Tuberculous Duodenal Stenosis: Report of Two Cases

Benzekri, O.; Mouhadi, S. El; Chourak, M.; Boussetta, Sami; Absi, M. El; Echarab, Mahjoub; Elouanani, M.; Amraoui, M.; Errougani, A.; Alami, Fadoua; Chkoff, R.

doi:10.1159/000161566

Cited by 3 publications

(2 citation statements)

References 11 publications

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“…The lack of special manifestations leads to a final diagnosis that requires surgical intervention. [ 21 ] Primary duodenal adenocarcinoma accounts for nearly half of all small-bowel adenocarcinomas. While no tumors arise from 1st part of the duodenum, 87% of duodenal adenocarcinoma occurs on 2nd part of the duodenum.…”

Section: Discussionmentioning

confidence: 99%

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Metastases to duodenum in cervical squamous cell carcinoma

Chen

Zhang²,

Zhou³

et al. 2022

Medicine

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Rationale: Metastases to the duodenum in cervical squamous cell carcinoma are extremely rare, with only 7 cases reported in the published English literature. Patient concerns: We present the case of a 66-year-old woman with duodenal metastasis of cervical squamous cell carcinoma who presented with nausea and vomiting within the past 12 days. Diagnosis: Esophagogastroduodenoscopy revealed a circular narrowed 2nd part of the duodenum with congested and edematous mucosa, which was biopsied for a suspected neoplastic lesion. The pathological diagnosis indicated squamous cell carcinoma identical to the original tumor, confirming duodenal metastasis. Interventions: The patient received total parenteral nutrition on admission, but symptoms of jaundice soon appeared in the following week, suggesting infiltration of carcinoma into the common bile duct. After percutaneous transhepatic cholangial drainage was performed, jaundice eased in the following 3 days, and an uncovered self-expandable metallic stent was subsequently inserted into the stenosis of 2nd and 3rd part of the duodenum. Subsequently, the patient's diet quickly resumed. Outcomes: The patient refused further intervention and was discharged home to continue palliative care at the local hospital. Lessons: Clinicians should be alert to patients’ past medical history to ensure that duodenal metastasis of other tumors is considered in the differential diagnosis. For endoscopists, awareness of such patterns of duodenal stenosis is vital for the accurate recognition of such infrequent diseases.

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Section: Discussionmentioning

confidence: 99%

“…Luminal stenosis may be the only endoscopic finding, and endoscopic biopsy findings are nonspecific. The lack of special manifestations leads to a final diagnosis that requires surgical intervention [21] . Primary duodenal adenocarcinoma accounts for nearly half of all small-bowel adenocarcinomas.…”

Section: Discussionmentioning

confidence: 99%

Metastases to duodenum in cervical squamous cell carcinoma

Chen

Zhang²,

Zhou³

et al. 2022

Medicine

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Primary duodenal tuberculosis mimicking malignancy

et al. 2013

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Duodenal tuberculosis with gastric outlet obstruction: a case report of successful diagnosis and treatment, with review of literature

Sato,

Shiobara,

Wakatsuki

et al. 2024

surg case rep

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Background Duodenal tuberculosis (TB) is extremely rare, and its diagnosis is challenging owing to the lack of specific symptoms and radiological or endoscopic findings. When it leads to gastric outlet obstruction (GOO), diagnosing it accurately and providing appropriate treatment is crucial. However, this is often overlooked. Case presentation A 35-year-old man presented with abdominal pain, fullness, vomiting, and weight loss. Upper gastrointestinal endoscopy and radiography revealed nearly pinpoint stenosis with edematous and reddish mucosa in the D1/D2 portion of the duodenum. Computed tomography (CT) showed the duodenal wall thickening, luminal narrowing, multiple enlarged abdominal lymph nodes, and portal vein stenosis. Conventional mucosal biopsy during endoscopy revealed ulcer scars. We initially suspected stenosis due to peptic ulcers; however, chest CT revealed cavitary lesions in both lung apices, suggesting tuberculosis. Due to the suspicion of duodenal TB and the need to obtain deeper tissue samples, endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) was performed. The tissue sample showed caseating granulomas with multinucleated giant cells, and acid-fast bacilli were positive by Ziehl–Neelsen staining. The patient was diagnosed with duodenal TB and subsequent GOO. Because the patient had difficulty eating, surgical intervention was prioritized over antitubercular drugs, and laparoscopic gastrojejunostomy was performed. The patient started an oral diet on the 3rd postoperative day and began antitubercular treatment immediately after discharge on the 11th day. During the 6th month of treatment, endoscopic examination revealed residual duodenal stenosis; however, the bypass route functioned well, and the patient remained asymptomatic. Conclusions An aggressive biopsy should be performed to diagnose duodenal TB. EUS-FNA has proven to be a useful tool in this regard. Both nutritional improvement and antitubercular treatment were achieved early and reliably by performing laparoscopic gastrojejunostomy for duodenal TB with GOO.

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Tuberculous Duodenal Stenosis: Report of Two Cases

Cited by 3 publications

References 11 publications

Metastases to duodenum in cervical squamous cell carcinoma

Metastases to duodenum in cervical squamous cell carcinoma

Primary duodenal tuberculosis mimicking malignancy

Duodenal tuberculosis with gastric outlet obstruction: a case report of successful diagnosis and treatment, with review of literature

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