Acute abdomen caused by infected duodenal duplication

Infected cystic duplications of the duodenum are unusual lesions. We report two cases of duodenal duplications complicated by infection. The literature is reviewed, and the diagnostic modalities and management options for this unusual pathology are discussed.     

Perforated duodenal diverticulum: report of a case

After the colon, the duodenum is the most common site of diverticula. Duodenal diverticula can be divided into two types: intraluminal or extraluminal. The latter are more frequent, with a prevalence ranging from 0.6 to 27% in relation to the diagnostic methods utilized. Females are more often affected than males. About 70-75% of extraluminal duodenal diverticula are located in a circular area centred around the ampulla of Vater within a radius of 2-3 cm; these are defined as periampullary or juxtapapillary. Perforation is the rarest type of complication and can simulate different clinical conditions. CT plays a fundamental role in diagnosis also in relation to the different diverticular topography. Perforation is an indication for emergency surgery. The authors describe the clinical case of a duodenal diverticulum containing the outlet of the papilla, complicated by perforation; CT showed retroduodenal fluid and free air. Emergency surgery with an external biliary drainage, naso-biliary probe, and a diverticulo-jejunostomy on a Roux-en-Y defunctionalised loop, resolved the condition.     

A case of mediastinitis caused by rupture of esophageal diverticulum

A 42-year-old male student from abroad visited a department of internal medicine of a hospital because of fever and dyspnea. A diagnosis of purulental mediastinitis with empyema was made. After drainage of the right thoracic cavity, the patient was referred to our department. Although consecutive treatment consisting of administration of antibiotics and thoracic drainage was conducted, dyspnea became worse, and widening of the mediastinum become severer. Mediastinal drainage was done via the parasternal approach under general anesthesia. Thereafter, the patient temporarily suffered from respiratory failure, and controlled respiration by a respirator was needed. Since the amount of discharge from the mediastinal and thoracic drains gradually decreased, and clinical symptoms disappeared, the drain tubes were removed. During the clinical course, laryngoscopy, bronchoscopy, esophago-gastro-endoscopic examination and esophagography were performed. Esophagoscopy revealed a diverticulum, and esophagography showed a fistula from the esophageal diverticulum to mediastinum. From these examination results, a diagnosis of mediastinitis caused by rupture of esophageal diverticulum was established.     

An extended retroperitoneal abscess caused by duodenal diverticulum perforation: report of a case and short review of the literature

The authors report a case of an extended retroperitoneal abscess that developed secondarily after a duodenal diverticulum perforation. The diagnosis was established preoperatively endoscopically and by abdominal CT scan. The patient was treated surgically. The authors performed a subtotal gastrectomy and reconstruction with antecolic Billroth II anastomosis to bypass the inflamed region, as well as simultaneous drainage of the retroperitoneal abscess. The postoperative course of the patient was uncomplicated. The authors suggest that this method may be an acceptable approach in the management of similar cases, in which conservative or endoscopic means have failed.     

Massive upper gastrointestinal bleeding originating from a fourth-stage duodenal diverticulum: a case report and review of the literature

Duodenal diverticulum is well-known pathologic entity. Most such diverticula are asymptomatic and located on the second stage of the duodenum. The diagnosis is most often established by endoscopy or upper gastrointestinal radiography. Hemorrhage has been described but is an infrequent complication. We report on a patient who presented with massive upper gastrointestinal bleeding, originating from a fourth-stage duodenal diverticulum. The diagnosis was made with a combination of arteriography and scanning with technetium 99-labelled red cells. Diverticulectomy was performed with a successful outcome. This report underlines the diagnostic limits of fiberoptic endoscopy for hemorrhagic lesions located past the third stage of the duodenum.     

A case report: Cecal volvulus caused by Meckel's diverticulum

INTRODUCTION

Meckel''s diverticulum is the most common congenital anomaly of the small intestine. Common complications related to Meckel''s diverticulum include hemorrhage, intestinal obstruction and inflammation. Acute large bowel obstruction is a rare complication of Meckel''s diverticulum and in the presented case it is caused by volvulus.

PRESENTATION OF CASE

We report a 39 year old female who presented with the diagnosis of a large bowel obstruction occurring as a result of cecal volvulus caused by adhesions of a perforated diverticulum.

DISCUSSION

The reported case presents one of the rare complications of MD, which is volvulus. The case described above presented with signs and symptoms suggestive of acute intestinal obstruction and radiological findings suggestive of cecal volvulus. The patient was taken to the operation room for exploration and we discovered the presence of a perforated MD. The main treatment of such case is to perform diverticulectomy in all symptomatic patients.

CONCLUSION

MD is mostly identified intraoperatively. Knowledge of the pathophysiologies by which MD can cause complications such as volvulus is important in order to plan management.     

十二指肠旷置术治疗十二指肠乳头旁憩室致胆管炎的探讨

目的 探讨十二指肠旷置术治疗十二指肠乳头旁憩室致胆管炎的效果。方法 采用旷置十二指肠的3种术式,即胃空肠Roux-en-Y吻合术、毕Ⅱ式胃空肠吻合术、十二指肠空肠吻合术对42例十二指肠旁憩室所致胆管炎进行外科治疗。效果 本组42例术后均无胆管炎复发,无严重并发症的发生。随访1～10年,无吻合口狭窄、溃疡、术后营养不良等并发症的发生。胃空肠Roux-en-Y手术后4例有轻度术后滞留综合征,经对症处理后可缓解。结论 采用十二指肠旷置术治疗十二指肠乳头旁憩室的3种术式治疗效果满意,可根据患者的实际情况选用。     

Recurrent pancreatitis due to an intraluminal duodenal diverticulum: report of a case

We report the investigation and treatment of a 14-year-old girl in whom a detailed assessment of recurrent episodes of pancreatitis revealed a large intraluminal 'windsock'-like duodenal diverticulum. As the diverticulum was closely attached to the papilla of Vater, it was resected by a transduodenal approach. This report focuses on the significance of rare congenital anomalies of the duodenum (e.g., duplication cyst, intraluminal diverticulum) during the diagnostic workup of recurrent pancreatitis in children.     

Choledochopancreatoduodenal fistula caused by duodenal ulceration. A case report

A penetrating duodenal ulcer may occasionally erode into the common bile duct and form a choledochoduodenal fistula. Such a fistula occurring simultaneously with a pancreatic duodenal fistula is reported. The presenting features of these fistulas are those of the ulcer and confirmation of the fistula may be difficult, although use of endoscopic retrograde cholangiopancreatography has greatly facilitated their diagnosis. In this case both fistulas could be cannulated through the base of the ulcer. The majority of these fistulas heal spontaneously with intensive medical management. The remainder require surgery, and a conservative approach avoiding direct interference with the fistula should be adopted. Drainage procedures are rarely required and once closed the fistulas usually cause no further problem.     

Iatrogenic perforation of perivaterian duodenal diverticulum: report of a case

The author reports a case of iatrogenic perforation of a duodenal diverticulum, an extremely rare occurrence, during percutaneous radiologic extraction of a retained common-bile-duct stone. Perforation was related to the perivaterian location of the duodenal diverticulum. Because an inflammatory reaction was present, tube duodenostomy was chosen over excision, closure and drainage to prevent the complication of lateral duodenal fistula and sepsis. Whenever iatrogenic duodenal perforation is suspected, prompt radiologic documentation and early surgical consultation should be sought.     

Penetration injury of the pyramis caused by a kick from a racehorse

A 56-year-old man presented with an unusual cranial penetration injury due to a horse's hoof. The CT number of the hoof was 269, and thus clearly not that of a wooden fragment or bone. An emergency operation was performed to remove the foreign body. The operation went well, and no infection developed. Eight months later he could walk unaided and had only mild disorientation.