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Distal Duodenal Obstruction: a Surgical Enigma

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Abstract

The postbulbar segment also known as the distal duodenum is a separate clinical entity in terms of the intrinsic pathologies of this region and its varied anatomical relations. The common bile duct and the pancreatic duct open through the major papilla, which marks the beginning of this segment. Distal duodenal obstruction can be defined as a clinicoradiological entity that is characterized by features of gastric outlet obstruction with recurrent bilious vomiting and a radiological evidence of postbulbar obstruction. A Medline search for distal duodenal obstruction revealed 1409 entries, mostly in the form of case reports. In the last 10 years, 310 cases are reported. Clinical features like abdominal pain, nausea, and vomiting are non-specific and quite similar to gastric outlet obstruction. Clinical findings are also non-specific and do not aid in diagnosis. Laboratory findings also do not add much. Contrast-enhanced CT scan and MR enterography are diagnostic modalities of choice. Distal duodenal obstruction is a clinical entity that has a wide list of differential diagnosis which requires due consideration in terms of its management and follow-up. Most of these lesions require adequate workup with the help of a multidisciplinary team consisting of radiologists, gastroenterologists, and pathologists to adequately diagnose and stage the disease before a treatment plan is formulated. A thorough knowledge is a must regarding the treatment options available for each of the conditions so that the management can be personalized leading to better results.

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Author Contributions

Author 1 (SK)—Conceptualization of the article, interpretation of review data, and critical revision of data.

Author 2 (PG)—Literature review and drafting of manuscript.

Author 3 (RK)—Mentor author, critical revision of data, and final approval of manuscript.

Author 4 (DD)—Literature review, patient data acquisition (radiographic images), and drafting of manuscript.

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Authors and Affiliations

  1. Department of General Surgery, Institute of Medical Sciences, BHU, Varanasi, 221005, India

    Seema Khanna, Piyush Gupta & Rahul Khanna

  2. Institute of Medical Sciences, BHU, Varanasi, India

    Disha Dalela

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  1. Seema Khanna
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  2. Piyush Gupta
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Correspondence to Seema Khanna.

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Khanna, S., Gupta, P., Khanna, R. et al. Distal Duodenal Obstruction: a Surgical Enigma. Indian J Surg 79, 245–253 (2017). https://doi.org/10.1007/s12262-017-1604-4

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