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Duodenal emergencies: utility of multidetector CT with 2D multiplanar reconstructions for challenging but critical diagnoses

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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

  1. 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

  2. Horton KM, Fishman EK (2004) MDCT of the duodenum: technique and clinical applications. Crit Rev Comput Tomogr 45(5-6):309–334

    Article  Google Scholar 

  3. 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

    Article  CAS  Google Scholar 

  4. 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

    Article  CAS  Google Scholar 

  5. Herlinger H (1994) Malabsorption. In: Gore RM, Levine MS, Laufer I (eds) Textbook of gastrointestinal radiology. Saunders, Philadelphia, pp 879–880

    Google Scholar 

  6. Eisenberg RL (2003) Gastrointestinal radiology. Lippincott Williams & Wilkins, Philadelphia

    Google Scholar 

  7. 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

    Article  CAS  Google Scholar 

  8. Bittle MM, Gunn ML, Gross JA et al (2012) Imaging of duodenal diverticula and their complications. Curr Probl Diagn Radiol 41(1):20–29

    Article  Google Scholar 

  9. Macpherson RI (1993) Gastrointestinal tract duplications: clinical, pathologic, etiologic, and radiologic considerations. Radiographics 13(5):1063–1080

    Article  CAS  Google Scholar 

  10. Ames JT, Federle MP, Pealer KM (2009) Perforated duodenal diverticulum: clinical and imaging findings in eight patients. Abdom Imaging 34(2):135–139

    Article  Google Scholar 

  11. 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

    Article  Google Scholar 

  12. 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

    Article  CAS  Google Scholar 

  13. 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

    Article  CAS  Google Scholar 

  14. Melamud K, LeBedis CA, Soto JA (2015) Imaging of pancreatic and duodenal trauma. Radiol Clin N Am 53(4):757–771

    Article  Google Scholar 

  15. Miller LA, Shanmuganathan K (2005) Multidetector CT evaluation of abdominal trauma. Radiol Clin N Am 43(6):1079–1095

    Article  Google Scholar 

  16. Timaran CH, Martinez O, Ospina JA (1999) Prognostic factors and management of civilian penetrating duodenal trauma. J Trauma 47(2):330–335

    Article  CAS  Google Scholar 

  17. 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

    Article  CAS  Google Scholar 

  18. 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

    Article  CAS  Google Scholar 

  19. Calhan T, Sahin A, Kahraman R et al (2015) A lethal complication of endoscopic therapy: duodenal intramural hematoma. Case Rep Gastrointest Med 2015:201675

    PubMed  PubMed Central  Google Scholar 

  20. 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

    Article  CAS  Google Scholar 

  21. 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

    Article  Google Scholar 

  22. 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

    Article  Google Scholar 

  23. 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

    Article  Google Scholar 

  24. 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

    Article  Google Scholar 

  25. 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

    Article  CAS  Google Scholar 

  26. Serour F, Dona G, Birkenfeld S, Balassiano M, Krispin M (1992) Primary neoplasms of the small bowel. J Surg Oncol 49(1):29–34

    Article  CAS  Google Scholar 

  27. Buckley JA, Fishman EK (1998) CT evaluation of small bowel neoplasms: spectrum of disease. Radiographics. 18(2):379–392

    Article  CAS  Google Scholar 

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Correspondence to Harshna V. Vadvala.

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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

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