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CNAA / Theses / 2007 / May /

Possibilities of contemporary radioimaging methods in diagnosis duodenal malrotation and its consequences.


Author: Valerii Pripa
Degree:doctor of medicine
Speciality: 14.00.19 - Medical Imagistics
Year:2007
Scientific adviser: Vladimir Hotineanu
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Scientific consultant: Andrei Roşca
doctor habilitat, professor, Public Medical Sanitary Intitution Institute of Oncology
Institution:
Scientific council:

Status

The thesis was presented on the 25 May, 2007
Approved by NCAA on the 14 June, 2007

Abstract

Adobe PDF document1.39 Mb / in romanian

Thesis

CZU 616.342-007.59-053.1-073,75

Adobe PDF document 3.10 Mb / in romanian
108 pages


Keywords

duodenal malrotation, secondary duodenostasis, symptomathic chronic ulcer, duodenogastral reflux

Summary

Intraoperatively at the group of patients with ulcers was recorded enlarged duodenum with atypical form and localization. In the absences of extraorganic and intrinsic causes, neuromuscular pathology, which could contribute to duodenostasis, direct cause of duodenostasis is established, congenital factor – malrotation of duodenum. Duodenal malrotation (DMR) at the some evolutional stages leads to evaco-motorical duodenal disturbances, facilitating to appearing of symptomatic duodenal ulcer (SDU). The last is included in those 5-10% of ulcers, resistant to contemporary therapeutical schemes, fact, which create diagnostical and therapeutical problems, requiring specific diagnostical and therapeutical methodics.

Dissertation study was performed in professorship of radiology and medical imaging and surgical clinic №2 of State Medical University and departments of radiology and gastrosurgery of Republican Clinical Hospital.

During the period of 1990-2005 years 3176 patients with ulcer disease were admissed in the clinic, 200 (6.5%) from them with DMR. Applicated methods of examination showed the peculiarities of ulcers, caused by DMR: appearance in young age 156 (78%), resistance to conservative treatment 168 (84%), presence of complications 162 (81%), reflux biliary gastritis 152 (76%), evaco-motorical duodenal disturbances and persistence of free H+ ions in duodenal content – 200 (100%) cases. Interpretation of the results, obtained via radio-imaging methods, was based on following criteria: delaying of barium in duodenum more then 40 seconds in all cases - 100 % ; presences of paradoxical movements type “pendulous”, recorded at 128 (67,8%) patients; duodenogastric reflux at 178 (94,7%) patients; dilatation more than 4 cm of duodenal lumen – at 169 (89,4%) cases; establishing of horizontal level in D3 -D4 – at 129 (68,2 %) cases; caudal shifting of D3 to L3 was manifested at 92 (46%) patients; cranial shifting to L2 of duodenojejunal flexure – in 108 (54 %) cases; deviation of duodenojejunal flexure to the right side of vertebral column - at 132 (69,8%) patients; presence of additional loops of D3 and/or D4 – 72 (36%) cases. Up to the 1995 year the treatment of symptomatic duodenal ulcers caused by DMR consisted in gastric resection by Bilroth I, Bilroth II (Hofmeister-Finsterer), trunkal or supraselective vagotomy. These surgical techniques did not remove etiopathogenic factor, keeping the duodeno-gastric reflux, duodenostasis, with non-satisfactory results in majority of cases. Persistent radio-imaging semiology of peptic ulcer of anastomosis, syndrome of afferent loop, pseudo-diverticular deformation of stomach showed the way to the surgeons in implantation of new surgical techniques such as gastric resection by Balfour or Roux. Diagnostical algorithm, which we proposed, permitted to record the duodenal malrotation at patients with ulcers and the results of surgical treatment showed, that gastric resections by Balfour or Roux are the methods of choice in the treatment of these patients. These surgical techniques permitted the disappearance of postoperative complications and were obtained satisfactory results in 96,3% cases, with complete socio-familiar and professional rehabilitation of patients.