Abstract
Duodenal pathology is an infrequent cause of acute abdominal pain for which patients present to the emergency department. Critical pathology on multidetector CT (MDCT) may be overlooked if the radiologist does not carefully evaluate the duodenum as part of the search pattern. Optimal MDCT protocols include intravenous contrast with multiplanar reconstructions (MPRs). A variety of etiologies ranging from infection to malignancy can involve the duodenum, for which interrogation with MPRs is most helpful given the anatomy and complex relationship with surrounding structures. The purpose of this review article is to highlight the importance of CT acquisition with multiplanar reconstructions and review the spectrum of emergent duodenal pathology, with the goal of ensuring accurate and timely diagnosis to best guide patient management.
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References
Jayaraman MV, Mayo-Smith WW, Movson JS et al (2001) CT of the duodenum: an overlooked segment gets its due. Radiographics 21 Spec No: S147-60
Horton KM, Fishman EK (2004) MDCT of the duodenum: technique and clinical applications. Crit Rev Comput Tomogr 45(5-6):309–334
Horton KM, Fishman EK (1998) Helical CT of the stomach: evaluation with water as an oral contrast agent. AJR Am J Roentgenol 171(5):1373–1376
Poggioli G, Stocchi L, Laureti S, Selleri S, Marra C, Salone MC, Cavallari A (1997) Duodenal involvement of Crohn’s disease: three different clinicopathologic patterns. Dis Colon Rectum 40(2):179–183
Herlinger H (1994) Malabsorption. In: Gore RM, Levine MS, Laufer I (eds) Textbook of gastrointestinal radiology. Saunders, Philadelphia, pp 879–880
Eisenberg RL (2003) Gastrointestinal radiology. Lippincott Williams & Wilkins, Philadelphia
Roy PK, Venzon DJ, Shojamanesh H, Abou-Saif A, Peghini P, Doppman JL, Gibril F, Jensen RT (2000) Zollinger-Ellison syndrome: clinical presentation in 261 patients. Medicine. 79(6):379–411
Bittle MM, Gunn ML, Gross JA et al (2012) Imaging of duodenal diverticula and their complications. Curr Probl Diagn Radiol 41(1):20–29
Macpherson RI (1993) Gastrointestinal tract duplications: clinical, pathologic, etiologic, and radiologic considerations. Radiographics 13(5):1063–1080
Ames JT, Federle MP, Pealer KM (2009) Perforated duodenal diverticulum: clinical and imaging findings in eight patients. Abdom Imaging 34(2):135–139
de Perrot T, Poletti PA, Becker CD et al (2012) The complicated duodenal diverticulum: retrospective analysis of 11 cases. Clin Imaging 36(4):287–294
Herman J, Chavalitdhamrong D, Jensen DM et al (2011) The significance of gastric and duodenal histological ischemia reported on endoscopic biopsy. Endoscopy. 43(4):365–368
Rha SE, Ha HK, Lee SH, Kim JH, Kim JK, Kim JH, Kim PN, Lee MG, Auh YH (2000) CT and MR imaging findings of bowel ischemia from various primary causes. Radiographics. 20(1):29–42
Melamud K, LeBedis CA, Soto JA (2015) Imaging of pancreatic and duodenal trauma. Radiol Clin N Am 53(4):757–771
Miller LA, Shanmuganathan K (2005) Multidetector CT evaluation of abdominal trauma. Radiol Clin N Am 43(6):1079–1095
Timaran CH, Martinez O, Ospina JA (1999) Prognostic factors and management of civilian penetrating duodenal trauma. J Trauma 47(2):330–335
Kunin JR, Korobkin M, Ellis JH, Francis IR, Kane NM, Siegel SE (1993) Duodenal injuries caused by blunt abdominal trauma: value of CT in differentiating perforation from hematoma. AJR Am J Roentgenol 160(6):1221–1223
Brody JM, Leighton DB, Murphy BL et al (2000) CT of blunt trauma bowel and mesenteric injury: typical findings and pitfalls in diagnosis. Radiographics. 20(6):1525–1536
Calhan T, Sahin A, Kahraman R et al (2015) A lethal complication of endoscopic therapy: duodenal intramural hematoma. Case Rep Gastrointest Med 2015:201675
Stapfer M, Selby RR, Stain SC et al (2000) Management of duodenal perforation after endoscopic retrograde cholangiopancreatography and sphincterotomy. Ann Surg 232(2):191–198
Tamm EP, Balachandran A, Bhosale P, Szklaruk J (2009) Update on 3D and multiplanar MDCT in the assessment of biliary and pancreatic pathology. Abdom Imaging 34(1):64–74
Artigas JM, Martí M, Soto JA, Esteban H, Pinilla I, Guillén E (2013) Multidetector CT angiography for acute gastrointestinal bleeding: technique and findings. Radiographics. 33(5):1453–1470
Horton KM, Fishman EK (2004) Multidetector-row computed tomography and 3-dimensional computed tomography imaging of small bowel neoplasms: current concept in diagnosis. J Comput Assist Tomogr 28(1):106–116
Wei CJ, Chiang JH, Lin WC, Tiu CM, Chang CY (2003) Tumor and tumor-like lesions of duodenum: CT and barium imaging features. Clin Imaging 27(2):89–96
Sata N, Endo K, Shimura K, Koizumi M, Nagai H (2007) A new 3-D diagnosis strategy for duodenal malignant lesions using multidetector row CT, CT virtual duodenoscopy, duodenography, and 3-D multicholangiography. Abdom Imaging 32(1):66–72
Serour F, Dona G, Birkenfeld S, Balassiano M, Krispin M (1992) Primary neoplasms of the small bowel. J Surg Oncol 49(1):29–34
Buckley JA, Fishman EK (1998) CT evaluation of small bowel neoplasms: spectrum of disease. Radiographics. 18(2):379–392
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Polotsky, M., Vadvala, H.V., Fishman, E.K. et al. Duodenal emergencies: utility of multidetector CT with 2D multiplanar reconstructions for challenging but critical diagnoses. Emerg Radiol 27, 195–203 (2020). https://doi.org/10.1007/s10140-019-01735-7
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DOI: https://doi.org/10.1007/s10140-019-01735-7