Learning objectives
To illustrate the basic anatomy of the duodenum and its relationship with various adjacent organs.
To describe the multiple patterns of duodenal pathologies according to their origin.
Congenital abnormalities.
Inflammatory/infectious.
Vascular disorders.
Benign neoplasms.
Malignant neoplasms.
To provide the key images of such pathologies for a correct diagnostic.
Background
The duodenum,
the most proximal part of the small bowel,
has both an extra and intraperitoneal location without mesentery.
It measures about 25 cm to 30 cm in length and forms a C-loop.
(1)
Consist of four parts:
The bulb (1st portion) an intraperitoneal triangular shape segment,
extends from the gastric pylorus to the gallbladder neck and suspended by the hepatoduodenal ligament.
(2)
The descending (2nd portion) goes from the superior to inferior duodenal flexure.
It is the entry site of the common bile duct...
Findings and procedure details
1.0 Congenital Abnormalities
1.1 Duodenal Diverticulum
Are classified as primary or secondary.
Primary diverticula are believed to be due to abnormalities of recanalization of the duodenal lumen during gestation.
They usually occur within the 2nd part,
most are seen on the medial wall around the ampulla.
(5)
Secondary diverticula are related to an underlying chronic duodenal ulcer.
Acquired type is more common than the congenital.
(4)
Findings.Fig. 2
Barium meal: Contrast filled outpouching of the duodenal lumen.
CT: Saccular outpouching with air,
fluid,
contrast or...
Conclusion
Duodenal pathologies are frequently overlooked or misdiagnosed.
Cross-sectional imaging modalities and barium studies have made their detection and characterization easier.
However,
computed tomography remains the first line imaging modality because it gives us intra and extraluminal information of the disease.
Knowledge of the differential diagnosis with the clinical presentation may help in reaching the correct diagnosis.
Personal information
Dra.
Maria Jose Acosta Falomir
Second year resident of Centro médico ABC
[email protected]
References
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Juanpere S,
Valls L,
Serra I,
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Gelabert A,
Maroto A,
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Imaging of non-neoplastic duodenal diseases.
A pictorial review with emphasis on MDCT.
Insights Imaging.
abril de 2018;9(2):121–35.
3.
Federle MP,
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Diagnostic imaging.
[Internet].
2015 [citado el 11 de diciembre de 2018].
Disponible en: http://public.eblib.com/choice/publicfullrecord.aspx?p=2074557
4.
McNeeley MF,
Lalwani N,
Dhakshina Moorthy...