BACKGROUND: Conservative treatment of chronic pancreatitis has only a limited effect in most patients. Surgery offers very good long-term results, even in the early stages of the disease. Unfortunately, only a minority of patients undergo surgical treatment. The aim of this work was to summarise the current treatment options for patients with an inflammatory mass of the pancreatic head. Data from patients in our study demonstrates that the surgery is a safe method, and here we compare the perioperative and early postoperative outcomes of patients who underwent a pancreatoduodenectomy and duodenum-preserving pancreatic head resection for chronic pancreatitis. METHODS: All patients who underwent a pancreaticoduodenectomy or a duodenum-preserving pancreatic head resection in our department between 2014 and 2022 were included in this study. Perioperative and early postoperative results were statistically analysed and compared. RESULTS: Thirty-eight pancreaticoduodenectomies and 23 duodenum-preserving pancreatic head resections were performed. The overall mortality was 3%, whereas the in-hospital mortality after pancreaticoduodenectomy was 5%. The mortality after duodenum-preserving pancreatic head resection was 0%. No statistically significant differences in the hospital stay, blood loss, and serious morbidity were found in either surgery. Operative time was significantly shorter in the duodenum-preserving pancreatic head resection group. CONCLUSIONS: Both pancreatoduodenectomy and duodenum-preserving pancreatic head resection are safe treatment options. Duodenum-preserving pancreatic head resection showed a statistically significant superiority in the operative time compared to pancreaticoduodenectomy. Although other monitored parameters did not show a statistically significant difference, the high risk of complications after pancreaticoduodenectomy with a mortality of 5%; maintenance of the duodenum and upper loop of jejunum, and lower risk of metabolic dysfunctions after duodenum-preserving pancreatic head resection may favour duodenum-preserving pancreatic head resection in recommended diagnoses. Attending physicians should be more encouraged to use a multidisciplinary approach to assess the suitability of surgical treatment in patients with chronic pancreatitis.

• MeSH
• Pancreatitis, Chronic * surgery   MeSH
• Operative Time * MeSH
• Length of Stay statistics & numerical data   MeSH
• Adult MeSH
• Duodenum surgery   pathology   MeSH
• Organ Sparing Treatments methods   MeSH
• Middle Aged MeSH
• Humans MeSH
• Hospital Mortality MeSH
• Pancreas * surgery   pathology   MeSH
• Pancreatectomy methods   adverse effects   MeSH
• Pancreaticoduodenectomy * methods   adverse effects   MeSH
• Postoperative Complications etiology   epidemiology   MeSH
• Retrospective Studies MeSH
• Aged MeSH
• Treatment Outcome MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

• MeSH
• Intestinal Atresia * surgery   diagnostic imaging   etiology   pathology   MeSH
• Duodenum abnormalities   surgery   diagnostic imaging   pathology   MeSH
• Humans MeSH
• Duodenal Diseases * surgery   diagnostic imaging   pathology   congenital   MeSH
• Infant, Newborn MeSH
• Check Tag
• Humans MeSH
• Infant, Newborn MeSH
• Publication type
• Review MeSH

Primary melanoma of the duodenum is an extremely rare, aggressive and life-threatening malignant neoplasm. Published data regarding the effectiveness of current treatment strategies is limited, and our knowledge relies mostly on sporadic case reports. The diagnosis of primary duodenal melanoma is challenging and is based on the patient's medical history and findings from physical examination and radiological and endoscopic imaging as well as proper and careful pathological examinations of the tumor. Despite the many advances in cancer treatment, the prognosis for patients with this type of melanoma remains extremely poor. Delayed diagnosis at advanced disease stage, the general aggressive behavior of this neoplasm, the technical difficulty in achieving complete surgical resection, along with the rich vascular and lymphatic drainage of the intestinal mucosa, all have a negative impact on patients' outcome. In the present review, we aimed to collect and summarize the currently available data in the literature regarding the pathogenesis, clinical features, diagnosis, management and long-term outcomes of this rare, malignant tumor, in order to expand knowledge of its biological behavior and investigate optimal therapeutic options for these patients. Additionally, we present our experience of a case involving a 73-year-old female with primary duodenal melanoma, who was successfully treated with complete surgical resection.

• MeSH
• Duodenum surgery   pathology   MeSH
• Endoscopy MeSH
• Humans MeSH
• Melanoma * diagnosis   surgery   MeSH
• Aged MeSH
• Check Tag
• Humans MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Case Reports MeSH
• Review MeSH

• MeSH
• Autoimmunity MeSH
• Celiac Disease * complications   physiopathology   pathology   MeSH
• Duodenum pathology   MeSH
• Histological Techniques MeSH
• Pregnancy Complications immunology   physiopathology   pathology   MeSH
• Humans MeSH
• Antibodies immunology   MeSH
• T-Lymphocytes MeSH
• Pregnancy MeSH
• Transglutaminases antagonists & inhibitors   immunology   MeSH
• Infertility, Female * etiology   MeSH
• Check Tag
• Humans MeSH
• Pregnancy MeSH
• Female MeSH
• Publication type
• Review MeSH

Whippleova choroba je vzácné, potenciálně život ohrožující onemocnění se širokou škálou možných příznaků a z nich vyplývající rozsáhlou diferenciálně diagnostickou rozvahou. Lze se setkat jak s lokalizovanou formou postižení, tak se systémovými projevy. Původcem onemocnění je bakterie Tropheryma whipplei. Mezi nejčastější manifestace nemoci patří bolesti kloubů, horečky, průjmy, bolesti břicha, malabsorpční syndrom a váhový úbytek. Ve svém příspěvku přináším přehled literatury a kazuistiku pacienta s poměrně typickým průběhem choroby.

Whipple disease is rare, potentionally life-threatening disease with broad scale of possible symptoms and therefore wide differential diagnosis. Localized forms as well as systemic manifestations are possible. Etiological agent is bacteria Tropheryma whipplei. The most common manifestations include arthralgias, fever, diarrhea, abdominal pain, malabsorption syndrome and weight loss. In my article I present literature review and a case report of the pacient with relatively typical course of the disease.

• MeSH
• Anti-Bacterial Agents therapeutic use   MeSH
• Duodenum pathology   MeSH
• Fever etiology   MeSH
• Immunosuppressive Agents therapeutic use   MeSH
• Middle Aged MeSH
• Humans MeSH
• Lymphadenopathy etiology   MeSH
• Malabsorption Syndromes diagnosis   etiology   therapy   MeSH
• Heart Failure complications   MeSH
• Tropheryma * pathogenicity   MeSH
• Treatment Outcome MeSH
• Whipple Disease * diagnosis   etiology   therapy   MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Publication type
• Case Reports MeSH
• Review MeSH

BACKGROUND AND AIMS: There are no agreed-on endoscopic signs for the diagnosis of villous atrophy (VA) in celiac disease (CD), necessitating biopsy sampling for diagnosis. Here we evaluated the role of near-focus narrow-band imaging (NF-NBI) for the assessment of villous architecture in suspected CD with the development and further validation of a novel NF-NBI classification. METHODS: Patients with a clinical indication for duodenal biopsy sampling were prospectively recruited. Six paired NF white-light endoscopy (NF-WLE) and NF-NBI images with matched duodenal biopsy sampling including the bulb were obtained from each patient. Histopathology grading used the Marsh-Oberhuber classification. A modified Delphi process was performed on 498 images and video recordings by 3 endoscopists to define NF-NBI classifiers, resulting in a 3-descriptor classification: villous shape, vascularity, and crypt phenotype. Thirteen blinded endoscopists (5 expert, 8 nonexpert) then undertook a short training module on the proposed classification and evaluated paired NF-WLE-NF-NBI images. RESULTS: One hundred consecutive patients were enrolled (97 completed the study; 66 women; mean age, 51.2 ± 17.3 years). Thirteen endoscopists evaluated 50 paired NF-WLE and NF-NBI images each (24 biopsy-proven VAs). Interobserver agreement among all validators for the diagnosis of villous morphology using the NF-NBI classification was substantial (κ = .71) and moderate (κ = .46) with NF-WLE. Substantial agreement was observed between all 3 NF-NBI classification descriptors and histology (weighted κ = 0.72-.75) compared with NF-WLE to histology (κ = .34). A higher degree of confidence using NF-NBI was observed when assessing the duodenal bulb. CONCLUSIONS: We developed and validated a novel NF-NBI classification to reliably diagnose VA in suspected CD. There was utility for expert and nonexpert endoscopists alike, using readily available equipment and requiring minimal training. (Clinical trial registration number: NCT04349904.).

• MeSH
• Atrophy pathology   MeSH
• Celiac Disease * diagnostic imaging   MeSH
• Adult MeSH
• Duodenum diagnostic imaging   pathology   MeSH
• Endoscopy MeSH
• Middle Aged MeSH
• Humans MeSH
• Aged MeSH
• Narrow Band Imaging MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

Netraumatický spontánny intramurálny hematóm duodena je zriedkavou príčinou obštrukcie proximálneho gastrointestinálneho traktu, ktorý sa môže prezentovať ako hemorágia, ikterus a pankreatitída. V kazuistike prezentujeme prípad spontánneho hematómu duodena u 28-ročnej pacientky, v stave po akútnej pankreatitíde v minulosti, prijatej do nemocnice pre kŕčovité bolesti hornej časti brucha so zvracaním ako podozrenie na akútnu pankreatitídu. MR vyšetrením brucha sme verifikovali intraluminálne zakrvácanie do duodena. Pri konzervatívnom manažmente došlo ku spontánnemu ústupu klinických ťažkostí a úprave laboratórnych parametrov. Vďaka včasnej diagnóze a terapii mala pacientka dobrú prognózu, bez nutnosti chirurgického výkonu. Kontrolné zobrazovacie vyšetrenia ukázali resorpciu hematómu.

Non-traumatic spontaneous intramural duodenal hematoma is a rare cause of proximal gastrointestinal obstruction which may present with hemorrhage, jaundice and pancreatitis. In this case report we present a case of spontaneous duodenal hematoma in a 28-year-old female with a history of acute pancreatitis, admitted to hospital for convulsive upper abdominal pain with vomiting as suspected pancreatitis. An MRI examination of the abdomen confirmed intraluminal bleeding into the duodenum. Following supportive therapy the clinical symptoms spontaneously subsided and laboratory parameters improved. Due to early diagnosis and therapy the patient had a good outcome, without requiring surgery. Repeated imaging showed hematoma resorption.

• Keywords
• hematóm duodena,
• MeSH
• Abdominal Pain etiology   MeSH
• Adult MeSH
• Duodenum * pathology   MeSH
• Hematoma * diagnosis   MeSH
• Humans MeSH
• Treatment Outcome MeSH
• Vomiting MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Female MeSH
• Publication type
• Case Reports MeSH

• Keywords
• duplikatura duodena, syndrom velkého břicha,
• MeSH
• Ascites diagnosis   etiology   therapy   MeSH
• Biomarkers blood   urine   MeSH
• Digestive System Surgical Procedures * methods   utilization   MeSH
• Diagnosis, Differential MeSH
• Duodenum abnormalities   surgery   pathology   MeSH
• Gastroenterology MeSH
• Histological Techniques utilization   MeSH
• Infant MeSH
• Humans MeSH
• Tomography, X-Ray Computed methods   utilization   MeSH
• Prognosis MeSH
• Ultrasonography methods   utilization   MeSH
• Congenital, Hereditary, and Neonatal Diseases and Abnormalities * diagnosis   etiology   therapy   MeSH
• Outcome and Process Assessment, Health Care MeSH
• Check Tag
• Infant MeSH
• Humans MeSH
• Female MeSH
• Publication type
• Case Reports MeSH

Pacientem byl pes, samec, kříženec, sedmiletý. Po dobu asi tří měsíců trpěl zažívacími potížemi, převážně vomitem. Sonografické vyšetření abdomenu prokázalo extrémně dilatovaný žaludek, z 90 % naplněný tekutinou. Při laparotomii byl ve střední části duodena patrný útvar velikosti meruňky s adhezí omenta, který způsobil strikturu střeva. Provedli jsme marginální resekci střeva. Rekonvalescence po operaci proběhla poměrně rychle a ještě za 7,5 měsíce po operaci byl pes ve velmi dobré tělesné kondici. Za 312 dní po operaci byl však utracen vzhledem k tomu, že asi týden před eutanazií se jeho zdravotní stav rapidně zhoršil. Přestal přijímat potravu, často zvracel a byl apatický. Vzhledem k tomu, že zvíře bylo utraceno na jiném pracovišti, nebylo provedeno postmortální vyšetření.V resekovaném střevě jsme histologicky diagnostikovali mucinózní cystadenokarcinom duodena. Z imunohistochemického průkazu cytokeratinů považujeme za zajímavé zjištění, že pozitivita cytokeratinu AE1/AE3 byla střední v enterocytech, epitelie krypt byly převážně slabě pozitivní, ale nádorové epitelie byly silně pozitivní.

The patient was a dog, male, a crossbreed, aged 7 years. He suffered from digestive problems, mostly vomiting, for about three months. Sonographic examination of the abdomen showed an extremely dilated stomach, 90 % filled with fluid. During the lapa-rotomy, an apricot-sized formation with omental adhesion was visible in the middle part of the duodenum, which caused intestinal stricture. We performed a marginal resection of the intestine. After the surgical procedure, the convalescence took place relatively quickly and even 7.5 months after the surgical procedure the dog was in very good physical condition. However, 312 days after the surgery, he was euthanized due to the fact that about a week before euthanasia, his health state deteriorated rapidly. He stopped eating, often vomited and he was apathetic. Due to the fact that the animal was killed at another veterinary facility, no post-mortal examination was performed.Mucinous cystadenocarcinoma was histologically diagnosed in the resected part of the duodenum. From the immunohistochemical detection of cytokeratins, we consider finding that positivity of cytokeratin AE1/AE3 was moderate in the enterocytes, epithelial cells in crypts were mostly weakly positive, but tumor epithelium was strongly positive to be interesting.

• MeSH
• Adenocarcinoma * diagnosis   classification   pathology   veterinary   MeSH
• Anti-Bacterial Agents administration & dosage   MeSH
• Abdomen surgery   pathology   MeSH
• Duodenum pathology   MeSH
• Euthanasia, Animal MeSH
• Histological Techniques veterinary   MeSH
• Immunohistochemistry veterinary   MeSH
• Keratins classification   MeSH
• Laparotomy methods   veterinary   MeSH
• Cystadenocarcinoma, Mucinous diagnosis   pathology   veterinary   MeSH
• Mucins MeSH
• Duodenal Neoplasms * diagnosis   pathology   veterinary   MeSH
• Disease Progression MeSH
• Dogs MeSH
• Ultrasonography veterinary   MeSH
• Treatment Outcome MeSH
• Animals MeSH
• Vomiting etiology   veterinary   MeSH
• Check Tag
• Male MeSH
• Dogs MeSH
• Animals MeSH
• Publication type
• Case Reports MeSH

A two-year-old girl with two weeks of abdominal pain, vomiting, and food refusal, ten months after percutaneous endoscopic gastrostomy insertion because of inadequate peroral intake, was admitted to a tertiary centre hospital. On admission, the extracorporeal part of the gastrostomy was much shortened. X-ray examination revealed migration of the end of the gastrostomy tube with a left-shifted course of the tube through the duodenum. Gastroscopy and subsequently laparotomy were performed. A longitudinal pressure necrosis was identified under the tube, with two perforations in the duodenojejunal region. Ten centimeters of that duodenojejunal region were resected, and end-to-end anastomosis was made. The migration of the gastrostomy was probably caused by insufficient care by the parents. Pathophysiologically, the tube caused the pressure necrosis in the duodenojejunal area; this was supported by histology. This is a hitherto undescribed complication of a percutaneous endoscopic gastrostomy, showing that migration of the gastrostomy to the deeper part of the small bowel can lead to pressure necrosis, a potentially life-threatening condition in children which cannot be treated without invasive procedures.

• MeSH
• Duodenum pathology   MeSH
• Enteral Nutrition MeSH
• Gastroscopy MeSH
• Gastrostomy adverse effects   MeSH
• Humans MeSH
• Necrosis etiology   MeSH
• Duodenal Diseases etiology   surgery   MeSH
• Device Removal MeSH
• Intestinal Perforation etiology   surgery   MeSH
• Child, Preschool MeSH
• Prosthesis Failure adverse effects   MeSH
• Pressure adverse effects   MeSH
• Catheters, Indwelling adverse effects   MeSH
• Check Tag
• Humans MeSH
• Child, Preschool MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Case Reports MeSH