Duodenal stenosis

Duodenal stenosis and left-sided hydronephrosis and hydroureter due to an abnormal opening of the left ureter into the bladder have been reported associated with pho-comelia in a 5-month-old male infant. The mother had taken thaUdomide in early pregnancy (126). 

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. 

H-type tradieo-esophageal fistula. The differential diagnosis for the double-bubble should include duodenal stenosis and annular pancreas (Rathaus et al. 1992 Poki et al. 2005). 

Duodenal duplication and diverticula are rare and incidentally cause a duodenal stenosis. A cystic non-communicating duplication is easy to detect sonographically while a communicating duplication... 

Fig. 5.7. a Duodenal stenosis caused by a duodenal web with a windsock appearance, b Eccentric narrowing of the descending duodenum at the level of the sphincter of Oddi annular pancreas... 

Deans GT, Krukowski ZH, Irwing St (1994) Malignant obstruction in the left colon. Br J Surg 81 1270-6 De Baere T, Harry G, Ducreux M, Elias D, Briquet R, Kuoch V, Roche A (1997) Self-expanding metallic stents as palliative treatment of malignant gastro-duodenal stenosis. AJR 169 1079-1083... 

Fig. 1. Postoperative nitrogen, potassium, and phosphorus balances. Patient operated on 5th day of life for duodenal stenosis. No postoperative intakes whatsoever until the 3rd day, when 90 ml 5% glucose was infused. From the 4th postoperative day on increasing amounts of human milk was given. Cow s milk mixture was added from the 8th day. Balance diagrams are conventional, with negative balances marked in solid black.

Fig. 2.30. Ischaemic duodenal stenosis. Double Contrast barium study which demonstrates a pinpoint stenosis in the post-bulbar region of the duodenum. This has resulted from ischaemic change four months after right nephrectomy for benign disease. Note the surgical clips...

Fig. 2.31a,b. Caustic Duodenal Stenosis. Barium studies of the duodenum following ingestion of acid as part of a suicide attempt. Note (a) the irregular duodenal wall in the early phase after ingestion and (b) the development of irreversible tubular narrowing of the duodenum 5 months after ingestion, (prone image)... 

Extrahepatic obstructive jaundice is caused by stenos-ing processes. The region of Vater s papilla is particularly affected, for example by inflammations, stones, duodenal diverticula, carcinoma, parasites, cicatricial stenosis or adenomatosis. In this respect, special mention should also be made of carcinoma, cicatricial strictures and gallstones (s. figs. 8.14, 8.15 32.1, 32.15), compression of the common bile duct due to a cystic duct stone (= Mirizzi syndrome), haemobilia, and various parasites - such as Ascaris lumbricoides (s. fig. 25.8 ). All of these disorders can be found in the area of the extrahepatic bile ducts. (9, t9)... 

Almost all marketed drugs are used to treat some rare diseases. A few examples among the largest selling drugs in the world include propranolol, which is used to treat idiopathic hypertrophic subaortic stenosis (in addition to the more well-known cardiovascular diseases), cimetidine, which is used to treat Zollinger-Ellison Syndrome (in addition to duodenal ulcers), and all antibiotics used to treat rare bacterial infections, in addition to common ones. 

Gastric rupture is mainly seen in neonates due to acute distention of the stomach, ischemic necrosis associated with perinatal asphyxia and distal obstruction such as annular pancreas (Ibach and Inouye 1965) or duodenal atresia/stenosis. On the other hand, duodenal rupture in neonates is rare. 

Mikulicz-Radecki had, by 1884, given considerable thought to the management of both stenosis and perforation as complications of duodenal ulcer disease. 

The complications of duodenal ulcer are to a certain extent site dependent. Perforations are usually anterolateral, penetration is posteromedial, bleeding is posteromedial, and stenosis can occur circumferentially. 

Fig. 2.29. Crohn s stenosis and Duodenal fistula. Double Contrast barium study shows an irregular narrowing of the postbulbar duodenum due to lonstanding Crohn s duodenitis. There is also a duodenal-biliary fistula occurring as a complication of the Crohn s disease. Cholecystectomy clips are noted...

Chronic ulcer disease is marked by scar formation caused by the healing of earlier ulcers that have penetrated into the submucosa. If there is continuous ulcer disease it will result in progressive fibrosis of the duodenal cap, creating a so-cdled clover leaf deformity from pseudodiverticulum formation (Fig. 3.50). Severe fibrosis may lead to pyloric stenosis and cause gastric retention. With this background any new ulcer may then be irregular in shape. 

Primary tuberculosis of stomach and duodenum is very rare and usually develops secondary to pulmonary tuberculosis. Simultaneous involvement of the duodenum occurs in 10% of patients. There is increased incidence in patients with AIDS. The radiological appearances are classified as predominantly ulcerative or hypertrophic type (Tishler 1979 Agrawal et al. 1999). The ulcerative form is more frequent and consists of multiple large and deep ulcerations, sometimes with antral fistulas (Fig. 5.10). In the hypertrophic form, there is thickening of stomach and duodenal folds which can lead to pyloric stenosis and gastric outlet obstruction. A narrowed antrum can mimic a linitis plastica appearance. There is usually extensive lymph node involvement in the adjacent areas (Tishler 1979 Agrawal et al. 1999). Sarcoidosis and syphilis have identical appearances on conventional barium studies, both ulcerative and hypertrophic (Fig. 5.11). 

Fig. 4.2. 25. Bile duct anastomotic stricture. A 37-year-old female status post fulminant acute hepatitis A, followed by orthotopic cadaveric liver transplant presenting now with abnormal liver function tests. Coronal thick-slab T2-weighted single-shot fast spin echo (SSFSE) MRCP image shows a short-segment stenosis (arrow) at the biliary anastomosis with upstream dilatation of the common bile duct. The remnant of the cystic duct (arrowhead) and a small amount of hyperintense fluid in the duodenal lumen (asterisk) are also seen...

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