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Duodenal obstruction: diagnosis by gastroduodenal manometry
E V Loftus1, G Farrugia, J H Donohue
1Division of Gastroenterology and Internal Medicine, Mayo Clinic Rochester, MN 55905, USA.
Mayo Clinic Proceedings
|February 1, 1997
Summary
Diagnosing distal duodenal adenocarcinoma is challenging. Gastroduodenal manometry, a diagnostic tool, revealed characteristic contractions indicative of mechanical obstruction, aiding in the diagnosis of duodenal adenocarcinoma.
Area of Science:
- Gastroenterology
- Diagnostic Imaging
- Surgical Oncology
Background:
- Distal duodenal adenocarcinoma diagnosis is often delayed due to non-specific symptoms and limitations of conventional imaging like barium radiography and upper endoscopy.
- Mechanical small intestinal obstruction presents with characteristic manometric patterns, including simultaneous, prolonged contractions postprandially.
Observation:
- A 68-year-old female presented with nausea, vomiting, and weight loss, with initial investigations including upper GI endoscopy and barium studies yielding normal results.
- Gastroduodenal manometry demonstrated high-amplitude, simultaneous duodenal contractions (portions 3 and 4) without jejunal involvement, strongly suggesting distal duodenal mechanical obstruction.
Findings:
- Laparotomy confirmed an obstructing adenocarcinoma of the duodenum proximal to the ligament of Treitz, which was successfully resected.
- Retrospective analysis identified subtle abnormalities on the small bowel barium contrast study, highlighting the diagnostic challenges.
Implications:
- Gastroduodenal manometry can be a valuable tool in differentiating mechanical intestinal obstruction from pseudo-obstruction when initial diagnostic modalities are inconclusive.
- This case underscores the utility of manometry in diagnosing rare duodenal malignancies presenting with obstructive symptoms.