Abstract:Gastro-duodenal obstruction encompasses a spectrum of benign and malignant disease. Historically, chronic peptic ulcer disease was the main cause of gastro-duodenal obstruction, whereas now malignant cause with gastric carcinomas for gastric obstruction and pancreatic tumors for duodenal obstruction predominate. This paper reviews the role of CT in diagnosing gastro-duodenal obstruction, its level, its cause by identifying intraluminal, parietal, or extrinsic process, and the presence of complication.
“…Albeit not the diagnostic technique of choice for suspected PUD, multidetector CT may allow aware radiologists to diagnose both uncomplicated PUD and complications such as haemorrhage, GOO, and biliary or pancreatic fistulisation, thus allowing for timely appropriate treatment [ 5 , 7 , 19 ].…”
Section: Discussionmentioning
confidence: 99%
“…12 ). Endoscopic balloon dilatation of benign GOO is feasible but rarely allows long-term cure [ 5 , 7 , 19 ]. Fig.…”
Section: Gastric Outlet Obstructionmentioning
confidence: 99%
“…Delayed gastric emptying or gastroparesis (Fig. 15 ) secondary to diabetes, central nervous system or smooth muscle disorders such as scleroderma and amyloidosis, post-viral syndromes and medications such as anticholinergics and narcotics may mimic GOO [ 11 – 13 , 19 , 20 ]. Fig.…”
Despite availability of effective therapies, peptic ulcer disease (PUD) remains a major global disease, resulting from a combination of persistent Helicobacter pylori infection and widespread use of nonsteroidal anti-inflammatory drugs. Albeit endoscopy definitely represents the mainstay diagnostic technique, patients presenting to emergency departments with unexplained abdominal pain generally undergo multidetector CT as an initial investigation. Although superficial ulcers generally remain inconspicuous, careful multiplanar CT interpretation may allow to detect deep ulcers, secondary mural and extraluminal signs of peptic gastroduodenitis, thereby allowing timely endoscopic verification and appropriate treatment. This pictorial essay aims to provide radiologists with an increased familiarity with CT diagnosis of non-perforated PUD, with emphasis on differential diagnosis. Following an overview of current disease epidemiology and complications, it explains the appropriate CT acquisition and interpretation techniques, and reviews with several examples the cross-sectional findings of uncomplicated PUD. Afterwards, the CT features of PUD complications such as ulcer haemorrhage, gastric outlet obstruction, biliary and pancreatic fistulisation are presented.Teaching points• Gastric and duodenal peptic ulcers are increasingly caused by nonsteroidal anti-inflammatory drugs
• Multiplanar CT interpretation allows detecting deep ulcers and secondary signs of gastroduodenitis
• CT diagnosis of uncomplicated peptic disease relies on direct and indirect signs
• Currently the commonest complication, haemorrhage may be treated with transarterial embolisation
• Other uncommon complications include gastric outlet obstruction and biliopancreatic fistulisation
“…Albeit not the diagnostic technique of choice for suspected PUD, multidetector CT may allow aware radiologists to diagnose both uncomplicated PUD and complications such as haemorrhage, GOO, and biliary or pancreatic fistulisation, thus allowing for timely appropriate treatment [ 5 , 7 , 19 ].…”
Section: Discussionmentioning
confidence: 99%
“…12 ). Endoscopic balloon dilatation of benign GOO is feasible but rarely allows long-term cure [ 5 , 7 , 19 ]. Fig.…”
Section: Gastric Outlet Obstructionmentioning
confidence: 99%
“…Delayed gastric emptying or gastroparesis (Fig. 15 ) secondary to diabetes, central nervous system or smooth muscle disorders such as scleroderma and amyloidosis, post-viral syndromes and medications such as anticholinergics and narcotics may mimic GOO [ 11 – 13 , 19 , 20 ]. Fig.…”
Despite availability of effective therapies, peptic ulcer disease (PUD) remains a major global disease, resulting from a combination of persistent Helicobacter pylori infection and widespread use of nonsteroidal anti-inflammatory drugs. Albeit endoscopy definitely represents the mainstay diagnostic technique, patients presenting to emergency departments with unexplained abdominal pain generally undergo multidetector CT as an initial investigation. Although superficial ulcers generally remain inconspicuous, careful multiplanar CT interpretation may allow to detect deep ulcers, secondary mural and extraluminal signs of peptic gastroduodenitis, thereby allowing timely endoscopic verification and appropriate treatment. This pictorial essay aims to provide radiologists with an increased familiarity with CT diagnosis of non-perforated PUD, with emphasis on differential diagnosis. Following an overview of current disease epidemiology and complications, it explains the appropriate CT acquisition and interpretation techniques, and reviews with several examples the cross-sectional findings of uncomplicated PUD. Afterwards, the CT features of PUD complications such as ulcer haemorrhage, gastric outlet obstruction, biliary and pancreatic fistulisation are presented.Teaching points• Gastric and duodenal peptic ulcers are increasingly caused by nonsteroidal anti-inflammatory drugs
• Multiplanar CT interpretation allows detecting deep ulcers and secondary signs of gastroduodenitis
• CT diagnosis of uncomplicated peptic disease relies on direct and indirect signs
• Currently the commonest complication, haemorrhage may be treated with transarterial embolisation
• Other uncommon complications include gastric outlet obstruction and biliopancreatic fistulisation
“…Annular pancreas normally presents during childhood [ 6 ], usually manifesting with symptoms resulting from gastricoutlet obstruction; however, in adults it is mostly asymptomatic, being discovered incidentally in patients with peptic ulcers, duodenal obstruction, or pancreatitis. Clinical findings of gastroduodenal obstruction are found in 21% of patients [ 7 ]. A complete ring of pancreatic tissue surrounding the second part of the duodenum diagnoses a complete annular pancreas (Fig.…”
Section: Congenital Anomaliesmentioning
confidence: 99%
“…Patients with duodenal obstruction in the context of chronic pancreatitis often have dilated pancreatic and biliary ducts (Fig. 16 ) [ 7 ]. Fig.…”
A wide spectrum of abnormalities can affect the duodenum, ranging from congenital anomalies to traumatic and inflammatory entities. The location of the duodenum and its close relationship with other organs make it easy to miss or misinterpret duodenal abnormalities on cross-sectional imaging. Endoscopy has largely supplanted fluoroscopy for the assessment of the duodenal lumen. Cross-sectional imaging modalities, especially multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI), enable comprehensive assessment of the duodenum and surrounding viscera. Although overlapping imaging findings can make it difficult to differentiate between some lesions, characteristic features may suggest a specific diagnosis in some cases. Familiarity with pathologic conditions that can affect the duodenum and with the optimal MDCT and MRI techniques for studying them can help ensure diagnostic accuracy in duodenal diseases. The goal of this pictorial review is to illustrate the most common non-malignant duodenal processes. Special emphasis is placed on MDCT features and their endoscopic correlation as well as on avoiding the most common pitfalls in the evaluation of the duodenum.Teaching points
• Cross-sectional imaging modalities enable comprehensive assessment of duodenum diseases.
• Causes of duodenal obstruction include intraluminal masses, inflammation and hematomas.
• Distinguishing between tumour and groove pancreatitis can be challenging by cross-sectional imaging.
• Infectious diseases of the duodenum are difficult to diagnose, as the findings are not specific.
• The most common cause of nonvariceal upper gastrointestinal bleeding is peptic ulcer disease.
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