Duodenum Miscellaneous, El Salvador Atlas of Gastrointestinal VideoEndoscopy. A Large Database of Images and Video Clips with Cases Reported.
El Salvador Atlas of Gastrointestinal VideoEndoscopy

 

 

 
Multiple Duodenal Erosions due to Acute Gastroenteritis Gastrointestinal infections secondary to Salmonella Enteritis. This is the case of a 42 year-old woman with acute diarrhea, (loose watery stools) fever chills, nausea and vomiting and acute abdominal pain with diffuse nonfocal abdominal tenderness, patient was hospitalized management with intravenous fluids and broad spectrum antibiotics.

Video Endoscopic Sequence 1 of 5.

 Multiple Duodenal Erosions due to Acute Gastroenteritis Gastrointestinal infections secondary to Salmonella Enteritis.

 This is the case of a 42 year-old woman with acute diarrhea,
 (loose watery stools) fever chills, nausea and vomiting and
 acute abdominal pain with diffuse nonfocal abdominal
 tenderness, patient was hospitalized management with
 intravenous fluids and broad spectrum antibiotics.

 For more endoscopic details download the video clips by
 clicking on the endoscopic images.
 All endoscopic images shown in this Atlas contain video
 clips.

Duodenal Involvement in Salmonella, Gastroenteritis usually starts 12 to 48 h after ingestion of organisms, with nausea and cramping abdominal pain followed by diarrhea, fever, and sometimes vomiting. Usually the stool is watery but may be a pastelike semisolid. Rarely, mucus or blood is present. The disease is usually mild, lasting 1 to 4 days. Occasionally, a more severe, protracted illness occurs. If the infection is more severe, a disruption of the intestinal mucosa can occur with necrosis and ulceration, non-typhoidal salmonella. In rare cases, Salmonella infection mimics inflammatory bowel disease or pseudoappendicitis.

Video Endoscopic Sequence 2 of 5.

Duodenal Involvement in Salmonella

 Gastroenteritis usually starts 12 to 48 h after ingestion of
 organisms, with nausea and cramping abdominal pain
 followed by diarrhea, fever, and sometimes vomiting.
 Usually the stool is watery but may be a pastelike
 semisolid. Rarely, mucus or blood is present. The disease
 is usually mild, lasting 1 to 4 days. Occasionally, a more
 severe, protracted illness occurs.

 If the infection is more severe, a disruption of the intestinal
 mucosa can occur with necrosis and ulceration,
 non-typhoidal salmonella.

 In rare cases, Salmonella infection mimics inflammatory
 bowel disease or pseudoappendicitis.
Nontyphoidal Salmonellosis. Salmonella infection most commonly begins with ingestion of bacteria in contaminated food or water. However, direct contact with animal and human carriers has also been implicated. Reptile and amphibian carriers are the most commonly recognized sources of direct contact Studies involving healthy human volunteers required a median dose of 1 million bacteria to produce disease. However, point outbreaks suggest as few as 200 bacteria may produce nontyphoid gastroenteritis

Video Endoscopic Sequence 3 of 5.

Nontyphoidal Salmonellosis

  • Prognosis of patients with simple gastroenteritis is excellent except for very young infants or patients with debilitating diseases.
  • The prognosis for Salmonella meningitis or endocarditis is poor.

    • Salmonella infection most commonly begins with ingestion of bacteria in contaminated food or water. However, direct contact with animal and human carriers has also been implicated. Reptile and amphibian carriers are the most commonly recognized sources of direct contact Studies involving healthy human volunteers required a median dose of 1 million bacteria to produce disease. However, point outbreaks suggest as few as 200 bacteria may produce nontyphoid gastroenteritis.

     
Salmonella organisms are gram-negative bacilli in the family Enterobacteriaceae. Differences in lipopolysaccharide (LPS) and flagellar structure generate the antigenic variation that is reflected in the more than 2,000 known serotypes. The principal reservoirs for nontyphoidal Salmonella organisms are poultry, livestock, reptiles, and pets. The mode of transmission is ingestion of foods of animal origin, including poultry, red meats, unpasteurized milk, and eggs that have been contaminated by infected animals or an infected human. Contact with infected reptiles, such as iguanas, pet turtles, and tortoises, and ingestion of contaminated water are other modes of transmission.

Video Endoscopic Sequence 4 of 5.

 Salmonella organisms are gram-negative bacilli in the
 family Enterobacteriaceae. Differences in
 lipopolysaccharide (LPS) and flagellar structure generate
 the antigenic variation that is reflected in the more than
 2,000 known serotypes. The principal reservoirs for
 nontyphoidal Salmonella organisms are poultry, livestock,
 reptiles, and pets. The mode of transmission is ingestion of
 foods of animal origin, including poultry, red meats,
 unpasteurized milk, and eggs that have been contaminated
 by infected animals or an infected human. Contact with
 infected reptiles, such as iguanas, pet turtles, and tortoises,
 and ingestion of contaminated water are other modes of
 transmission.
Salmonella syndromes can be divided into gastroenteritis, enteric fever, bacteremia, localized infection, and a chronic carrier state.

Video Endoscopic Sequence 5 of 5.

 Salmonella syndromes can be divided into gastroenteritis,
 enteric fever, bacteremia, localized infection, and a chronic
 carrier state.
Extensive neoplasia of the head of pancreas that invades he duodenal bulb and causes pancreato duodenal fistula. The patient had gastrojejunum anastomosis in a public hospital.

  Video Endoscopic Sequence 1 of 4.

 Extensive neoplasia of the head of pancreas that invades
 the duodenal bulb and causes pancreato duodenal fistula.
 The patient had gastrojejunum anastomosis in a public
 hospital. See that anastomosis.

 
The gastric antrum is observed deformed.

Video Endoscopic Sequence 2 of 4.

The gastric antrum is observed deformed.

.
The neoplasia is observed ulcerated and necrotic.

Video Endoscopic Sequence 3 of 4.

The neoplasia is observed ulcerated and necrotic.

 
Se observa la neoplasia ulcerada y hacia abajo y pared posterior un agujero excavado (fístula), donde se observan los acinos pancreáticos. Más rasgos endoscópicos descargar el video presionado sobre la imagen y observar estos en pantalla completa.

Video Endoscopic Sequence 4 of 4.

 The fistula is observed below and to the posterior wall
 the pancreatic segment is observed into the fistula.

 
Duodenal Lymphoma B cells. The pylorus is observed, the duodenal bulb contains several nodules.

Video Endoscopic Sequence 1 of 7.

Duodenal Lymphoma B cells.

 The pylorus is observed, the duodenal bulb contains
 several nodules.

 
Duodenal Lymphoma B cells. The duodenal bulb is infiltrated and ulcerated there are multiple tumors that thickening the lumen.

Video Endoscopic Sequence 2 of 7.

Duodenal Lymphoma B cells.

 The duodenal bulb is infiltrated and ulcerated there are
 multiple tumors that thickening the lumen.
Duodenal Lymphoma B cells. The image and the video display the third portion of the duodenus. This image displays several tumors varying in size length.

Video Endoscopic Sequence 3 of 7.

 The image and the video display the third portion of the
 duodenus.
 This image displays several tumors varying in size length.
 
Duodenal Lymphoma B cells.

Video Endoscopic Sequence 4 of 7.

Duodenal Lymphoma B cells.

 
Duodenal Lymphoma B cells. The lumen is compromised by marked thickening and crowding of the circular folds.

Video Endoscopic Sequence 5 of 7.

 The lumen is compromised by marked thickening and
 crowding of the circular folds.
     

There are several sub mucosal tumors.

Video Endoscopic Sequence 6 of 7.

There are several sub mucosal tumors.

    
Stomach retroflexed view. The image and the video display multiple small nodules.

Video Endoscopic Sequence 7 of 7.

Stomach retroflexed view.

 The image and the video display multiple small nodules.

   
Duodenal Carcinoid. A 58 year-old female who came from the republic of Guatemala with your husband who is thorax surgeon. She has this small sessile lesion at the duodenal bulb.

Video Endoscopic Sequence 1 of 4.

Duodenal Carcinoid.

 A 58 year-old female who came from the republic of
 Guatemala with your husband who is thorax surgeon.
 She has this small sessile lesion at the duodenal bulb.
 
Duodenal Carcinoid. The tip of this small sessile lesion suggest an early ulceration that is typical for this tumor. In the duodenum, a small submucosal nodule located in the duodenal bulb is typical. In the Ileum , they are generally larger and may ulcerate. Most common in middle -aged patients. Duodenal carcinoids may cause obstruction or symptoms due to peptide secretion. Distal small bowel carcinoids cause obstructive symptoms such as abdominal pain, vomiting due to kinking from mesenteric involvement Ulcerated ileal carcinoids cause acute, episodic, or occult gastrointestinal bleeding.

Video Endoscopic Sequence 2 of 4.

 Duodenal Carcinoid.

 The tip of this small sessile lesion suggest an early
 ulceration that is typical for this tumor.
 In the duodenum, a small submucosal nodule located in
 the duodenal bulb is typical. In the Ileum , they are
 generally larger and may ulcerate.
 Most common in middle-aged patients. Duodenal
 carcinoids may cause obstruction or symptoms due to
 peptide secretion. Distal small bowel carcinoids cause
 obstructive symptoms such as abdominal pain, vomiting
 due to kinking from mesenteric involvement.
 Ulcerated ileal carcinoids cause acute, episodic, or occult
 gastrointestinal bleeding. 

Video Endoscopic Sequence 3 of 4.

Pancreatic Heterotopia.

 In addition to the described carcinoide in the duodenum
 Patient had this mass 
 Antral nodule with typically central depression and intact
 overlying, antral mucosa.
The histopatologic study of the above case. Carcinoid tumor is a term applied to low-grade neuroendocrine tumors. They are composed of uniform cells with ampholilic cytoplasm, round nuclei, and inconspicuous nucleoli and arranged in nest, ribbons, cords, glands, and trabeculae Mitotic figures are scarce. More aggresive atypical or intermediate grade carcinoid tumors have increased numbers of mitotic figures and sometimes areas of necrosis.

Sequence 4 of 4.

 The histopatologic study of the above case.
 Carcinoid tumor is a term applied to low-grade
 neuroendocrine tumors. They are composed of uniform
 cells with ampholilic cytoplasm, round nuclei, and
 inconspicuous nucleoli and arranged in nest, ribbons,
 cords, glands, and trabeculae Mitotic figures are
 scarce. More aggresive atypical or intermediate grade
 carcinoid tumors have increased numbers of mitotic
 figures and sometimes areas of necrosis.
Pancreatic Cancer that Infiltrates the Duodenal Wall.

 Pancreatic Cancer that Infiltrates the Duodenal Wall.

The cat scan showed a tumor of the head, this nodule is in the second part of the duodenum that was proven to be by biopsies adenocarcinoma.

 Among cancers of the gastrointestinal tract, it is the third most
 common malignancy and the fifth leading cause of cancer-related
 mortality. The disease is difficult to diagnose in its early stages,
 and most patients have incurable disease by the time they present
 with symptoms. The overall 5-year survival rate for this disease
 is less than 5%.
Mycobacterium Avium Complex of the Duodenum. Endoscopically Mycobacterium Avium and Mycobacterium Tuberculosis infection can be suspected by the presence of tiny, punctate white nodules or exudate. Both illnesses can cause ulcers, bleeding, diarrhea, and malabsorption Mycobacterium Avium Complex infection occurs in the small intestine in patient with HIV disease, typically presents with weight loss, fever, diarrhea and abdominal paint. The duodenum is most commonly involved in 90% of the cases.

Mycobacterium Avium Complex of the Duodenum.

 Endoscopically Mycobacterium Avium and
 Mycobacterium Tuberculosis infection can be suspected
 by the presence of tiny, punctate white nodules or exudate.
 Both illnesses can cause ulcers, bleeding, diarrhea, and
 malabsorption.
 Mycobacterium Avium Complex infection occurs in the
 small intestine in patient with HIV disease, typically
 presents with weight loss, fever, diarrhea and abdominal
 paint. The duodenum is most commonly involved in 90% of
 the cases.
       

Infiltrating Pancreatic Cancer into the duodenal bulb.

Infiltrating Pancreatic Cancer into the Duodenal Bulb.   
Diverticula of the duodenum are incidental findings in 1%-5% of barium examinations of the upper gastrointestinal tract. They are acquired lesions consisting of a sac of mucosal and submucosal layers herniated through a muscular defect in the bowel wall. They are found most commonly along the medial border of the descending duodenum where penetrating vessels cause potential weak spots in the bowel wall. Thirty to forty percent of diverticula arise in the third and fourth portions of the duodenum.

Duodenal Diverticula.

 Diverticula of the duodenum are incidental findings in
 1%-5% of barium examinations of the upper
 gastrointestinal tract. They are acquired lesions consisting
 of a sac of mucosal and submucosal layers herniated
 through a muscular defect in the bowel wall. They are found
 most commonly along the medial border of the descending
 duodenum where penetrating vessels cause potential weak
 spots in the bowel wall. Thirty to forty percent of diverticula
 arise in the third and fourth portions of the duodenum.
Duodenal Diverticula. Pathophysiology: The cause of this condition is not known. It is believed to develop as the result of abnormalities in peristalsis, intestinal dyskinesis, and high segmental intraluminal pressures.

Duodenal Diverticula.

 Pathophysiology: The cause of this condition is not known. It is
 believed to develop as the result of abnormalities in peristalsis,
 intestinal dyskinesis, and high segmental intraluminal pressures.

 
Small hole of which bile emerges at anterior wall of duodenal bulb.

 
 Small hole of which bile emerges at anterior wall of
 duodenal bulb.
Post bulbar Adenocarcinoma.

Duodenal Adenocarcinoma.

Post bulbar Adenocarcinoma.

 
Choledoscopy. A 20 year-old female that undergone open cholecystectomy due to choledocolitiasis a T-Tube was placed. A choledoscopy was performed 6 week after surgery through the fistula.

Choledoscopy.

 A 20 year-old female that undergone open cholecystectomy
 due to choledocolitiasis a T-Tube was placed.
 A choledoscopy was performed 6 week after surgery
 through the fistula.
 
Duodenal Mucosa in Celiac Disease. This video endoscopy sequence shows magnifying endoscopy that displayed the mucosa of the duodenum with flat or absent microvillis. Celiac disease (CD) is a genetic disorder. In people with CD, eating certain types of protein, called gluten, sets off an autoimmune response that causes damage to the small intestine. This, in turn, causes the small intestine to lose its ability to absorb the nutrients found in food, leading to malnutrition and a variety of other complications. The offending protein, gluten, is found in wheat, barley, rye, and to a lesser extent. characterized by damage to the mucosal lining of the small intestine which is known as villous atrophy.

Video Endoscopic Sequence 1 of 6.

Duodenal Mucosa in Celiac Disease.

This video endoscopy sequence shows magnifying endoscopy that displayed the mucosa of the duodenum with flat or absent microvillis.

 Celiac disease (CD) is a genetic disorder. In people with
 CD, eating certain types of protein, called gluten, sets off
 an autoimmune response that causes damage to the small
 intestine. This, in turn, causes the small intestine to lose its
 ability to absorb the nutrients found in food, leading to
 malnutrition and a variety of other complications.

 The offending protein, gluten, is found in wheat, barley,
 rye, and to a lesser extent.

 Characterized by damage to the mucosal lining of the small
 intestine which is known as villous atrophy. responsible for
 the malabsorption of nutrients resulting in malnutrition.

 
Celiac disease endocopic video. Mosaicism and fold scalloping in duodenum. Celiac disease has a 95 percent genetic predisposition and, thus, it is frequently associated with autoimmune conditions such as diabetes mellitus type 1 and thyroid disease. Untreated patients have an increased incidence of osteoporosis and intestinal lymphoma. Excellent diagnostic screening tests are now available, including those that detect antigliadin and antiendomysial antibodies. Therapy with a gluten-free diet is effective, resulting in complete resolution of symptoms and secondary complications in almost all patients.

Video Endoscopic Sequence 2 of 6.

Celiac disease endocopic video. Mosaicism and fold scalloping in duodenum.

Celiac disease has a 95 percent genetic predisposition and, thus, it is frequently associated with autoimmune conditions such as diabetes mellitus type 1 and thyroid disease. Untreated patients have an increased incidence of osteoporosis and intestinal lymphoma. Excellent diagnostic screening tests are now available, including those that detect antigliadin and antiendomysial antibodies. Therapy with a gluten-free diet is effective, resulting in complete resolution of symptoms and secondary complications in almost all patients.
The only treatment for celiac disease is to follow a gluten-free diet

Video Endoscopic Sequence 3 of 6.

The only treatment for celiac disease is to follow a gluten-free diet

 
The changes seen in celiac disease include: 1. Reduced or absent duodenal folds 2. Scalloping of folds 3. Mosaic pattern to the mucosa 4. Mucosal fissures or cracks 5. Visible vessels.

Video Endoscopic Sequence 4 of 6.

The changes seen in celiac disease include:

 

1. Reduced or absent duodenal folds

2. Scalloping of folds

3. Mosaic pattern to the mucosa

4. Mucosal fissures or cracks

5. Visible vessels

Atrofia1

Video Endoscopic Sequence 5 of 6.

 
Atrofia2

Video Endoscopic Sequence 6 of 6.

 
Duodenal diverticula are acquired outpouchings of the mucosa and submucosa, 90 percent of which are on the medial aspect of the duodenum. They are rare before age 40. There is a high incidence of gallstone disease of the gallbladder in patients with juxtapapillary diverticula. Diverticula are not seen in the first portion of the duodenum, where diverticular configurations are due to scarring by peptic ulceration or cholecystitis (inflammation of the gall bladder).

Video Endoscopic Sequence 1 of 2.

Duodenal Diverticula

 Duodenal diverticula are acquired outpouchings of the
 mucosa and submucosa, 90 percent of which are on the
 medial aspect of the duodenum. They are rare before age
 40. There is a high incidence of gallstone disease of the
 gallbladder in patients with juxtapapillary diverticula.
 Diverticula are not seen in the first portion of the
 duodenum, where diverticular configurations are due to
 scarring by peptic ulceration or cholecystitis (inflammation
 of the gall bladder).

 
PeriampularDivert2

Video Endoscopic Sequence 2 of 2.

Duodenal Diverticula

 Great majority of duodenal diverticula areasymptomatic.

 Clinical presentation may be characterized by non-specific
 abdominal symptoms and less than 5% of patients have
 abdominal symptoms. Abdominal discomfort is usually
 locatedin epigastrium, right upper abdomen or umbilical
 area which is made worse or brought on by eating and
 relieved by vomiting, belching or assuming certain posture.
 There are no characteristic symptom complex from which
 one may make a positive diagnosis of Duodenal
 Diverticulum.

 
Angiodysplasia of the duodenum . This 72 year-old female has been presented with several episodes of melenas the upper endoscopy shows this vascular lesion in the second portion of the duodenum. Aberrant blood vessels are frequently found in the gastrointestinal tract, where they are probably more common than anywhere else in the body. Some are present from birth or develop as part of inherited syndromes, but the vast majority are acquired later in life. The reasons for the distortion of vascular structures observed with advancing age are poorly understood.

Video Endoscopic Sequence 1 of 4.

Angiodysplasia of the duodenum

 This 72 year-old female has been presented with several
 episodes of melenas, her hemoglobin was 8.3 Gr/dl. the
 upper endoscopy shows this vascular lesion in the second
 portion of the duodenum.

 Aberrant blood vessels are frequently found in the
 gastrointestinal tract, where they are probably more
 common than anywhere else in the body. Some are present
 from birth or develop as part of inherited syndromes, but
 the vast majority are acquired later in life. The reasons for
 the distortion of vascular structures observed with
 advancing age are poorly understood.

 

 
Endoscopic Ablation. Bleeding was controlled using the argon plasma coagulator. One of the most common complications associated with angiodysplasias is bleeding, which is often occult Angiodysplastic lesions of the upper GI tract are an increasingly recognized cause of occult and obscure GI bleeding.

Video Endoscopic Sequence 2 of 4.

Endoscopic Ablation

 Bleeding was controlled using the argon plasma coagulator.

 One of the most common complications associated with
 angiodysplasias is bleeding, which is often occult
 Angiodysplastic lesions of the upper GI tract are an
 increasingly recognized cause of occult and obscure GI
 bleeding.

 
Angiodysplasia is characterized by degenerative vascular dilation of the capillary net in the absence of dysplastic tissue. On endoscopy, flat or slightly elevated, reddish, roundish or starry lesions are observed, measuring normally between 2 and 10 mm. Angiodysplasia is a frequent cause of unexplained upper gastrointestinal bleeding with significant morbidity.

Video Endoscopic Sequence 3 of 4.

 Angiodysplasia is characterized by degenerative vascular
 dilation of the capillary net in the absence of dysplastic
 tissue. On endoscopy, flat or slightly elevated, reddish,
 roundish or starry lesions are observed, measuring
 normally between 2 and 10 mm. Angiodysplasia is a
 frequent cause of unexplained upper gastrointestinal
 bleeding with significant morbidity.
A Hiatal Hernia is displays, pallor of the gastric mucosa.

Video Endoscopic Sequence 4 of 4.

A Hiatal Hernia is displays, pallor of the gastric mucosa.