The Duodenum

The duodenum, although subject to the above generalities, is one of the most unique and dynamic parts of the body [12-16]. It has both intra- and retro-peritoneal portions. Being centrally located in the abdomen, it is often affected by diseases in neighboring organs. It is a battleground of acids and alkalis relating to drainage from three of the body's major sources of digestive chemicals: the liver via the biliary tree; the pancreas, draining alkaline secretions and powerful enzymes through the major and minor papillae; and the stomach, producing caustic acids. It has a complex embryology involving development of adjacent organs and numerous anomalies. As a consequence of location, embryology, histology, surrounding structures and the adjacent organs draining into it, the pathology of the duodenum differs from that of other alimentary tract organs. Inch for inch and ounce for ounce, more distinct pathologies occur here than in any other abdominal organ.

Developmental phenomena give rise to annular pancreas, webs and choledochoceles, and account for ectopias. Anatomy dictates patterns of obstruction and spread of disease from adjacent organs, as well as patterns of rupture

Fig. 12. Lipoma in the duodenal bulb. a Smooth filling defect displacing contrast in bulb on barium upper GI study. b CT in same case showing smooth, intraluminal mass in duodenal bulb with very low attenuation measured in the rectangular area of interest

and hematoma formation in blunt trauma. Exposure to gastric acid leads to ulcers and hyperplasias. Influx of bile and pancreatic juice is thought to determine some types and sites of mucosal neoplasia. The examples presented here will stress radiologic-pathologic correlation.

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