February 15, 2025 International Trending News Stories

An enigmatic patient excruciating tightness

At the age of 14 years, the patient is diagnosed with bulimia. She vomits regularly, accompanied by pain in the abdominal cavity, and is incredibly slimming. With psychotherapeutic help, the adolescent survives this phase. She likes to eat again and is gaining weight. However, she has depressive phases, which is why she takes the antidepressant Mirtazapine.

At the age of 16, the adolescent goes to a doctor again for treatment because of the food. She gets tired so quickly that she has lost weight again. Her chest area often hurts. Sometimes she spontaneously vomits when she bends over to tie her shoes. Also, during sports, she sometimes vomits. Usually, she has a sour taste in her mouth. All this puts a lot of strain on her in everyday life.

The doctors at the University Hospital in Heidelberg examine the patient thoroughly and also check various blood values, all of which are unremarkable.

The stomach does not belong there

However, X-rays after administration of a contrast medium immediately show where the problem lies, as the team of doctors reports in the “International Journal of Surgery Case Reports.” The patient has a so-called axial hernia: The upper part of the stomach protrudes through the gap in the diaphragm, which generally only leaves room for the esophagus into the chest cavity. The hernia is huge. The findings may explain why adolescent vomits repeatedly. Because such hernias often cause heartburn in patients.

Usually, the stomach lies entirely in the abdomen, i.e., below the chest cavity. The dome-shaped diaphragm muscle serves as a partition between the chest and the abdomen, although the esophagus passes through it. In the 16-year-old girl, the opening around the throat has become considerably more significant, causing part of the stomach to press into the chest cavity. The enlarged gap in the diaphragm also causes the stomach contents to rise slightly back into the esophagus – which often causes the adolescent to have an acidic taste in her mouth or even vomit.

An operation should correct the hernia – and thus, the problems of the young patients. The medical team, led by Giovanni Frongia, performs the process in Heidelberg. They move the stomach back into the abdominal cavity and reduce the gap in the diaphragm back to a standard size. Also, a cuff on the esophagus is intended to help it close better in the future and allow less gastric acid to flow back.

After the operation, the young person feels better for a while, but this does not last long. Only four weeks later, after eating, she again has a strong feeling of fullness and has to throw up again. The doctors prescribe her a medication to speed up the emptying of her stomach. This helps at least a little bit. They also recommend that the patient eat only small portions, but more often. Frongia and his team regularly check how the 16-year-old is doing.

Hidden bottleneck

In spite of all measures, the patient does not get rid of all her complaints. The doctors, therefore, decide to examine the stomach and abdomen using magnetic resonance imaging. The images reveal that not only the patient’s stomach is dilated, but also the first section of the small intestine, the so-called duodenum. This dilation extends to the point where the intestine passes through the branch of an intestinal artery – the so-called upper mesenteric artery – from the aorta. Normally the angle between the two blood vessels is 40 to 60 degrees – and provides enough space for the intestine. At an angle of fewer than 25 degrees, however, it becomes narrow.

In the patient, the angle is just 14 degrees. As a result, her intestine has to squirm so much through the narrowing that most of the food gets stuck here. Doctors can confirm this with an endoscope: even after the patient has not eaten for 24 hours, there are still relevant amounts of food above the narrowing.

If the duodenum is trapped by the mesenteric artery and aorta in this way, it is called Wilkie syndrome. The diagnosis is rare; doctors estimate that between 0.01 and 0.3 percent of people are affected.

Rapid surgery

When making a diagnosis, it is recommended that patients first build up the weight by consuming very high-calorie drinks, among other things. Afterward, the angle of the blood vessels can widen again so that the problem can be solved without surgery.

However, the patient has now had several months in which many unsuccessful attempts have been made. Therefore she is now undergoing surgery quickly. The surgeons bridge the narrowing by connecting a part of the intestine that lies in front of the obstacle with a part behind it.

The operation proceeds as planned; six days later, the patient can leave the clinic. In the coming weeks, she can finally eat normally again. She gains weight as desired and can enjoy her life back. Like the doctors, she hopes that her case will help other patients with Wilkie syndrome to receive the correct diagnosis early on.

In retrospect, it is not possible to say whether the patient already had Wilkie Syndrome when she was diagnosed with bulimia. However, Frongia thinks this is likely. The hernia also probably resulted from the duodenal constriction.

in Health, News
Related Posts

Dr. Parham Yashar, the Founder of Yashar Neurosurgery, Advises Young Surgeons to Prioritize Patient Care

December 16, 2021

December 16, 2021

Everyone deserves the chance to live a life free of sickness and impairment caused by avoidable causes. And upon suffering...

Should facial recognition worry us?

January 16, 2020

January 16, 2020

A group of activists has tried to prove that yes, with a strange protest in Washington: but there are many...

Qaboos bin Said, Sultan of Oman, has died

January 18, 2020

January 18, 2020

He was 79 years old and had been the Arab leader in power for the longest time. Qaboos bin Said,...

The Sun as we have never seen it

January 30, 2020

January 30, 2020

The spectacular images collected by a Hawaii telescope, with details never seen before on the solar surface The Sun is...

WD: larger hard drives with ePMR

January 23, 2020

January 23, 2020

Until now, WD has wanted to use microwaves to increase hard drive capacity, but the process is not yet ready...

H2 from light and water

January 15, 2020

January 15, 2020

Claudia Turro and her colleagues Whittemore, Xue, Huang, and Gallucci from Ohio State University presented a rhodium catalyst that achieves...

Loa Blasucci on Self-Healing through Biofield Purification Technique

April 2, 2024

April 2, 2024

In a world where the clock ticks relentlessly and the pressures of modern life weigh heavily upon us, the quest...

Be careful when charging smartphones from USB ports in public places

January 17, 2020

January 17, 2020

In addition to passing the current, they could be used to steal data or install dangerous software: but there are...

Making Your Life Pain-Free and Healthy with Josie Medema, a Fitness Model, and Influencer

November 26, 2022

November 26, 2022

Living pain-free and active is the ultimate health and fitness goal. Having a great shape or strong body isn’t always...

Amber Wentworth Shares 3 Tips to Achieve a Healthy Lifestyle

August 3, 2021

August 3, 2021

Should a number on a scale matter so much if you feel mentally and physically healthy? The answer to this...

Germany has introduced a measles vaccine requirement for students and children in kindergartens

January 23, 2020

January 23, 2020

The German parliament has passed a law obliging students and kindergarten children to vaccinate themselves against measles. The German Health...

filed against Israeli Prime Minister Netanyahu

January 28, 2020

January 28, 2020

Benjamin Netanyahu has withdrawn his immunity application to parliament. Now he could become the first incumbent Prime Minister of Israel to...

The photo that won the Comedy Wildlife Photography Awards

January 4, 2020

January 4, 2020

It’s the contest for the funniest and funniest pictures of animals, and even the images that didn’t win are doing...

Medical Student and Content Creator Kumail Hussain Shares Tips to Avoid Burnout

December 31, 2021

December 31, 2021

Medical student burnout is a prevalent issue considering the exhausting routine and tedious program it is. It tends to bring...

Why developers should pay attention to their health

January 8, 2020

January 8, 2020

The irresponsible sale of new features favors pressure in software development. This increases health risks for developers. Many programmers, and...