Image of the month
Duodenal target sign
Signo del blanco duodenal
Ana Laranjo
, Maria Carvalho, Andreia Rei, Nuno Veloso
Corresponding author
Hospital Espírito Santo de Évora, Évora, Portugal
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[ "autoresLista" => "Ana Laranjo, Maria Carvalho, Andreia Rei, Nuno Veloso" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Ana" "apellidos" => "Laranjo" "email" => array:1 [ 0 => "anamlaranjo@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Maria" "apellidos" => "Carvalho" ] 2 => array:2 [ "nombre" => "Andreia" "apellidos" => "Rei" ] 3 => array:2 [ "nombre" => "Nuno" "apellidos" => "Veloso" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Hospital Espírito Santo de Évora, Évora, Portugal" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Signo del blanco duodenal" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 723 "Ancho" => 905 "Tamanyo" => 93467 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Upper endoscopic image revealing a non-granular laterally spreading tumor in the duodenum.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 67-year-old man with MUTYH-associated polyposis underwent an en bloc endoscopic mucosal resection (EMR) of a 20<span class="elsevierStyleHsp" style=""></span>mm non-granular laterally spreading tumor, type 0-IIa of the Paris classification, in the duodenum, distally to the ampulla region (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">After resection, a “target sign” was observed (<a class="elsevierStyleCrossRefs" href="#fig0010">Figs. 2 and 3</a>). The defect was closed by endoscopic clipping using five clips in a zipper fashion and a nasojejunal feeding tube was placed distally to the EMR region.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Postprocedure abdominal CT with contrast showed a thin layer of retroperitoneal free air, but no contrast extravasation was observed. The patient was managed conservatively and discharged four days later, completely asymptomatic.</p><p id="par0020" class="elsevierStylePara elsevierViewall">EMR for the duodenum carries a high risk of perforation, due to the thin muscle layer in this region, compared with the remaining digestive tract. Generally, the risk for perforation is higher in large lesions (>20<span class="elsevierStyleHsp" style=""></span>mm)<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">1</span></a>. Early diagnosis of perforation can be made by careful analysis of the post-EMR specimen which may reveal a “target sign”, a marker of resection of the muscularis propria and imminent perforation. Colonic target sign is common, but it is rare in the duodenum<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">2</span></a>.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Recognition of this sign allows endoscopic management instead of surgery, with a shorter hospital stay and fewer adverse events.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interests</span><p id="par0030" class="elsevierStylePara elsevierViewall">None of the authors has any financial/conflicting interests to disclose.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflict of interests" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 723 "Ancho" => 905 "Tamanyo" => 93467 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Upper endoscopic image revealing a non-granular laterally spreading tumor in the duodenum.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 722 "Ancho" => 905 "Tamanyo" => 89968 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Endoscopic image showing the “target sign”.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 820 "Ancho" => 905 "Tamanyo" => 95297 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Inadvertently resected <span class="elsevierStyleItalic">muscularis propria</span> creating the “target sign”.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:2 [ 0 => array:3 [ "identificador" => "bib0015" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Current status and challenges of endoscopic treatments for duodenal tumors" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Y. Ochiai" 1 => "M. Kato" 2 => "Y. Kiguchi" 3 => "T. Akimoto" 4 => "A. Nakayama" 5 => "M. Sasaki" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000494408" "Revista" => array:6 [ "tituloSerie" => "Digestion" "fecha" => "2019" "volumen" => "99" "paginaInicial" => "21" "paginaFinal" => "26" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30554227" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0020" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The target sign: an endoscopic marker for the resection of the muscularis propria and potential perforation during colonic endoscopic mucosal resection" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M.P. Swan" 1 => "M.J. Bourke" 2 => "A. Moss" 3 => "S.J. Williams" 4 => "A. Hopper" 5 => "A. Metz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.gie.2010.07.003" "Revista" => array:6 [ "tituloSerie" => "Gastrointest Endosc" "fecha" => "2011" "volumen" => "73" "paginaInicial" => "79" "paginaFinal" => "85" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21184872" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/24443824/0000004400000008/v2_202201010832/S2444382421001711/v2_202201010832/en/main.assets" "Apartado" => array:4 [ "identificador" => "75461" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images of the month" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/24443824/0000004400000008/v2_202201010832/S2444382421001711/v2_202201010832/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2444382421001711?idApp=UINPBA00004N" ]
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