Duodenal obstruction

Section: Small bowel Curriculum: Curriculum, page 59

Aetiology

• Non-neoplastic
  • Congenital
    • Duodenal atresia
    • Malrotation/non-rotation/volvulus
    • Congenital bands
  • FB
  • Hamartoma - PJS
  • Leiomyoma
• Neoplastic
  • Benign
    • Adenoma
      • Tubular, TV, villous
  • Malignant
    • Primary
      • Adenocarcinoma
      • Lymphoma
      • NET
      • GIST
      • Leiomyosarcoma
    • Secondary
      • Mets
      • Melanoma
• Luminal
  • FB/bezoar
• Mural
  • Carcinoma, adenoma, GIST
  • Crohn’s
• Extraluminal
  • SMA syndrome
  • Adhesions - acquired/congenital

Pathophysiology

• Hypochloraemic hypokalaemic metabolic alkalosis - vomiting → loss of Cl, K and H
• Paradoxical aciduria - retain HCO3 and K at expense of H in distal tubule
• Obstructive jaundice from biliopancreatic obstruction

Management

• Endoscopic
  • Stent
  • Bolus obstruction removal
• Surgical
  • Local resection
  • Segmental
  • Whipples
  • Bypass
  • Gastrojej