Pellagra revealing a congenital duodenal diaphragm in an adult

Bouslama, Khouloud; Bedioui, H.; Saidani, A.; Maghrebi, Houcine; Yacine, Ben Safta; Farah, Jokho; Zoubeir, Ben Safta

doi:10.1016/j.clinre.2012.09.014

Cited by 4 publications

(6 citation statements)

References 5 publications

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“…Several patients with a duodenal obstruction caused by a congenital duodenal diaphragm have been described. [ 4 – 10 ] The duodenal obstruction in this patient was caused by a transverse septum. Transverse septa are usually observed in the vagina, and those involving the digestive tract are rare.…”

Section: Discussionmentioning

confidence: 90%

“…[ 1 – 3 ] The causes of duodenal obstruction in adults mainly include malignant pancreatic or duodenal tumors or benign strictures, such as those seen in patients with Crohn disease, tuberculosis, or potassium therapy. [ 4 , 5 ] Duodenal obstructions caused by congenital anatomic abnormalities are rare in adults. The duodenal obstruction in our patient was caused by a transverse septum, which has not been previously reported.…”

Section: Introductionmentioning

confidence: 99%

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Case report of a congenital duodenal transverse septum causing partial obstruction

Guo

Yu²,

Wang³

et al. 2017

Medicine

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Introduction:Duodenal obstructions caused by congenital anatomic abnormalities are rare in adults. Several patients in whom the duodenal obstruction was caused by a congenital duodenal diaphragm have been described. The duodenal obstruction in the patient presented herein was caused by a transverse septum, which has not been previously reported. A transverse septum is usually observed in the vagina; those involving the digestive tract have been rarely observed.Case Presentation:We herein report a case involving a 69-year-old woman with a congenital duodenal transverse septum causing partial obstruction. She was admitted to our hospital with a 3-month history of epigastric pain and vomiting. Upper gastrointestinal endoscopy, iodinated water-soluble contrast imaging, and abdominal computed tomography revealed dilation of the stomach and a neoplasm in the descending part of the duodenum. The patient was suspected to have a tumor in the descending part of the duodenum. Exploratory laparotomy showed a banded duodenal transverse septum at the junction of the second part of the duodenum. The duodenal transverse septum was approximately 2 mm thick and 1 cm wide and divided the duodenal lumen into 2 parts. The duodenal papillae were completely normal and located under the duodenal transverse septum. Histopathological analysis of the transverse septum showed that it was similar to the organizational structure of the duodenal wall.Conclusion:The possibility of congenital disease should be considered in older patients with intestinal obstruction, even when imaging studies reveal a duodenal neoplasm.

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Section: Discussionmentioning

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Case report of a congenital duodenal transverse septum causing partial obstruction

Guo

Yu²,

Wang³

et al. 2017

Medicine

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“…Varied operative techniques have been described for the management of duodenal web, including gastrojejunostomy, duodenojejunostomy, and duodenotomy with web excision [1] , [3] , [5] , [6] , [10] . Authors in the last decade concur that a longitudinal incision, excision of the web and transverse closure of the duodenotomy is the optimal optimal approach [1] , [4] , [5] , [7] , [11] , [12] . In appropriate patients, minimally invasive techniques may avoid the need for laparotomy or duodenotomy, which can also result in complications [13] .…”

Section: Discussionmentioning

confidence: 99%

Surgical management of duodenal web in an adult presenting with melaena; Case report and literature review

Grinlinton

Welsh

Phillips

et al. 2021

International Journal of Surgery Case Reports

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Introduction Duodenal web is a rare pathology presenting infrequently in adults. Diagnosis is challenging and definitive management is commonly delayed. We present a case of a patient with a late diagnosis of duodenal web, who underwent laparotomy, intraoperative gastroscopy and surgical removal of the web performed by two general surgeons. Case presentation A 32-year-old woman with a previous diagnosis of irritable bowel syndrome presented with a three day history of abdominal pain, nausea and anorexia, and a one day history of melaena and haematemesis. Investigations including a magnetic resonance enterography, barium swallow study and gastroscopy revealed the diagnosis. The patient underwent laparotomy and excision of duodenal web. Intraoperative gastroscopy assisted with identification of the web's anatomical location. A longitudinal duodenotomy was performed and this was closed in a transverse fashion using the Heineke-Mikulicz technique. Discussion This case reports successful application of intraoperative gastroscopy during laparotomy and duodenotomy. Longitudinal duodenotomy with excision of the web and transverse closure of the duodenum appears to be the best approach. There are no previous publications detailing gastroscopy at the time of laparotomy with duodenal web. This technique may be utilised in appropriate situations to improve operative accuracy. Conclusion Duodenal web is a rare entity in adults, and delayed diagnosis may lead to significant patient morbidity. Incorporating intraoperative endoscopy ensures accurate anatomical visualisation. This technique avoids duodenectomy, organ damage, bypass, or an unnecessarily large incision.

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“…Food refusal with failure to thrive is also expired by the patients [5]. Sometimes DD can occur with blurred symptoms, especially if there is a partial obstruction and it can be discovered later in the life [5,6]. Furthermore the dilatation of the stomach, caused by duodenal obstruction, may produce hypergastrinemia and peptic ulceration [4].…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore the dilatation of the stomach, caused by duodenal obstruction, may produce hypergastrinemia and peptic ulceration [4]. It is possible to explain adult manifestations by a progressive loss of compensatory peristaltic action to overcome the small duodenal hole [6].…”

Section: Discussionmentioning

confidence: 99%