Perales CJA, Paulín CE

Language: Spanish
References: 12
Page: 189-193
PDF size: 362.79 Kb.

ABSTRACT

Objective: To report the case of an adult female patient with gastric outflow obstruction syndrome due to the presence of a congenital, incomplete, dudodenal membrane treated with excision and duodenoplasty Heineke-Mickulicz type.
Design: Case report.
Setting: Private praxis.
Description of the case: A 35 years old woman with postprandial sensation of abdominal fullness of one week of evolution, intermittent epigastric pain, pyrosis, and vomiting of food ingested the day before, suggestive of gastric outflow obstruction. Endoscopy revealed erosive G-I esophagitis, dilated stomach with abundant food. Immediately before the duodenal angle, an important reduction in the lumen due to a circumferential membrane that reduced the diameter to 5 mm with fibrin exudates on its borders was observed. Biopsies were made from the borders of the stenosis. The esophagogastroduodenal series revealed gastric dilation and partial postbulbar stenosis. The patient was treated medically with rabeprazole and cisapride for 2 weeks until she was subjected to medial laparotomy. Duodenoplasty Heineke-Mickulicz type with excision of the stenotic concentric ring in the postbulbar region was performed. The patient was discharged from the hospital on the 6th day after surgery. The endoscopic and radiological monitoring after 8 months revealed free intestinal transit.
Conclusion: Congenital duodenal membrane as cause of high intestinal obstruction is not frequent in the adult. The early surgical treatment through excision and simple duodenoplasty remain the treatment of choice in non-complicated cases.

REFERENCES

1. Johnston GW, Stevenson HM. Reflux esophagitis secondary to duodenal diaphragm in an adult. Thorax 1996; 21: 65-7.

2. Suárez LA, Bolden EI. Congenital duodenal web in an adult. Curr Surg 1978; 35: 366-9.

3. Wood Gray S, Skandalakis JE. Embriology for surgeons: the embriological basis for the treatment of congenital defects. Philadelphia: WB Saunders; 1972.

4. Evans C. Atresias of the gastrointestinal tract. Collective review. Int Abstr Surg 1951; 92:1-8.

5. Santulli TV. Intestinal obstruction in newborn infants. J Pediatr 1954; 44: 317-37.

6. Walker WF, Dewar DAE, Stephen SA. Congenital intrinsic duodenal stenosis presenting after infancy. A review of recorded cases and report of a case showing duodeno-hepatic reflux. Br J Surg 1958; 46: 28-32.

7. Kazmers N. Duodenal diaphragm in the adult. A case report. Am J Gastroenterol 1966; 45: 342-7.

8. Mikaelsson C, Arnbjornsson E, Kullendorff CM. Membranous duodenal stenosis. Acta Paediatr 1997; 86: 953-5.

9. Brown RA, Millar AI, Linegar A, Moore SW, Cywes SJ. Fenestrated duodenal membranes: an analysis of symptoms, signs, diagnosis, and treatment. J Pediatr Surg 1994; 29: 429-32.

10. Huang FC, Chuang JH, Shieh CS. Congenital duodenal membrane: a ten-year review. Acta Paediatr Taiwan 1999; 40: 70-4.

11. Halko M, LoPresti PA, Patel HD, Chawla S, Marzullir V. Congenital duodenal stenosis. The duodenal cerviz sing. Am J Gastroenterol 1978; 69: 323-7.

12. Matsukawa Y, Inomata Y, Yamamoto E, Fujimura N. Clinical features of delayed diagnosis in congenital duodenal obstruction. Nipón Geka Hokan 1991; 60: 80-5.