Clinical and Endoscopic Features.--Ectopic gastric mucosa is a common finding in duodenal biopsies, generally identified in the duodenal bulb
. It consists either of gastric foveolar metaplastic cells without oxyntic glands, known as gastric foveolar metaplasia, or may be associated with oxyntic glands and referred to as gastric heterotopia.
Interestingly, this is the first presentation of a gastric phytobezoar causing temporary jaundice when impacted in the duodenal bulb
. The endoscopic fragmentation and removal of a large gastric phytobezoar with the transmission of high current flow in a single session, as described here, requires advanced endoscopic skills and experience, as well as the ability of immediate surgical intervention in the rare case of stomach perforation.
Dissected right gastric artery (12); common hepatic duct (HD); cystic duct (CD); caudate lobe (CL); pyloric region (RP); duodenal bulb
However, a large gallstone could be easily visualized just distal to the pylorus, situated in the distal duodenal bulb
and the first and second portions of the duodenum (Figure 3).
The duodenum should pass posterior to the stomach with the DJJ lateral to the left pedicles at the level of the duodenal bulb
. The DJJ can be as much as 1 vertebral body height inferior to the duodenal bulb
and still be considered normal.
Excess stomach acid and other irritating factors can cause inflammation of the upper end of the duodenum, the duodenal bulb
This examination revealed inflammation of the distal esophagus and mild erythema of the gastric cardia and antrum, as well as erythema of the duodenal bulb
and descending duodenum.
The "double bubble" seen in this condition corresponds to fluid in both the duodenal bulb
The endoscopy revealed a Mallory Weiss tear and large duodenal bulb
Ulcers rarely occur in the esophagus or in the first portion of the duodenum, the duodenal bulb
It is also found in the duodenal bulb
of patients with duodenal ulcer.21 The explanation is that these patients have metaplasia of the bulb, so that the lining is transformed from normal small-bowel epithelium to metaplastic gastric epithelium.
Gastroscopy demonstrated mosaic gastric mucosa, non-uniform hyperaemic mucosa in the duodenal bulb
and some blenching with hypertrophic folds and thickened villi in the outside bulbar region (Figure 1).