Patient Y.C. S. (42 years old, Cambodian nationality) was admitted to the hospital in critical condition with symptoms of vomiting blood, shock due to anemia and fluid deficiency, abdomen abnormally swollen, and physical exhaustion. The results of computed tomography showed that the stomach and duodenum were maximally dilated, occupying almost the entire abdominal cavity. As soon as the gastric catheter was inserted, doctors sucked out more than 5 liters of stagnant fluid, showing severe prolonged digestive stagnation.
According to MSc.BS. CKII Phan Van Thai, Head of General Surgery Department, FV Hospital, the patient's gastrointestinal bleeding was controlled by endoscopy and internal medicine treatment. However, the complex problem lies in the abnormal dilation of the duodenum. Initially, the team suspected that the patient had intestinal obstruction due to previous surgery history. However, in-depth surveys including endoscopy and CT scan did not record signs of mechanical obstruction.
Notably, after 3 days of drainage, the stomach has contracted almost normally, while the duodenum is still dilated, completely losing its contractility. The diameter of the duodenum measured is up to 12 cm, circumference 38 cm, many times larger than the normal physiological size, only equivalent to a finger. The duodenum is dilated, attached to adjacent organs and no longer functions to transport food.
After excluding common causes, doctors determined that the patient had a idiopathic giant megacolon, a rare disorder that prevents food from moving down to the small intestine, causing prolonged stagnation, malnutrition and exhaustion.
The optimal treatment method is surgery to remove the dysfunctional duodenum and regenerate the digestive system. This is a complex surgery because the duodenum is located close to the pancreas and is where the bile ducts, pancreas and many large blood vessels converge. The risk of complications is high if blood vessel damage or digestive fluid leakage occurs.
During the surgery, the team removed the entire pathological duodenum segment and used two segments of the small intestine to regenerate the digestive tract. One segment was directly connected to the stomach to lead food, and the other segment led bile and pancreatic fluid, ensuring digestive function close to normal physiology," Dr. Thai further explained.
After surgery, the patient recovered well, able to eat and drink again without vomiting. Post-operative examination images showed that the digestive system was operating stably, no longer stagnant. After nearly three weeks of monitoring, the patient was discharged from the hospital in stable condition.
According to experts, idiopathic duodenal dilation is very easily confused with bowel obstructive diseases or duodenal compression syndrome, causing many patients to take many years to be accurately diagnosed. This case shows the important role of correctly diagnosing the cause and timely surgical intervention in the treatment of rare and complex digestive diseases.
