Tapering duodenoplasty and Roux-en-Y duodenojejunostomy in the management of adult megaduodenum

Abstract

CASE REPORT A 41-year-old man with a history of chronic diarrhea and fatty stools since childhood and an inability to gain weight presented with C6 and T3 vertebral fractures. A bone mineral density scan of the lumbar spine from L2 to L4 was 61% of predicted, which was 4.3 standard deviations below the mean for an individual his age. An extensive endocrine work-up revealed a parathyroid hormone level of 4.1 and a serum calcium level of 7.8 mg/dL with an albumin of 3.5 g/dL. Based on these findings, malabsorption of vitamin D was suspected to be the cause of his bone disease. He underwent an upper gastrointestinal series that revealed a massively dilated duodenum (Fig 1). The remainder of his gastrointestinal evaluation was unremarkable. Based on these finding and our clinical suspicion that his bone disease and malabsorption were a direct result of megaduodenum and bacterial overgrowth, the patient was surgically explored. The duodenum was approxi-