Duodenal stenosis
| Classification according to ICD-10 | |
|---|---|
| Q41.0 | Congenital absence, atresia and stenosis of the duodenum |
| K31.5 | Duodenal occlusion - duodenal ileus (chronic) - stenosis |
| ICD-10 online (WHO version 2019) | |
The duodenal stenosis is a rare, usually congenital laying with narrowing ( stenosis ) of the lumen of the duodenum ( duodenum ), but they can also occur as acquired disease.
Classification
Anatomically , a distinction can be made based on the major duodenal papilla :
- Stenosis above ("high obstruction")
- Stenosis below ("deep obstruction")
A distinction can be made systematically
- external stenoses due to compression, e.g. B. by pancreas annulare , volvulus , with malrotation (most common cause) by Laddian ligaments or clamps , somewhat more common form, mostly in the lower duodenum or at the level of the flexura duodenojejunalis. Rarely atypical running vessels such as a portal vein in front of the duodenum or the superior mesenteric vein syndrome , intestinal duplicates or diverticula
- Internal stenoses due to a tubular narrow segment, a ring-shaped narrowing or a connective tissue ring-shaped change in the intestinal wall with a slowly increasing stenosis effect or a duodenal membrane (with differently sized openings, without see duodenal atresia )
- combined forms in 10–16S. %
Occurrence
The frequency of congenital forms is given as 1 in 7,000, additional malformations are often found , and a third has trisomy 21 .
Acquired forms can occur as complications after trauma (with vascular injuries), inflammation , reduced blood flow , surgical interventions , etc.
Clinical manifestations
In contrast to duodenal atresia, the symptoms are not always obvious, but depend on the extent of the passage disruption . The spectrum ranges from intrauterine polyhydramnios with massive vomiting occurring in the first few days of life, to symptom-free periods with good weight gain, to a diagnosis made in school or even adulthood. If the constriction is below the papilla, bilious vomiting can occur.
diagnosis
The diagnosis can already be suspected in the abdominal sonography and confirmed with the help of an X-ray ("double bubble", see duodenal atresia). The exact passage conditions result from a contrast agent examination, in older children the diagnosis can also be made endoscopically .
therapy
Treatment consists of surgical or, if a membrane is present, endoscopic removal of the cause. A duodeno-duodenostomy, a duodeno-jejunostomy or a membrane excision are possible.
Prospect of healing
The prognosis depends on the birth weight and the severity of any additional malformations. According to DG Young and AW Wilkinson , the following risk groups can be distinguished:
- Group A: birth weight> 2500 g without severe malformations
- Group B: birth weight 2000–2500 g without or birth weight> 2500 g with severe malformations
- Group C: birth weight <2000 g or birth weight 2000–2500 g with severe malformations
history
The first description comes from the year 1733 by J. Calder , together with a pancreas annulare from the year 1818 by the German anatomist Friedrich Tiedemann .
The first operation was carried out in 1905 by E. Vidal . (quoted from)
literature
- KD Bachmann: Congenital duodenal stenosis. In: German Medical Weekly (1946). Vol. 105, No. 41, October 1980, pp. 1428-1430, doi: 10.1055 / s-2008-1070886 , PMID 6450042 (review).
Individual evidence
- ^ Right Diagnosis
- ^ W. Pschyrembel: Clinical dictionary. Verlag Walter de Gruyter, 265th edition (2014), p 383, ISBN 3-11-018534-2
- ↑ a b c d M. Bettex, N. Genton, M. Stockmann (Ed.): Pediatric Surgery. Diagnostics, indication, therapy, prognosis. 2nd edition, Thieme 1982, p 7.36, ISBN 978-3-642-11330-7
- ↑ a b W. Schuster, D. Färber (editor): Children's radiology. Imaging diagnostics. Springer 1996, ISBN 3-540-60224-0 .
- ↑ JY Jang, JG Lee, H. Shim: Duodenal stenosis after injury of a pancreaticoduodenal artery caused by blunt abdominal trauma. In: The American surgeon. Vol. 80, No. 1, January 2014, pp. E5-E6, PMID 24401496 .
- ^ A Watanabe, H. Suzuki, N. Kubo, T. Kobayashi, K. Araki, S. Sasaki, T. Shimura, T. Oyama, H. Kuwano: A case of mesenteric cystic lymphangioma in an adult which caused duodenal stenosis after resection. In: International journal of surgery case reports. Vol. 4, No. 2, 2013, pp. 212-215, doi: 10.1016 / j.ijscr.2012.10.023 , PMID 23287062 , PMC 3540220 (free full text).
- ^ Q. Yin, X. Wei: Congenital duodenal stenosis misdiagnosed as iron deficiency anemia for 20 years. In: Annals of hematology. Vol. 93, No. 11, November 2014, pp. 1943-1945, doi: 10.1007 / s00277-014-2079-z , PMID 24923450 .
- ↑ MR Nicholson, SA Acra, DH Chung, MJ Rosen: Endoscopic diagnosis of duodenal stenosis in a 5-month-old male infant. In: Clinical endoscopy. Vol. 47, No. 6, November 2014, pp. 568–570, doi: 10.5946 / ce.2014.47.6.568 , PMID 25505725 , PMC 4260107 (free full text)
- ↑ MH Huang, HQ Bian, C. Liang, WQ Wei, XF Duan, J. Yang: Gastroscopic treatment of membranous duodenal stenosis in infants and children: report of 6 cases. In: Journal of pediatric surgery. Vol. 50, No. 3, March 2015, pp. 413-416, doi: 10.1016 / j.jpedsurg.2014.10.045 , PMID 25746699 .
- ^ DG Young, AW Wilkinson: Mortality in neonatal duodenal obstruction. In: The Lancet (London, England). Vol. 2, No. 7453, July 1966, pp. 18-20, PMID 4161049 .
- ^ J. Calder: Two examples of children born with preternatural conformations of the guts. In: Great Medical Essays and Observations, 2nd Edition, Edinburgh, 1733, pp. 203-6.
- ↑ F. Tiedemann: About the differences in the execution duct of the pancreas in humans and mammals. In: German Archive for Physiology , Vol. 4, 1818, p. 403.
- ^ E. Vidal: 18th Congress de Chirurgie, Paris, 1905. Proces Verbaux, Memoires et discussion, Assosc Franc Chiru, Vol. 18, p. 739.
- ↑ SK Singh, DK Agrawal, Suganita, et al .: Annular pancreas causing duodenal obstruction: A case report. In: Journal of Evolution of Medical and Dental Sciences , Vol. 5, No. 5, 2016, pp. 296-300, doi: 10.14260 / jemds / 2016/63
