TY - JOUR
T1 - Duodenal obstruction
T2 - diagnosis by gastroduodenal manometry
AU - Loftus, Edward V.
PY - 1997
Y1 - 1997
N2 - Establishing the diagnosis of adenocarcinoma of the distal duodenum is often difficult based on findings on barium radiography and routine endoscopy of the upper gastrointestinal tract. A characteristic manometric pattern of simultaneous, prolonged contractions of the small intestine after a meal has been associated with mechanical obstruction of the small intestine. Herein we describe a 68-year-old woman who had a 4-month history of nausea, vomiting, and weight loss. Findings on endoscopy of the upper gastrointestinal tract and a barium contrast examination of the stomach, duodenum, and small bowel were interpreted as normal. A radionuclide scan suggested mildly delayed gastric emptying. Gastroduodenal manometry revealed high-amplitude, simultaneous contractions in the third and fourth portions of the duodenum but not in the jejunum, findings highly suggestive of a mechanical obstruction in the distal duodenum. At laparotomy, an obstructing adenocarcinoma of the duodenum proximal to the ligament of Treitz was resected. Subtle abnormalities were detected retrospectively on the barium contrast study of the small bowel. In patients with features suggestive of intestinal obstruction, gastroduodenal manometry may be helpful in distinguishing mechanical causes from pseudo-obstruction.
AB - Establishing the diagnosis of adenocarcinoma of the distal duodenum is often difficult based on findings on barium radiography and routine endoscopy of the upper gastrointestinal tract. A characteristic manometric pattern of simultaneous, prolonged contractions of the small intestine after a meal has been associated with mechanical obstruction of the small intestine. Herein we describe a 68-year-old woman who had a 4-month history of nausea, vomiting, and weight loss. Findings on endoscopy of the upper gastrointestinal tract and a barium contrast examination of the stomach, duodenum, and small bowel were interpreted as normal. A radionuclide scan suggested mildly delayed gastric emptying. Gastroduodenal manometry revealed high-amplitude, simultaneous contractions in the third and fourth portions of the duodenum but not in the jejunum, findings highly suggestive of a mechanical obstruction in the distal duodenum. At laparotomy, an obstructing adenocarcinoma of the duodenum proximal to the ligament of Treitz was resected. Subtle abnormalities were detected retrospectively on the barium contrast study of the small bowel. In patients with features suggestive of intestinal obstruction, gastroduodenal manometry may be helpful in distinguishing mechanical causes from pseudo-obstruction.
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U2 - 10.4065/72.2.130
DO - 10.4065/72.2.130
M3 - Article
C2 - 9033545
AN - SCOPUS:0031429109
SN - 0025-6196
VL - 72
SP - 130
EP - 132
JO - Mayo Clinic proceedings
JF - Mayo Clinic proceedings
IS - 2
ER -