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Gastric outlet obstruction caused by duodenal intramural pseudocyst.

Rana SS, Bhasin DK, Rao C, Singh K - Ann Gastroenterol (2013)

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), India.

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There was history of loss of weight but appetite was preserved... Clinical examination was unremarkable... A contrast-enhanced computed tomography (CECT) of the abdomen revealed dilated stomach with a hypodense lesion posteromedial to the second part of the duodenum (Fig. 1; arrow)... An upper gastrointestinal endoscopy revealed dilated stomach with residue and narrowing at the junction of first and second part of the duodenum... Careful examination revealed that muscularis propria of the duodenal wall was seen intact around this lesion (Fig. 2; arrow), suggesting an intramural location... The pancreas showed echogenic foci and strands along with ill defined lobules... The main pancreatic duct was mildly dilated with hyperechoic wall... The cyst was completely emptied and a nasojejunal tube was placed for enteral feeding... The oral feeding was gradually reintroduced and once patient tolerated oral feeds well the nasojeunal tube was removed... Intramural pseudocysts of the duodenum are very rare and usually occur posteriorly with second part of the duo- denum being the most common site... This is because the posterior surface of the duodenum is in direct contact with the head of the pancreas with no effective barrier to prevent the digestive effects of pancreatic secretions... Depending on the depth of the penetration, these duodenal pseudocysts may develop between the serosa and muscularis, or between the muscularis and mucosa... In our case, it was located between muscularis and mucosa.

No MeSH data available.


Left: Contrast-enhanced computed tomography abdomen: hypodense lesion noted posteromedial to the second part of the duodenum (arrow); Right: Endoscopy showing an extrinsic bulge at the junction of first and second part of the duodenum
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Figure 1: Left: Contrast-enhanced computed tomography abdomen: hypodense lesion noted posteromedial to the second part of the duodenum (arrow); Right: Endoscopy showing an extrinsic bulge at the junction of first and second part of the duodenum

Mentions: A 36-year-old male, chronic alcohol consumer, presented to us with recurrent non-bilious vomiting of 15 days duration. He also complained of intermittent epigastric pain of one year duration with radiation to the back that used to get relieved with oral painkillers. There was history of loss of weight but appetite was preserved. Clinical examination was unremarkable. A contrast-enhanced computed tomography (CECT) of the abdomen revealed dilated stomach with a hypodense lesion posteromedial to the second part of the duodenum (Fig. 1; arrow). An upper gastrointestinal endoscopy revealed dilated stomach with residue and narrowing at the junction of first and second part of the duodenum. Careful examination revealed an extrinsic bulge at the area of the narrowing (Fig. 1) and scope was negotiable across this narrowing. Subsequently, endoscopic ultrasound (EUS) was performed with a radial echoendoscope and it revealed a 1.2 cm cystic lesion (Fig. 2) in the second part of the duodenum, at the site of narrowing. Careful examination revealed that muscularis propria of the duodenal wall was seen intact around this lesion (Fig. 2; arrow), suggesting an intramural location. The duodenal wall was also noted to be thickened with loss of wall stratification at places. The pancreas showed echogenic foci and strands along with ill defined lobules. The main pancreatic duct was mildly dilated with hyperechoic wall. EUS-guided aspiration of the cyst revealed hemorrhagic fluid with markedly elevated amylase and lipase and normal CEA levels. The cyst was completely emptied and a nasojejunal tube was placed for enteral feeding. The oral feeding was gradually reintroduced and once patient tolerated oral feeds well the nasojeunal tube was removed. He was diagnosed as chronic pancreatitis with intramural pseudocyst in the duodenum and was started on oral enzymes and anti-oxidants and he is doing well till the last follow up four months after the discharge.


Gastric outlet obstruction caused by duodenal intramural pseudocyst.

Rana SS, Bhasin DK, Rao C, Singh K - Ann Gastroenterol (2013)

Left: Contrast-enhanced computed tomography abdomen: hypodense lesion noted posteromedial to the second part of the duodenum (arrow); Right: Endoscopy showing an extrinsic bulge at the junction of first and second part of the duodenum
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3959512&req=5

Figure 1: Left: Contrast-enhanced computed tomography abdomen: hypodense lesion noted posteromedial to the second part of the duodenum (arrow); Right: Endoscopy showing an extrinsic bulge at the junction of first and second part of the duodenum
Mentions: A 36-year-old male, chronic alcohol consumer, presented to us with recurrent non-bilious vomiting of 15 days duration. He also complained of intermittent epigastric pain of one year duration with radiation to the back that used to get relieved with oral painkillers. There was history of loss of weight but appetite was preserved. Clinical examination was unremarkable. A contrast-enhanced computed tomography (CECT) of the abdomen revealed dilated stomach with a hypodense lesion posteromedial to the second part of the duodenum (Fig. 1; arrow). An upper gastrointestinal endoscopy revealed dilated stomach with residue and narrowing at the junction of first and second part of the duodenum. Careful examination revealed an extrinsic bulge at the area of the narrowing (Fig. 1) and scope was negotiable across this narrowing. Subsequently, endoscopic ultrasound (EUS) was performed with a radial echoendoscope and it revealed a 1.2 cm cystic lesion (Fig. 2) in the second part of the duodenum, at the site of narrowing. Careful examination revealed that muscularis propria of the duodenal wall was seen intact around this lesion (Fig. 2; arrow), suggesting an intramural location. The duodenal wall was also noted to be thickened with loss of wall stratification at places. The pancreas showed echogenic foci and strands along with ill defined lobules. The main pancreatic duct was mildly dilated with hyperechoic wall. EUS-guided aspiration of the cyst revealed hemorrhagic fluid with markedly elevated amylase and lipase and normal CEA levels. The cyst was completely emptied and a nasojejunal tube was placed for enteral feeding. The oral feeding was gradually reintroduced and once patient tolerated oral feeds well the nasojeunal tube was removed. He was diagnosed as chronic pancreatitis with intramural pseudocyst in the duodenum and was started on oral enzymes and anti-oxidants and he is doing well till the last follow up four months after the discharge.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), India.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

There was history of loss of weight but appetite was preserved... Clinical examination was unremarkable... A contrast-enhanced computed tomography (CECT) of the abdomen revealed dilated stomach with a hypodense lesion posteromedial to the second part of the duodenum (Fig. 1; arrow)... An upper gastrointestinal endoscopy revealed dilated stomach with residue and narrowing at the junction of first and second part of the duodenum... Careful examination revealed that muscularis propria of the duodenal wall was seen intact around this lesion (Fig. 2; arrow), suggesting an intramural location... The pancreas showed echogenic foci and strands along with ill defined lobules... The main pancreatic duct was mildly dilated with hyperechoic wall... The cyst was completely emptied and a nasojejunal tube was placed for enteral feeding... The oral feeding was gradually reintroduced and once patient tolerated oral feeds well the nasojeunal tube was removed... Intramural pseudocysts of the duodenum are very rare and usually occur posteriorly with second part of the duo- denum being the most common site... This is because the posterior surface of the duodenum is in direct contact with the head of the pancreas with no effective barrier to prevent the digestive effects of pancreatic secretions... Depending on the depth of the penetration, these duodenal pseudocysts may develop between the serosa and muscularis, or between the muscularis and mucosa... In our case, it was located between muscularis and mucosa.

No MeSH data available.