Duodenal obstruction and surgical methods of its treatment

     Chronic duodenal obstruction – is not a separate disease, it is a complex of different symptoms, which are caused by various reasons. In this case, the causes can be both organic (an obstacle: a mass) and functional (wall spasm).

            When chronic duodenal obstruction develops, the food clump cannot move to other parts of the gastrointestinal tract and remains in the duodenum.

            There are several theories of the origin of this pathology. The most commonly considered is the anatomo-mechanical theory. Various vessels are located around the duodenum: arteries and veins. The superior mesenteric artery surrounds the lower part of the duodenum and in some cases may compress it, resulting in dilatation of the upper-lying sections. In addition, the cause of impaired patency may be an abnormal location of the loop of jejunum. Also, damage to the vagus nerve due to past surgeries can impair duodenal motility.

    
In addition to the anatomical theory, there is the reflex theory of duodenal obstruction due to constant impulses that lead to reactive and degenerative changes in the nervous apparatus of the duodenum. If pathologic processes occur for a long time, the compensatory reserves of the intestine run out, and complete atony may occur, when the intestine is unable to contract.

            There are many different classifications of duodenal obstruction. Usually there are 4: two functional forms — in patients with psychiatric pathology and as a result of long-term somatic disease, as well as two mechanical forms — in congenital anomaly and due to complications of somatic disease.

            The causes for the development of duodenal obstruction are numerous, so they are usually divided into several subgroups.

— Congenital pathology.

— Causes outside the duodenum: due to compression by vessels, tumors and cysts.

— Processes in the duodenum itself: tumors, diverticula, Crohn‘s disease, inflammatory changes.

— Obturation of the lumen with foreign body, parasites.

— Processes that develop after surgery in the gastrointestinal tract.

            The disease may not manifest itself immediately. If pathological processes last long enough, it may manifest itself with abdominal pain, headaches, belching, abdominal bloating, vomiting and other manifestations.

            Chronic duodenal obstruction can occur in three stages: compensated, subcompensated and decompensated. To make a diagnosis, a radiologic study of the abdominal cavity is usually carried out, which shows increased peristalsis, enlargement of the duodenal wall. In addition, there may be a delay in the contrast agent.

            Treatment in Germany for this pathology is complex. The patient must follow a certain diet. After the stabilization of the body, as well as in case of ineffectiveness of conservative treatment, the patient undergoes surgical treatment of chronic duodenal obstruction.

            There are a large number of different surgical methods for the treatment of chronic duodenal obstruction. Two groups of operations are fundamentally defined: drainage of the intestine and exclusion of the intestine from the digestive process.

            In the first case, the most common operation is the Strong’s operation. In this operation, the ligament of Treitz is dissected, which leads to the release of the duodenum. In addition, in this operation, duodenoenterostomy is performed at the same time. This is an operation that consists in forming a connection between the duodenum and another part of the small intestine. In this case, duodenoenterostomy has many modifications. The best results were achieved with the Gregory-Smirnov operation and the Vitebsky operation. From the second group of operations the most positive results are achieved with antrumectomy with gastroenteroanastomosis. The volume of surgery is determined by the concomitant pathology, whether there was a history of ulcers, as well as what part of the intestine is still working.

            Chronic duodenal obstruction is a serious disease, which in the early stages requires complex treatment, and in case of its ineffectiveness, perform surgical intervention of various sizes.

Successful treatment of this complex pathology requires precise identification of the cause, i.e. accurate diagnosis, and a highly qualified surgeon. The clinics in Munich have leading specialists in the treatment of this disease who have extensive experience in the treatment of chronic duodenal obstruction, in particular with surgical methods.

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