Megaduodenum in аdults

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Abstract

This paper describes a clinical case of a patient with megaduodenum; the condition was detected in adulthood, it developed due to congenital duodenal malformation.

A 43-year-old female patient visited A.V. Vishnevsky National Medical Research Center with complaints of nausea and vomiting after eating, which brought her relief. These signs occasionally bothered the patient throughout her life. Based on the examination performed, the patient was diagnosed with a giant duodenal diverticulum and surgical intervention (laparoscopic diverticulectomy) was planned.

The obtained intraoperative data evidenced a presenting congenital megaduodenum associated with the duodenum bulb critical stenosis. During the surgical intervention, a duodenotomy was performed, which implied a step-by-step excision of the mucosal-submucosal fold of the duodenal wall with scar tissue at its base with duodenoplasty according to the original technique.

The article describes the difficulties of diagnosing the condition and the original surgical treatment option. A brief review of the literature comparing clinical outcomes of patients with a similar nosology is provided.

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About the authors

Pavel V. Markov

A.V. Vishnevsky National Medical Research Center

Author for correspondence.
Email: markov@ixv.ru

М.D., Head of the Department of Abdominal Surgery

Russian Federation, Moskva

Alexander I. Burmistrov

A.V. Vishnevsky National Medical Research Center

Email: aibur3619@gmail.com

сlinical graduate student of the Department of Abdominal Surgery

Russian Federation, Moskva

Ovanes R. Arutyunov

A.V. Vishnevsky National Medical Research Center

Email: Arutyunov_Ovanes@mail.ru

Surgeon of the Department of Abdominal Surgery

Russian Federation, Moskva

Vladimir Yu. Struchkov

A.V. Vishnevsky National Medical Research Center

Email: doc.struchkov@gmail.com

Ph.D., surgeon of the Department of Abdominal Surgery

Russian Federation, Moskva

References

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Supplementary files

Supplementary Files
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1. JATS XML
2. Fig. 1. Esophagogastroduodenoscopy: a – cavity of the dilated duodenal bulb with the area of the narrowed outlet; b – examination in inversion, the remains of chyme in the cavity of the megaduodenum.

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3. Fig. 2. X-ray examination of upper gastrointestinal tract organs with oral contrast: a – direct projection; b - lateral projection. The arrow indicates the megaduodenum.

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4. Fig. 3. CT with intravenous and oral contrast, arterial phase, coronary projection.

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5. Fig. 4. Intraoperative photos, laparoscopic access: a – the contour line indicates the area of the pylorus; b – the arrow indicates the border of the significantly expanded bulb and the descending part of the duodenum.

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6. Fig. 5. Intraoperative photo: a – the arrow indicates the zone of the pylorus; b – the arrow indicates the zone of transition of the duodenal bulb into the descending branch of normal size.

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7. Fig. 6. Intraoperative photo. A longitudinal duodenotomy was performed through the expanded part of the duodenum: a – the arrow indicates the area of the pylorus; b – the arrow indicates the narrowed exit portion of the duodenal bulb.

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8. Fig. 7. Intraoperative photo. A fold of mucosal-submucosal layers at the level of a narrowed section of the duodenal wall.

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9. Fig. 8. Intraoperative photo. Resection of the mucosal-submucosal fold of the duodenum and straightening of the stenosis zone.

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10. Fig. 9. Intraoperative photo. Stages of duodenoplasty: a – intermediate view; b – final view.

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11. Fig. 10. X-ray of the stomach, duodenum, and small intestine after oral contrast on the 10th day after surgery.

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Copyright (c) 2025 Markov P.V., Burmistrov A.I., Arutyunov O.R., Struchkov V.Y.

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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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