-020-01379-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 07/12/2020] [Indexed: 11/29/2022] Open
Abstract
Background The duodenal intussusception is rarely reported and usually occurs secondary to organic diseases of the duodenum such as polyps, tumors and duplication cysts. Herein we report a case of duodenal intussusception caused by duodenal diverticulum. Case presentation A 21-year old male patient presented with abdominal pain and vomiting for one day. A contrast enhanced computed tomography of the abdomen revealed duodenal intussusception. On emergency laparotomy, the intussusception had reduced spontaneously while an invaginated diverticulum was seen at the junction of the descending and horizontal segments of the duodenum. The diverticulum was resected and the patient had uneventful recovery. Conclusion Duodenal intussusception is a rare complication of duodenal diverticulum. Being aware of this complication of diverticulum can help in timely diagnosis and treatment.
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Affiliation(s)
- Yuchen Guo
- Department of Gastrointestinal Surgery, First Hospital of Jilin University, Changchun, 130021, Jilin, China
| | - Bin Liu
- Department of Gastrointestinal Surgery, First Hospital of Jilin University, Changchun, 130021, Jilin, China
| | - Ziwen Pan
- Department of Gastrointestinal Surgery, First Hospital of Jilin University, Changchun, 130021, Jilin, China
| | - Yang Zhang
- Department of Gastrointestinal Surgery, First Hospital of Jilin University, Changchun, 130021, Jilin, China.
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A. N. Alzerwi N. Duodenoduodenal and duodenojejunal intussusceptions in adults: A systematic review with a focus on demographics, diagnosis, and etiology. AIMS MEDICAL SCIENCE 2020. [DOI: 10.3934/medsci.2020012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Hirata M, Shirakata Y, Yamanaka K. Duodenal intussusception secondary to ampullary adenoma: A case report. World J Clin Cases 2019; 7:1857-1864. [PMID: 31417932 PMCID: PMC6692261 DOI: 10.12998/wjcc.v7.i14.1857] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 05/13/2019] [Accepted: 05/23/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Because the duodenum is fixed onto the retroperitoneum, duodenal intussusception is usually impossible except in cases of malrotational abnormality. Although cases of duodenal intussusception without malrotational abnormalities have been reported, it is unclear whether they constitute true intussusception or simple mucosal prolapse.
CASE SUMMARY A 66-year-old woman presented with whole-body edema and malaise. Blood analysis indicated severe anemia and cholestasis. Endoscopic examination revealed a pedunculate polyp on the second part of the duodenum that migrated distally with mucosal elongation. Computed tomography showed duodenal intussusception. A tumor as the lead point and retroperitoneal structure, including the head of the pancreas and fat, invaginated beyond the duodenojejunal flexure. She was diagnosed with ampullary adenoma caused repeated intussusception that reduced spontaneously and underwent pancreaticoduodenectomy. Laparotomy showed tumor prolapse beyond the duodenojejunal flexure without intussusception. There was no evidence of malrotational abnormality. She was discharged with no complications.
CONCLUSION We report true duodenal intussusception without malrotational abnormality. This phenomenon was also associated with mucosal prolapse.
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Affiliation(s)
- Masaaki Hirata
- Department of Surgery, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo 660-0892, Japan
| | - Yoshiharu Shirakata
- Department of Surgery, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo 660-0892, Japan
| | - Kenya Yamanaka
- Department of Surgery, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo 660-0892, Japan
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Unusual Presentation of Duodenal Ulcer Presenting with Duodenal Intussusception. ACG Case Rep J 2018; 5:e25. [PMID: 29619400 PMCID: PMC5876451 DOI: 10.14309/crj.2018.25] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 01/25/2018] [Indexed: 12/29/2022] Open
Abstract
We present a unique case of duodeno-duodenal intussusception from a duodenal bulb ulcer. A 38-year-old man presented with nausea, vomiting, and abdominal pain. Computed tomography showed duodenal intussusception. Esophagogastroduodenoscopy (EGD) showed a linear gastric ulcer and a duodenal bulb ulcer with an overlying blood clot. Helicobacter pylori status was positive. Intussusception resolved spontaneously without intervention. He completed treatment for H. pylori infection, and repeat EGD showed ulcer healing. Duodenal intussusception is rarely reported; intussusception from an edematous duodenal ulcer with an overlying blood clot mimicking a mass lesion acting as lead point has never been reported to our knowledge.
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Jabłoński S, Kustalik S, Klejszmit P, Misiak P. Total duodenal necrosis with retroperitoneal perforation in an adolescent with jejunal intussusceptions. J Dig Dis 2016; 17:483-5. [PMID: 27206647 DOI: 10.1111/1751-2980.12360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Revised: 04/28/2016] [Accepted: 05/18/2016] [Indexed: 12/11/2022]
Affiliation(s)
- Sławomir Jabłoński
- Department of Thoracic Surgery, General and Oncological Surgery, Medical University of Lodz, Łódź, Poland.
| | - Sylwia Kustalik
- Department of Thoracic Surgery, General and Oncological Surgery, Medical University of Lodz, Łódź, Poland
| | - Piotr Klejszmit
- Department of Thoracic Surgery, General and Oncological Surgery, Medical University of Lodz, Łódź, Poland
| | - Piotr Misiak
- Department of Thoracic Surgery, General and Oncological Surgery, Medical University of Lodz, Łódź, Poland
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Chai LF, Batista PM, Lavu H. Taking the Lead: A Case Report of a Leiomyoma Causing Duodeno-Duodenal Intussusception and Review of Literature. Case Rep Pancreat Cancer 2016; 2:19-22. [PMID: 30631810 PMCID: PMC6319677 DOI: 10.1089/crpc.2016.0001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background: Duodenal masses are rare entities and symptomatic presentation generally is due to abdominal pain or the presence of gastrointestinal bleeding. A number of published case reports in the literature have detailed various neoplasms that have caused an intussusception isolated to the duodenum. This is a particularly unusual phenomenon due to the location and fixation of this portion of the proximal small bowel to the retroperitoneum. We present here a case of duodeno-duodenal intussusception secondary to a leiomyoma. Case: A 65-year-old Caucasian male presented with intermittent bloody stools and syncope over a 9-month period secondary to a duodenal leiomyoma causing intussusception, which was treated through a pancreaticoduodenectomy. Conclusion: Intussusception of the duodenum is an uncommon entity and the diagnosis of a leiomyoma should be considered in the setting of a potential mass in the small intestine.
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Affiliation(s)
- Louis F. Chai
- Rutgers-Robert Wood Johnson Medical School, Piscataway, New Jersey
| | - Philip M. Batista
- Department of Surgery, Jefferson Pancreas, Biliary, and Related Cancer Center, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Harish Lavu
- Department of Surgery, Jefferson Pancreas, Biliary, and Related Cancer Center, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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15
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Imaging Findings of Duodenal Duplication Cyst Complicated with Duodenal Intussusception and Biliary Dilatation. Case Rep Radiol 2016; 2016:3069576. [PMID: 26989550 PMCID: PMC4773525 DOI: 10.1155/2016/3069576] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Accepted: 01/27/2016] [Indexed: 12/18/2022] Open
Abstract
Duodenal duplication cyst is an extremely rare congenital anomaly usually diagnosed in childhood. However, it may remain asymptomatic for a long period. In adults it usually manifests with symptoms related to complications as pancreatitis, jaundice, or intussusception. We present the radiology findings of a patient with a duodenal intussusception secondary to a duplication cyst. The usefulness of the magnetic resonance (MR) in this case is highlighted.
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Larsen PO, Ellebæk MB, Pless T, Qvist N. Acute pancreatitis secondary to duodeno-duodenal intussusception caused by a duodenal membrane, in a patient with intestinal malrotation. Int J Surg Case Rep 2015; 13:58-60. [PMID: 26117447 PMCID: PMC4529645 DOI: 10.1016/j.ijscr.2015.06.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 05/28/2015] [Accepted: 06/07/2015] [Indexed: 12/12/2022] Open
Abstract
Intussusception is not always seen on ultrasonography but can revealed by a CT-scan. Any child, and especially those with previous congenital disorders, must undergo upper GI- endoscopy at the presence of intermittent upper gastrointestinal symptoms as vomiting, abdominal pain and gastro-oesophageal reflux, to exclude upper GI anomaly.
Duodeno-duodenal intussusception is often caused by an intraluminal tumour. The condition is rare owing to the retroperitoneal fixation of the duodenum, which is sometime absent in cases of intestinal malrotation. We describe the case of a 19-year old man admitted to hospital with abdominal pain and vomiting. A CT scan revealed a duodeno-duodenal intussusception including the head of the pancreas, which was confirmed by laparotomy. The cause was found to be a duodenal membrane with a pinhole passage combined with non-rotation of the duodenum.
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Affiliation(s)
| | | | - Torsten Pless
- Department of Gastrointestinal Surgery, Odense University Hospital, Denmark
| | - Niels Qvist
- Department of Gastrointestinal Surgery, Odense University Hospital, Denmark
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Yang B, Chen WH, Zhang XF, Luo ZR. Adult midgut malrotation: multi-detector computed tomography (MDCT) findings of 14 cases. Jpn J Radiol 2013; 31:328-35. [PMID: 23475600 DOI: 10.1007/s11604-013-0194-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Accepted: 02/07/2013] [Indexed: 12/20/2022]
Abstract
PURPOSE To describe MDCT findings in adult patients of midgut malrotation and to correlate the types of adult midgut malrotation with its complications. MATERIALS AND METHODS CT scans were performed on 14 adult patients with midgut malrotation. The images were reviewed retrospectively by one radiologist. Abnormal intestinal location, mesenteric vascular arrangement, extraintestinal anomalies and complications were evaluated and correlated with patterns of adult midgut malrotation. RESULTS The 14 cases of adult midgut malrotation revealed the following CT findings: intestinal malposition (n = 14), abnormally oriented mesenteric vessels (n = 8), extraintestinal anomalies (n = 14). These cases were classified into six types: complete nonrotation (n = 3), nonrotated duodenum and partially rotated colon (n = 6), isolated nonrotation of the duodenum (n = 2), partial rotation of the duodenum and colon (n = 1), partially rotated duodenum (n = 1) and isolated colonic partial rotation (n = 1). Four of these patients had accompanying complications, including volvulus (n = 2), right paraduodenal hernia (n = 1) and gastroduodenal intussusception (n = 1), respectively. CONCLUSION Imaging features of adult midgut malrotation are characteristic. Adult midgut malrotation has various manifestations, and types of midgut malrotation may be closely related to their complications.
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Affiliation(s)
- Bin Yang
- Department of Radiology, Hangzhou First Municipal People's Hospital, Affiliated Hangzhou Hospital of Nanjing Medical University, Hangzhou, Zhejiang 310006, China.
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Rathi V, Jain BK, Garg PK, Singh A. An unusual case of duodenal beaking. Br J Radiol 2013; 85:1517-21. [PMID: 23091291 DOI: 10.1259/bjr/13193393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- V Rathi
- University College of Medical Sciences and Guru Teg Bahadur Hospital Dilshad Garden, Delhi, India.
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Duodenal intussusception due to a giant neuroendocrine carcinoma in a patient with Peutz-Jeghers syndrome: case report and systematic review. Eur J Gastroenterol Hepatol 2012; 24:722-6. [PMID: 22356785 DOI: 10.1097/meg.0b013e328351c1df] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Duodenal intussusception is a rare entity. To date, only a few cases have been reported in the literature. In this report, a case of duodenal intussusception due to an unusual tumor was presented and the clinical features of this entity were discussed. A 42-year-old man with Peutz-Jeghers syndrome presented with epigastric pain, vomiting, and severe anemia. Computed tomography scan revealed synchronous duodenojejunal and jejunojejunal intussusceptions. An emergency laparotomy revealed a polypoid mass originating from the lateral wall of the descending duodenum with intussusception of the distal duodenum. Histological examination demonstrated a poorly differentiated neuroendocrine carcinoma with muscularis infiltration, vascular invasion, and a Ki-67 index of 20%. A comprehensive literature search revealed 44 English reports that provided adequate descriptions of an additional 47 such cases. Clinical presentation was usually chronic and nonspecific. Diagnostic modalities included ultrasonography, upper gastrointestinal series, computed tomography, and endoscopy. Five patients were due to a non-neoplastic lesion; however, the other 43 patients were secondary to a tumor, benign in 35 cases and malignant in eight cases. Only one patient was treated by endoscopic polypectomy, whereas the remaining underwent open surgeries. Duodenal intussusception is a challenging condition due to its rarity and nonspecific presentation. It should be considered in the differential diagnosis of gastric outlet obstruction, upper gastrointestinal bleeding, pancreatitis, and obstructive jaundice.
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Ren PT, Lu BC. Intestinal malrotation associated with colon cancer in an adult: report of a case. Surg Today 2009; 39:624-7. [PMID: 19562454 DOI: 10.1007/s00595-008-3913-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2008] [Accepted: 10/30/2008] [Indexed: 12/12/2022]
Abstract
Intestinal malrotation is a congenital anomaly of intestinal rotation and fixation that generally becomes symptomatic during the neonatal period. However, it rarely occurs in adulthood, and synchronous colon cancer is even rarer. This report presents the case of a 45-year old man who suffered from intestinal malrotation associated with colon cancer.
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Affiliation(s)
- Pei-Tu Ren
- Department of General Surgery, Shaoxing People's Hospital, Shaoxing, 312000, Zhejiang Province, PR China
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