“…5 d, e), which usually affects the descending duodenum along its medial aspect, rather than the duodenal bulb. Periduodenal inflammatory changes ranging from mild “hazy” stranding to mass-forming infiltration of the pancreatic-duodenal groove are characteristic of paraduodenal pancreatitis [ 11 – 14 ]. Fig.…”
Section: Ct Appearances Of Uncomplicated Peptic Diseasementioning
confidence: 99%
“…Finally, ulcer outpouchings should be differentiated from duodenal diverticula, which are not uncommon in the elderly population, often asymptomatic, and typically located medially, at the transition between descending and horizontal portions (Fig. 7 ) [ 11 – 14 ]. Fig.…”
Section: Ct Appearances Of Uncomplicated Peptic Diseasementioning
Despite availability of effective therapies, peptic ulcer disease (PUD) remains a major global disease, resulting from a combination of persistent Helicobacter pylori infection and widespread use of nonsteroidal anti-inflammatory drugs. Albeit endoscopy definitely represents the mainstay diagnostic technique, patients presenting to emergency departments with unexplained abdominal pain generally undergo multidetector CT as an initial investigation. Although superficial ulcers generally remain inconspicuous, careful multiplanar CT interpretation may allow to detect deep ulcers, secondary mural and extraluminal signs of peptic gastroduodenitis, thereby allowing timely endoscopic verification and appropriate treatment. This pictorial essay aims to provide radiologists with an increased familiarity with CT diagnosis of non-perforated PUD, with emphasis on differential diagnosis. Following an overview of current disease epidemiology and complications, it explains the appropriate CT acquisition and interpretation techniques, and reviews with several examples the cross-sectional findings of uncomplicated PUD. Afterwards, the CT features of PUD complications such as ulcer haemorrhage, gastric outlet obstruction, biliary and pancreatic fistulisation are presented.Teaching points• Gastric and duodenal peptic ulcers are increasingly caused by nonsteroidal anti-inflammatory drugs
• Multiplanar CT interpretation allows detecting deep ulcers and secondary signs of gastroduodenitis
• CT diagnosis of uncomplicated peptic disease relies on direct and indirect signs
• Currently the commonest complication, haemorrhage may be treated with transarterial embolisation
• Other uncommon complications include gastric outlet obstruction and biliopancreatic fistulisation
“…5 d, e), which usually affects the descending duodenum along its medial aspect, rather than the duodenal bulb. Periduodenal inflammatory changes ranging from mild “hazy” stranding to mass-forming infiltration of the pancreatic-duodenal groove are characteristic of paraduodenal pancreatitis [ 11 – 14 ]. Fig.…”
Section: Ct Appearances Of Uncomplicated Peptic Diseasementioning
confidence: 99%
“…Finally, ulcer outpouchings should be differentiated from duodenal diverticula, which are not uncommon in the elderly population, often asymptomatic, and typically located medially, at the transition between descending and horizontal portions (Fig. 7 ) [ 11 – 14 ]. Fig.…”
Section: Ct Appearances Of Uncomplicated Peptic Diseasementioning
Despite availability of effective therapies, peptic ulcer disease (PUD) remains a major global disease, resulting from a combination of persistent Helicobacter pylori infection and widespread use of nonsteroidal anti-inflammatory drugs. Albeit endoscopy definitely represents the mainstay diagnostic technique, patients presenting to emergency departments with unexplained abdominal pain generally undergo multidetector CT as an initial investigation. Although superficial ulcers generally remain inconspicuous, careful multiplanar CT interpretation may allow to detect deep ulcers, secondary mural and extraluminal signs of peptic gastroduodenitis, thereby allowing timely endoscopic verification and appropriate treatment. This pictorial essay aims to provide radiologists with an increased familiarity with CT diagnosis of non-perforated PUD, with emphasis on differential diagnosis. Following an overview of current disease epidemiology and complications, it explains the appropriate CT acquisition and interpretation techniques, and reviews with several examples the cross-sectional findings of uncomplicated PUD. Afterwards, the CT features of PUD complications such as ulcer haemorrhage, gastric outlet obstruction, biliary and pancreatic fistulisation are presented.Teaching points• Gastric and duodenal peptic ulcers are increasingly caused by nonsteroidal anti-inflammatory drugs
• Multiplanar CT interpretation allows detecting deep ulcers and secondary signs of gastroduodenitis
• CT diagnosis of uncomplicated peptic disease relies on direct and indirect signs
• Currently the commonest complication, haemorrhage may be treated with transarterial embolisation
• Other uncommon complications include gastric outlet obstruction and biliopancreatic fistulisation
“…Rapid radiological improvement supports the lack of hemorrahge, since duedenal hematomas are expected to resolve in 1–3 weeks [3]. On the other hand, one may speculate that the reported rate of acute duodenitis following diagnostic UGI endoscopy could be underestimated considering such a rapid recovery.…”
Section: Discussionmentioning
confidence: 97%
“…Although duodenal diverticulum substantially increases the risk of perforation [1,2], patients with diverticuli may also present with diverticulitis and duodenal inflammation [4,5]. However, it should be noted that inflammation due to diverticulitis is predominantly local [3,5]. Nevertheless, the reported cases of duodenal diverticulitis, in general, had not had a history of any predisposing invasive procedure.…”
SummaryBackgroundDiagnostic upper gastrointestinal (UGI) endoscopy has been regarded as a safe procedure.Case reportWe report of a 67-year-old woman who developed epigastric pain and dyspeptic complaints following an uneventful upper gastrointestinal endoscopy. The diagnosis of an acute reversible duodenitis was made on the basis of imaging studies. A duodenal diverticulum was also found on CT images, which raised the suspicion that duodenal diverticulum could be a predisposing factor for duodenitis.ConclusionsDespite significant inflammation the patient demonstrated rapid clinical improvement with conservative treatment. Presence of a duodenal diverticulum may predispose to acute duodenitis following diagnostic UGI endoscopy.
“…In most of cases, gastroduodenal lesions are simultaneous with small or large bowel involvement and usually occur in the antrum, pylorus and proximal part of duodenum. [73][74][75] Typical features of upper gastrointestinal tract involvement at radiological imaging include short strictures with stenosis, whereas fistulas, though seldom present, seem to origin from other portions of the intestinal tract. Generally related symptoms include epigastric pain, nausea and vomiting, weight loss, intraluminal bleeding.…”
noscopy with biopsy is considered the reference standard for achieving a definitive diagnosis, as it can access hard-to-reach areas of the small intestine and can replace surgery in treatment of strictures through balloon dilation. 7 However, the main limits include invasiveness, related risks (i.e., bowel perforation) and a partial evaluation, limited to the mucosal surface. 8 Therefore, radiological imaging is of paramount importance in the estimation of the whole intestinal involvement, not only for the initial evaluation, but also for follow-up monitoring and treatment response assessment. 9,10 Beyond the mere detection of intestinal lesions, it can provide useful data concerning characteristics of bowel wall thickening, which is helpful in distinguishing active inflammation from fibrosis, along with and valuable information on the surrounding tissues, where complications arise. 11 The constant development of novel technical tools and techniques is a benefit for improving the patient' s clinical framework. On the other hand, the different imaging modalities and the number of tools and techniques they are provided with can be confounding while establishing the prop
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