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Background: The presence of duodenal atresia related to type IIIb intestinal atresia is a rare association, with few cases reported in the literature, representing a surgical challenge considering that even isolated cases of type IIIb intestinal atresia are a challenge. The objective was to report the successful surgical management of a case of a complex intestinal malformation, characterized by duodenal occlusion secondary to annular pancreas and type IIIb intestinal atresia, with intestinal malrotation by definition and the presence of Meckel's diverticulum., Clinical Case: We present the case report of a newborn sent to the second level of care with a diagnosis of duodenal obstruction not diagnosed prenatally, which resulted in duodenal atresia due to annular pancreas and type IIIb intestinal atresia according to the Grosfeld classification. The presence of duodenal atresia with type IIIb intestinal atresia is an extremely rare condition, even more so associated with annular pancreas. These cases are a challenge considering the short length of the small intestine and its consequent need for total parenteral nutrition for a prolonged period., Conclusions: The surgical management of this complex intestinal malformation resulted in a case with an adequate post-surgical evolution, based on the immediate start of enteral feeding with a short period of need for total parenteral nutrition that finally resulted in a short hospital stay., (© 2023 Revista Médica del Instituto Mexicano del Seguro Social.)

Endoscopic retrograde cholangiopancreatography (ERCP) is considered the first-approach for biliary drainage. In cases of ERCP failure, patients are usually referred for percutaneous transhepatic biliary drainage or surgical biliary bypass. In the last decade, the indications of endoscopic ultrasound (EUS) in the management of patients with pancreatic cancer have increased, and numerous cases of EUS-guided biliary drainage have been reported in patients with failures during the ERCP. Our goal is to report a patient with locally advanced pancreatic cancer who presented with painless jaundice and cholestasis with biliary and duodenal obstruction. A EUS-guided choledochoduodenostomy was performed by placement of a self-expanding metal stent.

Objective: To present a rare case of duodenal obstruction caused by an impacted gallstone(Bouveret s syndrome) and discusses the best therapeutic option for its resolution., Background: Bouveret's syndrome is the less common presentation of a gallstone ileus. This syndrome is rare and predominates in elderly women; the main symptoms are nausea, vomiting, and epigastric pain, and sometimes hematoemesis, mimicking a pyloric stenosis. Diagnosis is made by endoscopy. Endoscopic lithotripsy must be the first-line treatment however surgery is indicated in case of failure or complication during the procedure. Morbidity and mortality rates are high., Case Report: We present a 75 years old, female patient, with history of diabetes mellitus and hypertension. With 15 days of nausea, vomiting,loss of appetite and abdominal pain, with secondary dehydration and bad general conditions. She was subjected to an endoscopy and a duodenal obstruction by a large gallstone was founded,the endoscopic attempts to extract the gallstone were unsuccessful and surgery was performed with a dudenotomy and two layer closure with good outcome. The patient was discharged on the 8th postoperative day., Conclusions: Bouveret's syndrome is a rare variety of a gallstone ileus and must be considered like differential diagnosis in cases of gastric outlet obstruction.

Introduction: Controversy remains about the management of gallstone ileus. While some authors propose enterotomy, others defend the one-stage procedure (simultaneously fistula repair). The objective of the present study was to analyze management options and comparative study their results., Material and Methods: Retrospective and descriptive study with revision of clinical stories of patients with the diagnosis of gallstone ileus between 1987 and 2008. All the following variables were recorded: dates of hospital admission, surgery and discharge, age, sex, pathological antecedents, preoperative or intraoperative diagnosis, treatment, location of the fistula and location of the obstruction. End-result variables were: postoperative complications, mortality, complications during the follow-up and biliary complications., Results: A total of 40 patients were included of 46,648 admissions. Age, comorbidity, and intraoperative diagnosis were related with poorer short- and long-outcomes. The percentage of postoperative complications was similar for groups with and without fistula repair. Mortality was higher in the group with fistula repair (15 vs. 25%). Biliary complications were more frequent in the group without fistula repair (11 vs. 0%). Sex, location of the fistula and location of the obstruction did not be related with the prognosis., Conclusion: One-stage procedure is related with higher mortality rate than enterotomy alone. Nevertheless, fistula repair reduces the number of biliary complications during the follow-up.

Introduction: There are few studies on congenital duodenal obstruction. The poor peristalsis of the proximal duodenum that causes functional obstruction is a well known problem that occurs in the immediate postoperative period. The optimum technique to address the problem is still controversial., Objective: To compare the results obtained using two different surgical techniques to resolve congenital duodenal obstruction., Patients and Methods: A five-year retrospective review of the neonates who underwent surgery for duodenal obstruction was undertaken. Two different surgical techniques were used: the Kimura operation and Heinecke-Mikulicz enteroplasty. The clinical characteristics, operative time, onset of oral feeding, hospital stay, complications and mortality were analyzed. The results of both groups were compared., Results: Forty-one patients were included; 27 were operated on with the Kimura technique and 14 underwent Heinecke-Mikulicz duodenoplasty.Thirty-five patients had duodenal atresia (86%) and 6 (14%) an annular pancreas. All of them had post-Vater's papilla obstruction and 8 (20%) had trisomy 21. The clinical characteristics of both groups were similar. No significant difference was found in the operative time, onset of oral feeding and hospital stay. Eight patients in each group developed septicemia (30% in the Kimura group vs. 57% in the Heinecke-Mikulicz group, p = 0.16) and one patient in each group died (4% in the Kimura group vs.7% in the Heinecke-Mikulicz group, p = 0.78)., Conclusion: The Kimura duodenal-duodenal anastomosis and Heinecke-Mikulicz duodenoplasty seem to be useful procedures to resolve congenital duodenal obstruction.

The neonatal duodenal pathology has been diagnosed and treated with open surgery for many years. The use of minimally invasive techniques is widely use today on pediatric surgery, but its use on neonatal pathology poses a challenge. We have conducted a study of the 8 neonatal patients with duodenal obstruction that were operated with a laparoscopy in our hospital between 2001 and 2007. The analyzed parameters were the gender, prenatal diagnostic, type of duodenal malformation, weight at birth, hospitalization stay, start of feeding, complications and follow-up. In our sample (6 girls and 2 boys) the 62.5% of the cases was diagnosed after a prenatal ultrasound scan. The duodenal malformations discovered were 5 atresias, 2 webs and 1 anular pancreas. In all the cases, the feeding started by means of a trans-anastomotic probe 48 hours postoperatives. There were 3 complications: one re-surgery and 2 stenosis of anastomosis. The average hospitalization stay was of 27 days with a mean follow-up of 3 years. We think that laparoscopy is a good method for the treatment of the neonatal duodenal pathology, although the scarce volume of our sample does not allow us to generalize the technique.

Unlabelled: Bouveret syndrome is a duodenal obstruction caused by a biliary stone., Aim: To report patients with Bouveret syndrome., Material and Methods: Retrospective review of medical records of patients with Bouveret syndrome treated between 1976 and 2006., Results: We report three women and one man with a mean age of 62.5 years. None had a previous diagnosis of cholelithiasis. AH presented with colicky pain in the right upper quadrant and vomiting, suggesting gastric retention. The diagnosis was suspected after a barium meal in two patients and with a CT scan on the other two. The endoscopical extraction or fragmentation of stones was attempted in three patients but was successful only in one. Three patients were operated and a stone impacted in the first portion of the duodenum was identified, along with a cholecystoduodenal fistula. A duodenostomy and stone extraction was performed. One patient was subjected to a cholecystectomy fistula repair and gastrojejunoanastomosis. No patient died and all were discharged within 8 to 12 days after surgery., Conclusions: Bouveret syndrome is an uncommon complication of cholelithiasis. Endoscopy can be diagnostic and therapeutic. Surgery is the other therapeutic option.

The desmoid tumor is a solid tumor with soft parts and with various possible locations. It is not very frequent and of unknown presentation in our medium. We presented the case of a patient who was treated of extrinsic duodenal obstruction. A compression of the third section of the duodenum was found. The diagnosis was made by pathological anatomy.

Malignant gastroduodenal obstruction may cause significant morbidity. Insertion of enteral prostheses as a palliative treatment is an acceptable option to achieve an appropriate gastric voiding without the morbidity associated to palliative surgery, with a lesser procedure-related mortality and a lower cost, while providing a better quality of life. Its is important to unify and consolidate the endoscopic procedure for the placement of enteral prostheses, avoiding variations that may preclude an adequate analysis of this procedure outcome.

Introduction: Bouveret's syndrome is characterized by piloro-duodenal obstruction following the implant of a giant gallstone with gallstone ileus origin. It constitutes the less common variety of gallstone ileus (1-3%), mainly affecting elderly patients with chronic degenerative illnesses, possibly with high mortality., Objective: We report the case of a patient with a less common variety of gallstone ileus. The patient was treated at a third-level care hospital., Clinic Case: Patient is a 52-year-old male with gastric obstruction and secondary dehydration. Studies were supported by a series of esophagus-gastric-duodenal and broad endoscopy. Piloro-duodenal obstruction by a giant gallstone was reported which could not be extracted by endoscopy. The patient was taken to surgery where a giant gallstone lying in the duodenal site was found and biliary vesicular scleroatrophic. Gastrotomy is effected with the extraction of the gallstone and gastrography. Gallstone duodenal fistula is then identified with support analysis., Conclusions: Bouveret's syndrome is a rare entity whose diagnosis has a high sensitivity and specificity with a supported radiographic diagnosis. Endoscopy is difficult in the case of a giant impacted gallstone, making surgery the best therapeutic choice.

We present a case left paramesocolic hernia and review the literature. The patients was a 14 years old male and had suffered periods of relapses into abdominal pain from the age of three. When for years old he was operated on using the Nisses technique. Also a laparoscopy had already been performed on this same patient when he was 13 years old, without discovering any pathological conditions. In a new upper gastrointestinal serie, realized one year later, a retroperitoneal incarceration and a paraduodenal loop of jejunum was observed, which obstructed, partially the second part of the duodenum. We have not found the anatomical characteristics of this case in any previous report. In the ample literature pressured, it was confirmed that almost all the clinical cases, previously published had suffered a relapse abdominal pain crisis, diagnosed in advanced states and in/or emergency situations. This produces a mortality rate higher than 20% and or irreparable digestive damage. In cases involving paraduodenal hernias, there exists a low rate of diagnostic suspicion. These delays and diagnostic errors cause irreparable damage. In those patients who suffer relapses into abdominal pain syndrome, one should always include the differential diagnosis of PMH, applying a complete gastrointestinal serie or a CT-Scan with contrast.

We report a recent case of small bowel atresia and biliary atresia in a newborn. We describe the management of the patient and we make a revision of the literature. Only 13 cases have been found, that confirms that this association is extraordinary rare.

Bouveret's syndrome is an unusual presentation of gallstone ileus, due to duodenal obstruction. It is produced by the migration of biliary calculus through a cholecystogastric or cholecystoduodenal fistula. We present 3 new cases of Bouveret's syndrome, and the clinical and radiological findings on different imaging procedures (plain abdominal radiography, barium studies, ultrasonography and computed tomography). On the basis of these cases, we discuss the diagnostic and possibly therapeutic merits of digestive endoscopy and about the different surgical procedures.

Within the last ten years and by the introduction of some new instruments, laparoscopy is a safe and effective method that has been further extended in children. We report our experience in the treatment of laparoscopy on a seven day old newborn affected by malrotation with an intermittent duodenal obstruction. The treatment consisted of a duodenal liberation after the section was easily performed in congenital Ladd's bands. The spiral twists of the small intestine found in the upper gastrointestinal series, disappeared in a new study done after surgery. We consider this operation as a new indication for an operative laparoscopy. It allows a good visualization of this congenital abnormality, and it is easy to perform with a significantly reduced operative trauma.

The case of an 81-year-old woman admitted for abdominal pain, nausea and vomiting diagnosed with Bouveret syndrome is presented. This rare disease, consisting in obstruction of gastric emptying by gallstones located in the pylorus or the duodenal bulb predominates in elderly women and represents 2% of the cases of biliary ileum. Diagnosis is based on the clinical manifestations, the existence of aerobilia, visualization of lithiasis by radiography, echography or fiber gastroscopy and the demonstration of duodenal obstruction. The treatment of choice is surgery consisting in gastrotomy or enterotomy and extraction of the stone. The importance of diagnosis and early treatment is emphasized to improve prognosis.

Annular pancreas (AP) is a rare congenital anomaly due to malrotation of the pancreatic ventral yolk. Although it has been described in young and middle age adults it predominates in children. Its clinical picture is that of duodenal obstruction or acute pancreatitis episodes. In this paper we report four cases of AP that were seen at the Instituto Nacional de la Nutricion Salvador Zubiran in Mexico City. Three were females and three were less than twenty years old. In one case the diagnosis was established at birth and the operation done in another hospital. In another patient a diagnosis of pyloric hypertrophy was made and a pyloroplasty was performed. This young man was admitted in our hospital because of abdominal pain and hyperamylasemia. An eighty four year old woman was seen due to abdominal pain, nausea and vomit. In all cases the diagnosis of AP was carried out with radiological studies and confirmed by laparotomy. Surgical procedures consisted of duodenal-duodenal anastomosis in two, sphincteroplasty in one, and gastrojejunoanastomosis in the other. Two patients are asymptomatic, one died in the postoperative period, and one was lost for follow up. These four cases represent all the experience of our institute and correspond to one case in 36,735 admissions.

We present a case of duodenal obstruction caused by biliary calculus (Bouveret's syndrome) an unusual cause of gallstone ileus. The clinical presentation simulated a pyloric stenosis, the gastrointestinal X-ray study being that which allowed us to establish diagnosis. Surgery was carried out only on the duodenal obstruction with successful results.

A review of 10 years (1964-1973) of patients admitted to the Hospital Infantil de Mexico with duodenal obstruction is made. There were 70 cases, 33 of which corresponded to intrinsic obstruction and 37 to the extrinsic type. The clinical picture, whether complete or incomplete obstruction is involved, is analysed and the importance of radiology is emphasized to reach an early diagnosis. The surgical management is described in accordance with the type of lesion found. Mortality in this type of pathology is still high in spite of the improvement in surgical techniques and intensive management of newborns, considering that these patients usually show low weight and a high frequency of associated malformations.

A case of congenital incomplete duodenal diaphragm associated to foreign bodies, in a 28 months child with Down's syndrom is reported. This case had an acute beginning of the symptoms and a severe clinical picture. We discuss the clinical features diagnostic and therapeutic aspects.

Two cases of congenital duodenal diaphragm were discovered during a review of 2.724 duodenal X-rays performed over the past 3 years. An analysis is made of the total of 40 cases published in the literature. The duodenal diaphragm is a thin wall located into the duodenal lumen with excentric perforation and which undergoes a progressive sacculation. Its embryologic development and close relationship to intraduodenal diverticulum are described. Clinical manifestations are few and unspecific, and the condition can easily be overlooked during surgery even when external palpation or digital exploration of the duodenal lumen is performed following duodenotomy. Special emphasis is placed on the significance of the X-ray images, though they are only orientative when dealing with this condition. Congenital duodenal diaphragm should be kept in mind as a possibility whenever chronic stenosis of the duodenum is diagnosed.

Three cases of preduodenal portal vein (PDPV) observed in newborns and young infants are reported. In two patients the diagnosis was made during operations for duodenal stenosis and in the remaining one while operating for midgut volvulus and necrosis. In no case was the PDPV responsible for the clinical picture but in all three patients it was accompanied by other causes of obstruction: annular pancreas, extrinsic adhesive bands and malrotation. In one case there was also an asplenia, and polisplenia was present in another one. Both had malrotation and some degree of abnormal visceral asimmetry. The incidence of associated malformations in 52 previously reported cases is analyzed, and the more convincing embriological explanation for this anomaly is commented upon.

Authors review fourteen cases of duodenal stenosis. A close observation can disclose early signs and enable an early diagnosis. A comment of the surgical technique is made.

The autors present their experience with nine cases of duodenal obstruction in newborns, admitted to this hospital between Janurary, 1972 and January, 1977. Six babies had duodenal atresia and three had stenosis. Two groups were formed based on the patient's weight: Group one (good prognosis) patients with weight above 2.500 g. Group two (poor prognosis) patient's weight under 2.500 g. All the patients of the first group survived and all the patients of the second died. The overall mortality was 4/9. All the patients from the second group (poor prognosis) also showed associated congenital malformations (esophageal atresia, multiple atresias, urological and cardiac disease). Even if the number of cases is not statistically significant, it seems that the weight of the baby and the associated malformations bear on the final outcome of these patients.

A case is presented of Bouveret's syndrome, an unusual form of biliary ileus, that developed a high intestinal obstruction simulating pyloric stenosis. We emphasize the value of fiberendoscopy, which permits an early diagnosis to be made, thus avoiding delays in treatment.

A 55 year old man presented with vomiting, abdominal pain, diarrhea, jaundice and choluria. An obstruction of the gastric outlet by a large gallstone located at the duodenum was demonstrated by radiologic, ultrasonographic and endoscopic examinations. The stone could not be removed through endoscopy and the patient was successfully operated on. A review of published reports is included.