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A clinically silent, but severe, duodenal complication of duodopa infusion
  1. Giovanni Bianco1,
  2. Giuseppe Vuolo2,
  3. Monica Ulivelli1,
  4. Sabina Bartalini1,
  5. Raffaele Chieca3,
  6. Alessandro Rossi1,
  7. Simone Rossi1
  1. 1Dipartimento di Neuroscienze, Sezione Neurologia e Neurofisiologia Clinica, Azienda Ospedaliera-Universitaria di Siena, Siena, Italy
  2. 2U.O. Chirurgia Bariatrica e Nutrizione Artificiale, Azienda Ospedaliera-Universitaria di Siena, Siena, Italy
  3. 3S.C. Gastroenterologia ed Endoscopia Digestiva, Azienda Ospedaliera-Universitaria di Siena, Siena, Italy
  1. Correspondence to Professor Simone Rossi, Dipartimento di Neuroscienze, Sezione Neurologia e Neurofisiologia Clinica, Azienda ospedaliera Universitaria di Siena, Policlinico Le Scotte, Viale Bracci, I-53100, Siena, Italy; rossisimo{at}unisi.it

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Duodenal levodopa/carbidopa gel infusion (Duodopa) is an efficacious therapeutic strategy for motor and non-motor symptoms in advanced Parkinson's disease (PD).1–3 Technical issues like kinking, knotting or obstruction of the tube are frequent, as well as complications due to the procedure, such as buried bumper syndrome, local infection and dislocation of the tube in the stomach (57%–69% of the patients), but they are seldom associated with severe adverse effects.1 3 4 In most cases, they are generally easy to suspect due to the immediate lack of therapeutic efficacy or malfunction of the infusion pump. We describe a rare and very serious gut complication associated with the device, which is difficult to recognise because of the persistence of clinical benefit on motor signs.

A 72-year-old man with a medical history of hypertension and chronic obstructive pulmonary disease, and with a …

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