PMC7813810_01
(A) Preoperative abdominal X-ray suggested incomplete duodenal obstruction. (B) Preoperative UGI suggested the duodenum dilates (White arrow).
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F1
The upper gastrointestinal (UGI) contrast study revealed the duodenum was markedly dilated along its entire length, the size of the expansion about 15 x 12 cm (Figure 1B); Abdominal ultrasound indicates that the duodenum is extremely distal; The patient eventually underwent exploratory laparotomy: the entire duodenum and the beginning of and the beginning of jejunum were markedly dilated, and the diameter was about 15 cm (Figure 2A). There was no obvious mechanical obstruction at the junction between the dilated segment and the jejunum; In the operation, the dilated duodenum was cut off, and pay attention to protect duodenal ampulla (Figure 2B); A loop of jejunum 45 cm from the ligament of Treitz was used for a side-to-side duodenojejunostomy oriented in a retrocolic fashion.
(A) Intraoperative demonstrated megaduodenum. (B) Protect duodenal ampulla (White arrow).
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F2
The upper gastrointestinal (UGI) contrast study revealed the duodenum was markedly dilated along its entire length, the size of the expansion about 15 x 12 cm (Figure 1B); Abdominal ultrasound indicates that the duodenum is extremely distal; The patient eventually underwent exploratory laparotomy: the entire duodenum and the beginning of and the beginning of jejunum were markedly dilated, and the diameter was about 15 cm (Figure 2A). There was no obvious mechanical obstruction at the junction between the dilated segment and the jejunum; In the operation, the dilated duodenum was cut off, and pay attention to protect duodenal ampulla (Figure 2B); A loop of jejunum 45 cm from the ligament of Treitz was used for a side-to-side duodenojejunostomy oriented in a retrocolic fashion.
(A) HE staining of surgical specimens, the submucosa was loose and edematous (Black arrow, original magnification: 40x). (B) IHC staining for CD34. (C) IHC staining for CR. (D) IHC staining for NSE (Balck arrow indicates a positive appearance, Original magnification: 200x).
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F3
Postoperative pathological findings showed that duodenal dilation, intestinal mucosal glands increased, the submucosa was loose and edematous, and the ganglion cells were seen in the muscles (Figure 3A). Immunohistochemistry (IHC): CD34 (+), CR (+), NSE (+), (Figures 3B-D).
Extended segment extinction, the anastomosis passed smoothly, no narrow. (A) Postoperative UGI showed resolution of the megaduodenum (1 month after operation). (B) Postoperative UGI showed resolution of the megaduodenum (1 year after operation) (White arrow).
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F4
Follow up UGI contrast study after operation showed that the anastomosis passed well without stenosis or obvious reflux and the duodenum was emptying well with near complete resolution of the megaduodenum (Figures 4A,B).