The American Journal of Digestive Diseases

, Volume 6, Issue 8, pp 757–771

Pathogenesis and treatment of acquired megaduodenum

  • Arrigo Raia
  • Danilo Acquaroni
  • Alipio Correa Netto
Article

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.

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References

  1. 1.
    Barnett, W. O., andWall, L. Megaduodenum resulting from absence of the parasympathetic ganglion cells in the Auerbach plexus.Ann. Surg. 141:527, 1955.PubMedGoogle Scholar
  2. 2.
    Bloodgood, J. C. Acute dilatation of the stomach. Gastromesenteric ileus.Ann. Surg. 46:736, 1902.Google Scholar
  3. 3.
    Chagas, C. Trypanosomiase americana—Forma aguda da Molestia.Mem. Inst. Oswaldo Cruz 8:37, 1916.Google Scholar
  4. 4.
    Correa Netto, A. Conferência pronunciada na Ass. Paul. Med., 1940.Google Scholar
  5. 5.
    Dalla Valle, A. Familial megacolon.Pediatria 32:569, 1924.Google Scholar
  6. 6.
    Devine, H. B. Basic principles and supreme difficulties in gastric surgery.Surg., Gynec. & Obst. 40:1, 1925.Google Scholar
  7. 6a.
    Di Dio, L. J. A. Piloros do sis tema digestorio.Rev. Hosp. N. S. Apparecidia 3:55, 1950.Google Scholar
  8. 7.
    Dudley, G. S. Duodenal dilatation.S. Clin. North America 9:667, 1929.Google Scholar
  9. 8.
    Etzel, E. A avitaminose como agente etiológico do megaesófago e do megacolon.An. Fac. med. Univ. São Paulo 11:59, 1935.Google Scholar
  10. 9.
    Finney, J. M. The relation of the dilatation of the duodenum to gastric disturbances.Bull. Johns Hopkins Hosp. 17:37, 1906.Google Scholar
  11. 10.
    Fonseca, K. C. Semiologia radiologica da discinesia funcional do duodeno.Arq. cir. clin. e exper. 15:176, 1952.Google Scholar
  12. 11.
    Fonseca, L. C., andToledo, P. A. Radiologia do bulbo e do arco duodenal naacalasia.Rev. brasil. med. 9:608, 1952.PubMedGoogle Scholar
  13. 12.
    Gregoire, R. Megaduodenum.Bull. et mém. Soc. chirurgiens Paris 47:528, 1921.Google Scholar
  14. 13.
    Guimaraes, J. de Paula. Megaesofago em macaco rhesus infectado pelo T. Cruzi. Congresso Int. sobre doença de Chagas, Rio de Janeiro, July 5–9, 1959.Google Scholar
  15. 14.
    Higgins, C. C. Chronic duodenal ileus.A.M.A. Arch. Surg. 13:1, 1926.Google Scholar
  16. 15.
    Hunter, R. H. A case of megaduodenum with multiple anomalies of the ileum.Arch. Dis. Childhood 8:155, 1933.Google Scholar
  17. 16.
    Kellogg, E. L., andKellogg, W. A. Chronic duodenal obstruction with duodenojejunostomy as a method of treatment.Ann. Surg. 73:578, 1921.Google Scholar
  18. 17.
    Köberle, F. Patogenese dos megas.Rev. goiania med. 2:101, 1956.Google Scholar
  19. 18.
    Okumura, M., Brito, T., Silva, L. H., Silva, A. C., andCorrea Netto, A. The pathology of experimental Chagas disease in mice: 1. Digestive tract changes with a reference to necrotising arteritis.Rev. Inst. med. trop. São Paulo 2:17, 1960.Google Scholar
  20. 19.
    Pedreira de Freitas, J. L., andMendonça, W. Inquerito sôbre moléstia de Chagas no município do Rio Verde.Hospital Rio de Janeiro 39:251, 1951.Google Scholar
  21. 20.
    Rezende, J. M. Megaesófago por doença de Chagas.Rev. goiania med. 2:297, 1956.Google Scholar

Copyright information

© Paul B. Hoeber, Inc., Medical Division of Harper & Brothers 1961

Authors and Affiliations

  • Arrigo Raia
    • 1
  • Danilo Acquaroni
    • 1
  • Alipio Correa Netto
    • 1
  1. 1.From the Department of SurgeryHospital das ClinicasSão PauloBrazil

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