Duodenal obstruction

These drugp are contraindicated in those with a hypersensitivity to the anticholinergic dragp, those with glaucoma (angle-closure), pyloric or duodenal obstruction, peptic ulcers, prostatic hypertrophy, achalasia (failure of... 

Pyloric or duodenal obstruction obstructive intestinal lesions or ileus achalasia Gl hemorrhage obstructive uropathies of the lower urinary tract. 

Hypersensitivity to any component glaucoma, particularly angle-closure glaucoma pyloric or duodenal obstruction stenosing peptic ulcers prostatic hypertrophy or... 

Antihistamines that produce sedation should not be used with alcohol or any other sedating drug, such as opioid analgesics. Antihistamines with strong anticholinergic effects should be avoided in patients with peptic ulcer disease, prostatic hypertrophy, or bladder or pyloro-duodenal obstruction and in patients who have the potential for acute angle-closure glaucoma. 

Prolonged vomiting or nasogastric suction Pyloric or upper duodenal obstruction Prolonged or abusive diuretic therapy (loop diuretics) Villous adenoma Posthypercapnic state... 

Inflammatory bowel disease Duodenal obstruction or infection Anorexia nervosa... 

Complete duodenal obstruction is much more frequent than congenital gastric obstruction. 

Fig. 1.3. Complete duodenal obstruction caused by a congenital duodenal web. The stomach (st) and duodenum (d) are dilated and with absence of air more distally in the gastrointestinal tract, producing the classical double bubble image...

Fig. 1.4a,b. Duodenal atresia, a Plain radiograph obtained 6 h after birth shows absence of air in the gastrointestinal tract of this neonate with severe lung disease, b Radiograph made after inflation ofthe stomach through a nasogastric tube demonstrates complete duodenal obstruction ( double bubble sign)... 

Partial duodenal obstruction may be produced by duodenal stenosis, duodenal web, Ladd s bands, midgut volvulus, annular pancreas, preduodenal portal vein, and duplication cyst. Plain radiographs show gaseous distension of the stomach and duodenum with a normal or diminished quantity of air in the small bowel. Content studies may be necessary to differentiate between midgut volvulus and partial duodenal obstruction caused by a web or stenosis (Auringer and Sumner 1994). Sonography is helpful to rule out extraluminal causes such as a duplication cyst. 

A patient with malrotation may also develop dense peritoneal bands, termed Ladd s bands, that originate in an attempt to fix the bowel. These bands extend from the cecum to the hilum of the liver, posterior peritoneum, or abdominal wall across the duodenum and can cause extrinsic duodenal obstruction. 

Bailey PV, Tracy TF Jr, Connors RH et al (1993) Congenital duodenal obstruction a 32-year review. J Pediatr Surg 28 92-95... 

In annular pancreas, the duodenum is often compressed at a point distal to the ampulla of Vater, making bilious vomiting a hallmark symptom. Abdominal distention is typically not a feature because of the proximal location of the obstruction. Patients may not pass meconium, or bowel movements may cease abruptly. A more insidious form of chronic partial duodenal obstruction may also occur. 

Duodenal Obstruction 170 Jejunal and Ileal Obstruction 172 Meconium Peritonitis 173 Meconium Ileus 173 Megacystis-Microcolon-Malrotation-Intestinal-Hypoperistalsis Syndrome (MMMIHS) 174... 

In the case of duodenal obstruction with similar clinical signs as atresia, but with air distal to the duodenum, intestinal malrotation should be ruled out. 

Annular pancreas with complete or incomplete duodenal obstruction is another cause of duodenal obstruction. Its cause is persistence of the left lobe of the ventral pancreatic bud around the sixth week of gestation that then raps around the duodenum causing a ring-like eccentric narrowing (Fig. 5.7b). The clinical and radiological findings are the same... 

Neonates with jejunal or ileal obstruction may also present with bilious vomiting depending on the level (most likely proximal) of obstruction. This clinical symptom is usually less severe than in duodenal obstruction. 

Superior mesenteric artery (SMA) syndrome is an uncommon but well recognized clinical entity characterized by compression of the third, or transverse, portion of the duodenum against the aorta by the SMA, resulting in chronic, intermittent or acute complete or partial duodenal obstruction. Clinical symptoms are chronic upper abdominal symptoms such as epigastric pain, nausea, vomiting (bilious or partially digested food), postprandial discomfort and sometimes subacute small bowel obstruction. The stomach can be massively dilated and perforation has been described (Carty et al. 2005 Parker 2003). 

Fig.4.6a,b. Duodenal obstruction by adenocarcinoma, a Sagittal sonogram of the right upper abdomen discloses a mass (arrows) with dilated first part of the duodenum (d). b Upper gastrointestinal series shows near-complete obstruction by adenocarcinoma (arrows)... 

Patients with gastric outlet or duodenal obstruction often exhibit intractable nausea and vomiting and are unable to eat. The consequences are gastric distension, weight loss and dehydration that may require treatment with intravenous administration of fluids. Furthermore, these patients are at constant risk of aspiration and pneumonia. 

If there is known or impending biliary obstruction in the presence of duodenal obstruction which needs possible stenting across the papilla an expandable metal biliary stent should be placed before the duodenal stent. The presence of a transpapillary duodenal stent may make transhepatic placement of a bihary stent more difficult and an endoscopic approach impossible. Therefore it would seem prudent to evaluate also the biliary tree in patients who are to undergo gastroduodenal stenting. 

Pancreatic carcinoma most frequently involves the head of the gland and usually presents with obstructive jaundice. About 10% of patients with pancreatic head cancer develop duodenal obstruction, usually quite late on in the course of their disease. Therefore most patients developing duodenal obstruction from pancreatic cancer will already have a biliary stent in... 

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