7 years of ‘eating and vomiting’ because of a disease that only 15 people in the world have

On February 27, M.D.2 Phan Van Thai, Head of the Department of General Surgery, FV Hospital, said that the Cambodian patient was admitted to the hospital in critical condition, vomiting blood, shock due to anemia and lack of fluid, his body was exhausted, and his abdomen was distended. CT scan noted that the stomach and duodenum were maximally dilated, occupying nearly the entire abdomen. After intensive resuscitation, a catheter was placed to drain more than 5 liters of stagnant fluid, and the hemodynamic condition was stable. A month earlier, the patient had surgery elsewhere for persistent nausea but no improvement.

Multi-specialty team consults. According to doctor Thai, vomiting blood due to diffuse hemorrhagic gastroduodenal inflammation has been controlled with medication, but the most difficult problem is the large dilation of the stomach and duodenum. Initially, doctors suspected intestinal obstruction due to old incisions, but endoscopy and CT ruled out this possibility.

According to the doctor, the duodenum (the first part of the small intestine connected to the stomach) is normally about 25 cm long, when collapsed it is only as big as a finger. Particularly, the patient had a duodenum diameter of up to 12 cm and a circumference of 38 cm. After 3 days of drainage, the stomach clearly collapsed but the duodenum was still maximally dilated, sticking to surrounding organs and losing contractile function, proving that the patient did not have intestinal obstruction. The team ruled out common causes and made the final diagnosis of idiopathic megaduodenum (Idiopathic Megaduodenum) – the world medical literature has only recorded about 15 cases.

The disease causes food to stagnate and not enter the small intestine, forcing the patient to vomit and experience prolonged exhaustion. The optimal solution is to remove the entire pathological duodenum and restore digestive circulation. This is a complicated surgery because the duodenum hugs the head of the pancreas, where many blood vessels and the biliary-pancreatic duct converge, and the risk of pancreatic fluid leakage is very high.

During the surgery, the team dissected and removed the deformed duodenum, using two healthy small intestine segments to restructure. One section connects to the stomach to carry food, the other section carries bile and pancreatic juice according to natural physiology, creating a new “digestive junction”. After surgery, the patient stopped vomiting, imaging tests showed good circulation in the digestive system, no fluid retention, and was discharged from the hospital after three weeks.

“After 7 years, I can eat without vomiting,” the patient said emotionally.

Experts say the disease is easily confused with superior mesenteric artery compression syndrome or common intestinal obstruction. Many cases around the world take many years to be properly diagnosed, requiring multidisciplinary coordination for successful treatment.