Clinical and ultrastructural studies in melanosis duodeni

Four cases with melanosis duodeni were described. Two cases were associated with chronic renal failure, and one case with hypertension. The other case is a deaf 23-year-old woman suffering from psychogenic vomiting and constipation. The duodenal mucosa of these cases, on endoscopy, showed scattered black or brown flecks, extending from the bulb to the proximal second portion of the duodenum. The density of the color faded away gradually at the distal portion of the papilla Vater. Through a magnifying fiberscope, the stroma and the tip of the villi appeared to be pigmented. On electron microscopy, the size and shape of pigmented granules were variable in individual case. The electron-probe x-ray analysis showed that these pigments contained ferrum and/or sulphur. These ultrastructual findings reveal that the constituents of pigment differ in each case of melanosis duodeni.