Presentation
Presented with abdominal discomfort, food regurgitation for 2 months and vomiting for 1 week. No family history of malignancy.
Patient Data
Presence of nasogastric tube with its tip in the stomach. The stomach is distended with contrast filled. Air fluid level is observed in the stomach. Relatively luminal narrowing is seen at the first part of duodenum (D1) as compared to the second part of duodenum (D2). No obvious gastric or duodenal wall thickening. No surrounding fat streakiness. Subcentimeter regional mesenteric lymph nodes are noted.
Right renal cyst with thin internal septation is seen at the upper pole.
No enlarged abdominal or pelvic lymphadenopathy. The rest of abdomen and pelvis are unremarkable.
Case Discussion
Features are consistent with benign D1 stricture evidenced by relatively luminal narrowing and no obvious duodenal wall thickening.
Esophagogastroduodenoscopy (OGDS) confirmed D1 luminal stenosis with no gastric or bowel wall thickening to suggest malignancy.
The patient underwent a laparoscopic gastrojejunostomy bypass and was discharged well. Currently, he is under surgical clinic follow-up.
Duodenal stricture can occur secondary to benign or malignant etiology. It may be divided into the following classification 1:
A. Intrinsic causes:
inflammatory bowel disease involvement of the duodenum
acute and chronic duodenitis
benign and malignant duodenal tumors
malignant duodenal ulcer
local infiltration from adjacent tumors: e.g. pancreatic carcinoma
B. extrinsic causes:
regional inflammation: e.g. pancreatitis
regional trauma-related hematoma
regional infective/ inflammatory collection
anomalies of the pancreas: e.g. annular pancreas
Gallbladder enlargement: e.g. acute cholecystitis, hydrops or gallbladder carcinoma
pressure from aneurysm, enlarged lymph nodes or nearby tumors
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