Contrast-Enhanced Endoscopic Ultrasound for Evaluation of Common Bile Duct in Presence of Portal Cavernoma
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Abstract:
Abstract Endoscopic ultrasound (EUS) is an excellent imaging modality for the evaluation of common bile duct (CBD) because of its close proximity to the transducer placed in duodenum. However, in the presence of portal cavernoma, identification and proper evaluation of CBD become difficult because of presence of numerous venous collaterals. In these circumstances, the evaluation of CBD is more difficult if it is nondilated. In these difficult situations, contrast-enhanced EUS can provide better and clear images of CBD and therefore seems to be an excellent modality to evaluate nondilated CBD in the presence of portal cavernoma.Keywords:
Endoscopic Ultrasound
Contrast-enhanced ultrasound
During 10 years there were 94 patients aged 16-68 years with injuries of the duodenum. Their case histories were studied in order to establish the causes of complications and lethality. Among them there were 48 patients with knife wounds, 5 patients with gunshot wounds, closed trauma of the abdomen was diagnosed in 40 patients, 1 patient had a iatrogenic wound of the duodenum. There were 17 isolated injuries of the gut and 77 combined and multiple injuries. Patients with traumatic perforations in the duodenum made up 89.4%, 31% of them died. In 70 patients suture of the duodenum was put during operation, 10 patients had sutures and intubation of the duodenum, in 6 patients the injured gut was excluded, in 1 patient resection of the duodenum was made and primary anastomosis was formed. 28 patients (29.8%) died. Among the causes of the deaths were non-compensated blood loss resulting from hemorrhage from the vessels of the liver and other organs, combined and multiple injuries. Pyo-septic complications led to death of 12 patients, duodenal fistula was found in 4 patients. An analysis of the material has shown that most patients with traumas of the duodenum could be cured by suturing the incised or lacerated wound of the duodenum. Exclusion of the duodenum is thought to be a helpful addition to operation on the injured duodenum, especially on large wounds. Pancreatoduodenectomy is necessary but seldom in surgery of such traumas.
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Objective: To evaluate the diagnostic methods of primary malignant tumors of duodenum. Methods: A retrospective analysis was conducted based on the clinical data of 28 patients with primary malignant tumors of duodenum. Results: Sixteen patients underwent endoscopic examination, 15 of them were positive (93.75%) with the tumors located at upper duodenum and around the papillae. Thirteen patients underwent hypotonic duodenogram and 10 of them were positive (76.92% ), with the tumors located both at upper and lower duodenum. 28 patients underwent ultrasonography, with the positive rate of 53.57% (15/28),all of them being cholangiectasis. Conclusions: Endoscopy was the main method for the diagnosis of tumors located at upper part and around the papillae of the duodenum,and hypotonic duodenogram was effective in the diagnosis of tumors located at lower duodenum.
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Objective:The purpose of this study is to discuss imaging technique of multi-slice spiral CT and its clinical application value in diagnosis of duodenum diseases.Methods:Nineteen patients with duodenum diseases underwent multi-slice CT image either with gaseous distension or drinking water,and correlated with operative findings and pathology.Using GE Light-speed Ultra 16 slice CT to perform whole duodenum scan in the supine and left decubitus positions.reconstruction images of duodenum were done at the console workstation,including MPR and SSD image.Results:CT images of nineteen patients with duodenum diseases can provide valuable in formation.Drinking water was the basic method of duodenum CT,especially for solid tumor in duodenum,and axial images combined with MPR should be the main technique.Success rate of duodenum imaging with gas is lower.But it is helpful for diagnosis of duodenum diverticulum and differentiated diagnosis between duodenum diverticulitis and malignancy,and SSD combined with MPR should be the main technique.Conclusion:MSCT with post-pressing reformation techniques have great value for diagnosis and differential diagnosis of duodenum diseases.
Supine position
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• We report two cases of early-childhood anomalous drainage of the common bile duct (CBD) into the fourth portion of the duodenum, which caused recurrent abdominal pain and hyperamylasemia. In both patients, this anomaly was associated with a long common channel between the CBD and the pancreatic duct. The CBD was obstructed by compression from the first portion of the duodenum, which passed anteriorly. Both children required choledochoenteric anastomosis to achieve permanent resolution of the abdominal pain. Elevation of the first portion of the duodenum does not produce permanent relief from symptoms. We believe that these patients represent the first described to have this unusual malformation. (Arch Surg1985;120:1077-1079)
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To clarify activity of the choledocho-duodenal junction the present study was made using sixty rabbits. A polyethylene tube with Y-connector to the common bile duct toward the duodenum. The tube was used for two purposes, one measuring the intraductal pressure variation of the terminal common bile duct, the other infusing the contrast medium into the common bile duct for the cinecholangiography. Two electrodes were sewn in the Oddi's muscle and duodenum respectively.Electrical activity of the Oddi's muscle and duodenum, intraductal pressure of the terminal common bile duct and the bile flow were simmultaneously recorded on a 16 mm cine film.The results are summerized as follows:1. The intraductal pressure tracing of the terminal common bile duct was divided in two phases, the one is large pressure waves and the other, slow phases of pressure.2. The large waves appeared always in accordance with the electrical activity of the Oddi's muscle and the slow phases accorded with the electrical activity of the duodenum.3. Bile flow was interrupted at the terminal portion of the common bile duct when the appearance of the large pressure waves, that is, electrical activity of Oddi's muscle was observed.4. Bile flow was poured into the duodenum by the appearance of the slow phaSes or pressure, that is, the electrical activity of the duodenum was observed.From these findings the author concluded that the muscle of Oddi has a sphincteric mechanism and acts independently of the activity of the duodenal wall muscle in rabblt.
Major duodenal papilla
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Duodenal bulb
Jejunum
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The authors report a case of complete rupture of the third duodenum after blind trauma of the abdominal wall. They discuss pre op diagnosis with amount to X ray findings; surgical management included resection of the left part of the 3rd duodenum, 4th duodenum, and 1rst jejunal loop, with latero terminal anastomosis of the lower part of the 2nd duodenum to the jejunum; uneventfull recovery.
Jejunum
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Objective: Present experiment was undertaken to find out the postnatal development (gross) of the duodenum in broiler chicken with regard to their location, shape, size and weight.
Materials and Methods: A group of five chickens, each at day 1 (D1), day 7 (D7), day 12 (D12), day 24 (D24) and day 34 (D34), total 5, were killed and their digestive tracts were dissected. After that, samples of duodenum were prepared and the length, width and muscle diameter of duodenum of different ages were recorded.
Results: The average length of duodenum were significantly higher in broilers at day 34(30.55cm) than that at day 24(28.12cm), day 12(19.50cm), day 7(17.25cm) and day 1(14.95cm). On the other hand, the width were significantly higher in broilers at day 34(7.1mm) than that at day 24(5.25mm), day 12(4.70mm), day 7(4.35mm) and day 1(2.75mm). In diameter of the muscle of duodenum also maintain this order.
Conclusion: Hence, it can be concluded that, length, width and muscle diameter of duodenum might be increased with the age of broiler.
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Long before the Christian era, the duodenum was named and its function in controlling gastric emptying was conjectured. It received almost no further attention until the Eighteenth century when its relation to the bile and pancreatic ducts became know. The embryogenesis of the duodenum and the histological features of the organ are described as well as the gross movements that explain the mature relations of the duodenum to the surrounding structures. The "sphincters" of the duodenum are mentioned and evaluated.
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Four cases of involvement of the duodenum by metastases arising from tumours of the reproductive organs have been reported. The mode of spread of tumours to the duodenum is described. The differential diagnosis of radiological changes in the duodenum and the management of patients with metastatic involvement of the duodenum have been briefly discussed.
Genital tract
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