• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.18 no.4
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• pp.280-285
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• 2015

Heterotopic pancreas (HP) is defined as pancreatic tissue lacking anatomic and vascular continuity with the main body of the pancreas. Most are asymptomatic, but can cause ulcer, bleeding, intussusception, and mechanical obstruction. Herein, we presented one case of HP presented as duodenal tumor causing duodenal obstruction. A 7-year-old girl visited the emergency room for abdominal pain with vomiting for 24 hours. Computed tomography and upper gastrointestinal series revealed a polypoid mass with short stalk in the 2nd portion of duodenum. We attempted an endoscopic removal. However, the lumen was nearly obstructed by the mass and the stalk was too broad and hard to excise. The mass was surgically removed via duodenotomy. It was confirmed as a HP with ductal and acini components (type 2 by Heinrich classification). Postoperatively, the patient has been well without any complication and recurrence.

• BMB Reports
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• v.31 no.3
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• pp.274-280
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• 1998

An inositol monophosphatase (IMPase) was purified to homogeneity from rat duodenal mucosa for the first time and its enzymatic properties were investigated. Rat duodenal mucosa peculiarly exhibited the highest IMPase activity among various rat tissues examined. By means of ammonium sulfate precipitation, followed by Q-Sepharose, polylysine agarose, reactive-red agarose column chromatography, Uno-Q FPLC, and Bio-Silect FPLC, duodenal IMPase was purified 223-fold to a specific activity of 13.6 U/mg protein. The molecular mass of the native enzyme was estimated to be 48,000 Da on gel filtration. The subunit molecular mass was determined by SDS-PAGE to be 24,000 Da. These results indicate that duodenal IMPase is a dime ric protein made up of identical subunits. Rat duodenal IMPase has distinct properties from brain IMPase. It has a broad spectrum of substrate specificity and is insensitive to $Li^+$. Duodenal IMPase does not absolutely require $Mg^{2+}$ for its catalytic activity. Furthermore, duodenal IMPase is less stable to heat than brain enzyme. It is suggested that the rat duodenal mucosa needs a large amount of IMPase whose properties are quite different from that of the brain enzyme.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.22 no.6
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• pp.571-575
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• 2019

We report a case of a 13-year-old girl who presented with a 2-month history of intermittent abdominal pain. Laboratory examination showed hepatitis and pancreatitis. Because of persistent vomiting, computed tomography (CT) was performed, which revealed a circumferential soft tissue density in the duodenal wall, causing partial obstruction. Supportive therapy failed. Repeat CT showed no significant change from the initial study. The patient underwent upper endoscopy, which revealed a mass in the second portion of the duodenum, which occluded most parts of the lumen. The histopathological finding was consistent with an anaplastic large cell lymphoma, a rare form of small bowel neoplasm. After the third course of chemotherapy, complete resolution of the mass was noted, and her symptoms were relieved.

• Journal of Veterinary Clinics
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• v.39 no.5
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• pp.258-263
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• 2022

An eight-year-old, intact female, Shih-Tzu, weighing 4.5 kg presented with complaints of anorexia, pale mucous membrane, and vomiting for the past 5 days. On physical examination, nausea, abdominal pain, and melena were noted. On hematologic examination, severe anemia and thrombocytosis were identified. On radiographs examination, soft tissue opacity with small faint mineral opacity mass in the mid-abdomen and two mineral opacity regions in the cranial aspect of mass were identified. Ultrasonographic findings showed thickening of descending duodenal wall with loss of layering and mineralization within the duodenal wall and mesentery adjacent to the duodenal lesion. Computerized tomography showed circumferential wall thickening of descending duodenum with mineralization. Mineralization of the mesentery and mesenteric lymph nodes was identified. Based on the diagnostic imaging, the tentative diagnosis was descending duodenal tumor with dystrophic mineralization. Endoscopy revealed mucosal hemorrhage and erythema within the descending duodenum and stomach. Surgery was performed, and mineralization in the pancreatic tail to duodenum and mesentery was found. Resection of the duodenum, regional lymph node, and mineralized pancreatic region and the duodenal anastomosis were performed. The histologic examination revealed a high-grade undifferentiated duodenal carcinoma with metastases to the regional lymph node and mesentery. The patient was managed with supportive therapy for 8 days and discharged. The patient was followed up for 5 months and there were no complications.

• Journal of Digestive Cancer Research
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• v.11 no.1
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• pp.49-54
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• 2023

Colorectal cancers often invade adjacent organs; however, direct duodenal invasion is rare. Adenocarcinoma is the most common type of colorectal cancer, but an undifferentiated carcinoma type is unusual. Herein, we present a case of undifferentiated carcinoma of the colon that directly invaded the duodenum and metastasized to distant lymph nodes. An 85-year-old female patient was admitted with a 7-cm-sized colonic mass invading the duodenum, detected by computed tomography. Positron emission tomography revealed fluorodeoxyglucose uptake in the colon, duodenum, and aortocaval lymph nodes. A large encircling mass in the ascending colon and an ulcerated mass in the duodenum were revealed by colonoscopy and esophagogastroduodenoscopy, respectively. Pathologic examinations of the colon and the duodenum revealed nonglandular, diffusely infiltrating atypical round cells, confirming undifferentiated carcinoma of the colon. The histologic type of this tumor was distinguished using immunohistochemical (IHC) markers. Finally, microscopic characteristics and IHC markers aided in identifying the histologic type of colorectal cancer.

• Journal of Veterinary Clinics
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• v.24 no.4
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• pp.644-646
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• 2007

This report deals with a 9-year-old neutered male Yorkshire terrier that had been suffered from vomiting, bloody diarrhea, anorexia. On exploratory laparotomy, pale-pink $10{\times}6cm$ duodenal mass was found and submitted to the Department of Veterinary Pathology, College of Veterinary Medicine, Seoul National University. Histologically, the duodenal mass consisted of compact sheet of poorly demarcated, highly infiltrative neoplasm. The neoplastic cells were round to polygonal and contained scant to moderate amounts of granular basophilic cytoplasm and eccentrically located irregularly round nuclei with stippled chromatins. The neoplastic cells were positive to lamda light chain immunohistochemically but were uniformly negative for toluidine blue stain and giemsa stains. Based on these results, this case was diagnosed as primary extramedullary plasma cell tumor of duodenum.

• Journal of Gastric Cancer
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• v.20 no.1
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• pp.81-94
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• 2020

Purpose: Duodenal stump leakage (DSL) is a potentially fatal complication that can occur after gastrectomy, but its underlying risk factors are unclear. This study aimed to investigate the risk factors and management of DSL after laparoscopic radical gastrectomy for gastric cancer (GC). Materials and Methods: Relevant data were collected from several prospective databases to retrospectively analyze the data of GC patients who underwent Billroth II (B-II) or Rouxen-Y (R-Y) reconstruction after laparoscopic gastrectomy from 2 institutions (Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, and HwaMei Hospital, University of Chinese Academy of Sciences). The DSL risk factors were analyzed using univariate and multivariate analysis regression. Results: A total of 810 patients were eligible for our analysis (426 with R-Y, 384 with B-II with Braun). Eleven patients had DSL (1.36%). Body mass index (BMI), elevated preoperative C-reactive protein (CRP) level, and unreinforced duodenal stump were the independent risk factors for DSL. DSL was diagnosed in 2-12 days, with a median of 8 days. Seven patients received conservative treatment, 3 patients received puncture treatment, and only 1 patient required reoperation. All patients recovered successfully after treatment. Conclusions: The risk factors of DSL were BMI ≥24 kg/㎡, elevated preoperative CRP level, and unreinforced duodenal stump. Nonsurgical treatments for DSL are preferred.

• Journal of Digestive Cancer Research
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• v.2 no.2
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• pp.68-71
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• 2014

A 57-year-old male visited our hospital due to a growing abdominal mass for 1 month. The patient was diagnosed as transverse colon cancer with duodenal fistula, and then was treated with neoadjuvant concurrent chemoradiation therapy (2 cycles of FOLFOX-4, 3-dimensional conformal radiation therapy: 3,000 cGy in 10 fractions). Despite the improvement of colon cancer and associated inflammation, the symptom of colonic obstruction was aggravated. Thus transverse colon segmentectomy was done. After surgery, he have received adjuvant 12 cycles of FOLFOX-4 chemotherapy. Now, he is currently being followed up in cure state.

• Journal of Digestive Cancer Research
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• v.3 no.2
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• pp.101-104
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• 2015

A 55-year-old man was admitted to the hospital for jaundice. Computed tomography (CT) scans showed a diffuse mass in the pancreas and peripancreatic area, with infiltration to of the whole pancreas, and overall reduced enhancement compared to normal pancreas. Esophagogastroduodenoscopy revealed elevated mucosal lesion covered hyperemic mucosa at duodenal bulb and ulcerative lesion at body of stomach. Endoscopic ultrasonography revealed an irregular mass with unclear boundaries was observed within the pancreas. Abrupt narrowing of mid to distal common bile duct was seen and the stricture was caused by compression of pancreatic mass. Plastic stent was inserted and clinical improvement was achieved including resolution of jaundice. The patient is currently being treated with combination of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone. We report a case of primary pancreatic lymphoma presenting with obstructive jaundice.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.22 no.1
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• pp.57-62
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• 2019

Purpose: This study was performed to assess the clinical usefulness of transabdominal ultrasonography (TUS) in detecting peptic ulcer disease (PUD) in children. Methods: Twenty-four patients (19 boys, 5 girls; mean age, $10.6{\pm}4.5years$ [range, 3.0-17.9 years]) who were admitted to the hospital for acute abdomen or gastrointestinal bleeding and diagnosed with PUD by endoscopy and who underwent TUS were included. Clinical data were retrospectively collected by reviewing patient medical records. Gastric ulcer (GU) was suspected when the gastric wall exceeded 8 mm in thickness and had lost its five-layer structure on TUS. Duodenal ulcer (DU) was suspected if the duodenal wall thickness exceeded 5 mm. Results: Sensitivity of TUS in diagnosing PUD was 66.7% for GU and 38.9% for DU. Mean age and body weight of the 11 patients suspected with PUD on TUS were $10.9{\pm}4.4years$ and $38.1{\pm}17.2kg$, respectively. For 13 patients without suspected PUD, they were $12.1{\pm}4.1years$ and $39.6{\pm}17.0kg$, respectively. There was a significant difference in height, weight, and body mass index between patients who were suspected to have PUD and those who were not suspected on TUS (p=0.014, 0.008, and 0.005, respectively). A significant difference in the sensitivity of TUS in diagnosing PUD was found between patients under 30 kg and those over 30 kg (88.9% and 20.0%, respectively; p=0.003). Conclusion: TUS investigation of the stomach and duodenum is an efficient method for PUD detection in children with low body weight. TUS can be used in preliminary diagnostic work-up before further invasive tests.