Consecutively, 2 days after an upper endoscopy was attempted in order to solve the duodenal stenosis
. The length of the stenosis was measured using a contrast medium on fluoroscopic view, and a duodenal uncoated 120/22 mm expandable metallic stent (Garson Flextent, Changzhou, China) was then inserted.
Characteristics EUS-guided biliary drainage (n = 24) Age, mean (SD), years 64.8 (11.4) Sex, male, n (%) 13 (54.2) Causes of biliary obstruction, n (%) Pancreatic cancer 9 (37.5) Cholangiocarcinoma 5 (20.8) Ampullary cancer 5 (20.8) Metastatic gastric cancer 3 (12.5) Metastatic gallbladder cancer 1 (4.2) Metastatic ureteral carcinoma 1 (4.2) Reasons for ERCP failure, n (%) Duodenal stenosis
7 (29.2) Tumor infiltrating papilla 7 (29.2) Failed deep biliary cannulation 4 (16.7) Preexisting duodenal stent 2 (8.3) Gastric outlet obstruction 2 (8.3) Surgically altered anatomy 1 (4.2) Periampullary duodenal 1 (4.2) diverticulum Presence of ascites, n (%) 4 (16.7) Previous duodenal stent, n (%) 3 (12.5) TABLE 2: Technique details and follow-up results of EUS-BD.
A fluid diet like milk can pass through the duodenal stenosis
but not solid food.
Moreover, the presence of duodenal stenosis
at the level of the third and fourth portion of the duodenum, identified on contrast CT, indicated chronic inflammation and secondary fibrosis.
Unsuccessful attempts at endoscopic retrograde cholangiopancreatography are usually attributed to duodenal stenosis
In addition, if the duodenal wall defect after full-thickness resection is too large, postoperative duodenal stenosis
Our cannulation rate was 216 out of 220 (98%) since 5 patients had come for review of previous stents and cannulation failed in 4 cases due to duodenal stenosis
At ERCP, 169 cases (76%) including 5 old ones had CBD stones, 12 (5%) had GB stones , 8 (4%) had CD stones, 7 (3%) had CBD stricture and 10 had ( 5 %) dilated biliary ducts only.
Abdominal situs inversus with congenital duodenal stenosis
: rare association.
One had a small hiatal hernia (a sliding of the stomach above the diaphragm) and another duodenal stenosis
(a narrowing of the duodenum--the first part of the small intestine).
Annular pancreas is a rare congenital malformation that manifests itself primarily by signs related to duodenal stenosis
. The diagnosis is currently based on abdominal CT scan and MRI of the pancreas.
Duodenal involvement is frequently observed in the typical long clinical course of CP, and duodenal stenosis
is a well-known complication in a proportion of cases ranging from 19.6% (12) to 31%.
Intestinal malrotation was associated with 80% of these cases, situs inversus with 40%, pancreatic malformations with 33%, and biliary atresia, duodenal stenosis
or atresia with 13%.