Loftus E V, Farrugia G, Donohue J H, Camilleri M
Division of Gastroenterology and Internal Medicine, Mayo Clinic Rochester, MN 55905, USA.
Mayo Clin Proc. 1997 Feb;72(2):130-2. doi: 10.4065/72.2.130.
Establishing the diagnosis of adenocarcinoma of the distal duodenum is often difficult based on findings on barium radiography and routine endoscopy of the upper gastrointestinal tract. A characteristic manometric pattern of simultaneous, prolonged contractions of the small intestine after a meal has been associated with mechanical obstruction of the small intestine. Herein we describe a 68-year-old woman who had a 4-month history of nausea, vomiting, and weight loss. Findings on endoscopy of the upper gastrointestinal tract and a barium contrast examination of the stomach, duodenum, and small bowel were interpreted as normal. A radionuclide scan suggested mildly delayed gastric emptying. Gastroduodenal manometry revealed high-amplitude, simultaneous contractions in the third and fourth portions of the duodenum but not in the jejunum, findings highly suggestive of a mechanical obstruction in the distal duodenum. At laparotomy, an obstructing adenocarcinoma of the duodenum proximal to the ligament of Treitz was resected. Subtle abnormalities were detected retrospectively on the barium contrast study of the small bowel. In patients with features suggestive of intestinal obstruction, gastroduodenal manometry may be helpful in distinguishing mechanical causes from pseudo-obstruction.
基于上消化道钡剂造影和常规内镜检查结果，通常难以确诊十二指肠远端腺癌。餐后小肠同时出现的持续性收缩这一特征性测压模式与小肠机械性梗阻有关。在此，我们描述一名68岁女性，她有4个月的恶心、呕吐和体重减轻病史。上消化道内镜检查结果以及胃、十二指肠和小肠的钡剂造影检查结果均被解读为正常。放射性核素扫描提示胃排空轻度延迟。胃十二指肠测压显示十二指肠第三和第四部分出现高振幅同步收缩，但空肠未见此现象，这些结果高度提示十二指肠远端存在机械性梗阻。剖腹手术时，切除了Treitz韧带近端的十二指肠梗阻性腺癌。小肠钡剂造影研究经回顾性分析发现了细微异常。对于有肠梗阻特征的患者，胃十二指肠测压可能有助于区分机械性病因与假性梗阻。
