The interpretation and management of duodenal lesions other than benign ulcer

Five patients, each with a unique disease, illustrate some of the unusual subtleties of interpretation, the challenges of operative approach, the avoidance of pitfalls and the management of complications in local duodenal surgical procedures. A Brunner's gland polyp was resected reversing prior pancreatitis and cardiac alterations. A rare ampullary gangliocytic paraganglioma, hemorrhaging, was managed by duct isolations, resection and papilloplasty. A perforated malignant bleeding ulcer with eventual common bile duct obstruction and mimicking a benign ulcer, was approached with a variety of effective palliative procedures. A complicated duodenoileocolic cutaneous fistula in a patient with a background of granulomatous disease was resected. Finally, an obstructing duodenal stricture, attributable to progressive pancreatitis and presenting two years after bypass for jaundice, was managed by gastrojejunostomy and vagotomy, later converted to a Roux-en-Y preparation because of poor emptying and reflux bile gastritis.