Hospitalized with severe abdominal pain and vomiting, patient T.H.T (19 years old) was quickly taken to the Emergency Department of Thong Nhat Hospital. A few days before, the patient only had a dull abdominal pain, so he subjectively did not go to the doctor.
CT scan results showed that the patient had superficial melaning artery syndrome (SMA), a rare disease that causes the duodenum to be compressed, causing intestinal obstruction. Worryingly, the patient had a history of 5-year-old scleroderma and hyperthyroidism, but had stopped treatment for 2 years.
Dr. Nguyen Thanh Phong - Department of Gastroenterology, Thong Nhat Hospital, Ho Chi Minh City said that at the time of hospitalization, immediate surgery was very dangerous because the thyroid function was unstable, there was a potential risk of "thyroid storm", severe complications that could cause death when patients were under stress from surgery. Therefore, the patient was transferred to the Endocrinology Department for stable treatment before returning to the Department of Gastroenterology.
When given a comprehensive assessment, the patient was determined to have severe malnutrition, general muscle atrophy, and severe exhaustion. The hospital has organized a multidisciplinary consultation, including Endocrinology, Nutrition, Respiratory, ENT, Dermatology - Immunology to best control pre-operative risks.
According to Dr. Thanh Phong, the surgery was predicted to be challenging. Scleroderma causes skin in the face and neck to shrink, limiting opening the mouth and neck, making it especially difficult to control the airway. During the anesthesia, the patient was forced to open the emergency room to ensure safety.
Not only that, the patient also faced the risk of arrhythmia, respiratory failure due to hyperthyroidism combined with scleroderma. stiff abdominal fibroids make it difficult to create a surgical facility, causing difficulties for the surgeon.
The surgical team decided to perform a Roux-en-Y reattachment of the duodenum and manufactured a Roux-en-Y to relieve the blockage. The surgery was performed under the condition of strict monitoring of each vital signs. After many stressful hours, the surgery was completed safely.
After 5 days of surgery, the patient was alert, eating again, the surgical wound was dry, and immediately went well. Underlying diseases continue to be monitored and treated in parallel to limit the risk of recurrence.
From this case, doctors recommend that young people should not be subjective with symptoms of abdominal pain and prolonged vomiting. In particular, arbitrarily stopping treatment of chronic diseases such as hyperthyroidism can put the body in a dangerous condition when encountering an event.
Early medical examination, adherence to treatment and regular monitoring are key factors to help avoid life-and-death emergency situations.
