Exploring the neglected segment of the intestine: the duodenum and its pathologies

Abstract

Herein we reviewed the computed tomography (CT) findings of a spectrum of pathological entities affecting the duodenum. We discuss the CT findings of some congenital, inflammatory, traumatic, and neoplastic pathologies of the duodenum along with the conventional barium studies of selected conditions. Pathologies of this C-shaped intestinal segment, derived from both foregut and midgut, are often overlooked in clinical practice and radiological literature. While congenital anomalies like duplication cysts and diverticula are usually asymptomatic, annular pancreas and malrotation may manifest in the first decade of life. Primary as well as secondary involvement of the duodenum by various disease processes can be evaluated by careful CT technique and proper attention to the duodenum. Among congenital conditions, annular pancreas, duplication cyst, superior mesenteric artery syndrome, midgut volvulus, and diverticula are presented. Duodenal involvement in adenocarcinoma, lymphoma, gastro intestinal stromal tumours, Crohn's disease, and groove pancreatitis are discussed. Duodenal wall haematoma and traumatic duodenal perforation causing pneumoretroperitoneum in two patients after blunt trauma of the abdomen are also illustrated. CT provides superb anatomic detail and offers high diagnostic specificity for the detection of duodenal pathologies because it allows direct imaging of the intestinal wall, secondary signs of bowel disease within the surrounding mesentery, and abnormal findings in adjacent structures. Primary duodenal malignancies and local extension from adjacent malignancies can be diagnosed by CT reliably. CT also plays a vital role in the diagnosis of traumatic duodenal injury by differentiating between mural haematoma and a duodenal perforation because the latter requires immediate surgical intervention.

Prenatal detection of gastrointestinal bubbles since early pregnancy: Clues to correct diagnosis

“…The third part is horizontal and crosses from right to left. The fourth part is located left to the abdominal aorta and ascends to the level of the second lumbar vertebra and ends at the duodenojejunal junction 14 . Although a double bubble usually represents a duodenal obstruction, two bubbles with an intervening normal duodenal segment are suspicious for a duodenal duplication cyst.…”

Superior mesenteric artery syndrome: Diagnosis and management

“…Due to its non-specific symptoms, SMA syndrome might be overlooked in clinical practice[ 26 , 91 ]. Even in radiologists, the duodenum seems to be a neglected segment in the intestine[ 92 ]. SMA syndrome requires a high degree of clinical suspicion and few teaching methods have been reported[ 93 , 94 ].…”

Intracorporeal linear‑stapled gastroduodenostomy in totally laparoscopic distal gastrectomy for gastric cancer: Consideration of the intraoperative management of the duodenal wall between the transecting staple line and anastomotic staple line (Review)

“…The duodenum, 25-30 cm in length, is the widest portion of the small bowel and is divided into four parts (1)(2)(3). The first part of the duodenum consists of the 2.5-cm-long intraperitoneal segment as a continuation of the pylorus, which is called the duodenal bulb, and the 2.5-cm-long retroperitoneal segment, which ends at the superior duodenal flexure (1)(2)(3).…”

“…The duodenum, 25-30 cm in length, is the widest portion of the small bowel and is divided into four parts (1)(2)(3). The first part of the duodenum consists of the 2.5-cm-long intraperitoneal segment as a continuation of the pylorus, which is called the duodenal bulb, and the 2.5-cm-long retroperitoneal segment, which ends at the superior duodenal flexure (1)(2)(3). Regarding the blood supply to the duodenal bulb, which is the portion utilized in anastomosing the duodenum and remnant stomach following distal gastrectomy, Hentati et al (4) reported that all of the arterial pedicles reached the duodenal bulb on its posterior wall and thereafter spread along its anterior wall.…”