Gastrojejunostomy and Duodenojejunostomy for Megaduodenum in Systemic Sclerosis Sine Scleroderma: Report of a Case

Excerpt

Systemic sclerosis is an autoimmune disease that causes sclerotic changes primarily in the skin and in other organs. Systemic sclerosis sine scleroderma (ssSSc) is a variant of the disease in which visceral involvement occurs in the absence of skin thickening [1]. Most patients with systemic sclerosis have digestive tract complications, 90% of which involve esophageal diseases such as gastroesophageal reflux disease (GERD) and Barrett esophagus [2‐6]. The rate of small intestinal complications in systemic sclerosis, although lower than that of esophageal complications, is estimated to be about 50%. In systemic sclerosis, more common small intestinal complications include intestinal pseudoobstruction with dilatation of the small intestine and small intestinal diverticula [1‐5]. Megaduodenum is relatively rare as a small intestinal complication in patients with systemic sclerosis, and treatment for megaduodenum is not yet well established. Because systemic sclerosis is systemic and progressive, surgery is generally not the first choice of treatment for these small intestinal complications [6]. We report a patient with ssSSc who complained of intractable vomiting associated with megaduodenum. Duodenal bypass and drainage was effective in this patient after failure of conservative therapies. …