Distal Duodenal Obstruction: a Surgical Enigma

Abstract

The postbulbar segment also known as the distal duodenum is a separate clinical entity in terms of the intrinsic pathologies of this region and its varied anatomical relations. The common bile duct and the pancreatic duct open through the major papilla, which marks the beginning of this segment. Distal duodenal obstruction can be defined as a clinicoradiological entity that is characterized by features of gastric outlet obstruction with recurrent bilious vomiting and a radiological evidence of postbulbar obstruction. A Medline search for distal duodenal obstruction revealed 1409 entries, mostly in the form of case reports. In the last 10 years, 310 cases are reported. Clinical features like abdominal pain, nausea, and vomiting are non-specific and quite similar to gastric outlet obstruction. Clinical findings are also non-specific and do not aid in diagnosis. Laboratory findings also do not add much. Contrast-enhanced CT scan and MR enterography are diagnostic modalities of choice. Distal duodenal obstruction is a clinical entity that has a wide list of differential diagnosis which requires due consideration in terms of its management and follow-up. Most of these lesions require adequate workup with the help of a multidisciplinary team consisting of radiologists, gastroenterologists, and pathologists to adequately diagnose and stage the disease before a treatment plan is formulated. A thorough knowledge is a must regarding the treatment options available for each of the conditions so that the management can be personalized leading to better results.

Duodenal Obstruction in a Patient Previously Treated With EndoVascular Aneurysm Sealing System Repair

“…[11][12][13][14] Distal DO is a clinical and radiological entity characterized by features of gastric outlet obstruction, with recurrent bilious vomiting and radiological evidence of post-bulbar obstruction. 15 Common clinical features of distal DO include epigastric/periumbilical pain, nausea, vomiting, early satiety, weight loss and rarely, abdominal distention. 15 A DO resulting from an AAA was first described by Osler in 1905, and is currently known as "aortoduodenal syndrome."…”

“…15 Common clinical features of distal DO include epigastric/periumbilical pain, nausea, vomiting, early satiety, weight loss and rarely, abdominal distention. 15 A DO resulting from an AAA was first described by Osler in 1905, and is currently known as "aortoduodenal syndrome." 16 Only 47 cases of aortoduodenal syndrome have been reported in the scientific literature to date.…”

Impact of retroperitoneal tumors on the digestive tract (Review)

“…A partial duodenal obstruction allows the passage of liquids and gas; therefore, these patients usually present with diarrhea, whereas a more severe obstruction is usually accompanied by constipation and in some cases even by the absence of transit for intestinal gas. Persistent vomiting and diarrhea may cause dehydration, which is clinically manifested by dry skin and dry mucous membranes, persistent cutaneous folds and thirst (18).…”

Iatrogenic Duodenal Obstruction due to Acupuncture Therapy Trauma

“…There are many possible causes of duodenal obstruction, such as congenital anomalies and various acquired conditions associated with space-occupying lesions [1]. The specific retroperitoneal position of the duodenum predisposes it to compression, displacement, and obstruction from a myriad of retroperitoneal disorders.…”