, Volume 6, Issue 8, pp 757-771

Pathogenesis and treatment of acquired megaduodenum

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Summary

There are two types of megaduodenum: congenital and acquired. The symptoms, diagnosis, and pathological anatomy of the condition were studied in 12 cases of the latter type. Histopathological study of the myenteric plexuses showed definite lesions of the ganglion cells, which in many cases led to complete destruction of the neurons forming the plexuses and which were replaced by newly formed connective tissue.

The most plausible explanation for the cause of the acquired megaduodenum observed in Brazil is the same as that of megaesophagus and megacolon, i.e.,Trypanosoma cruzi, the agent of Chagas' disease. The authors believe that the pathogenesis can best be explained by a modification of Hurst's theory of achalasia. An asynchronism exists between the movements of the duodenum and the duodenojejunal angle, causing duodenal stasis.

For treatment, we recommend two surgical procedures: Finney's duodenojejunostomy when the process is localized in the duodenum, and a partial enterectomy with reestablishment of the intestinal transit by end-to-end anastomosis when in addition to megaduodenum there is megajejunum.