Stomach and Small Bowel

Abnormal radiographic changes are not usually seen in the stomach or small intestine other than occasional instances of megastomach, megaduodenum or megajejunum (Fig. 4.15). Gastric emptying due to dysfunction of the pylorus can be evaluated by ultrasound instead of fluoroscopy and radiography. Pyloric dysfunction is seen in up to 22% of patients with intermediate or advanced stage megaesophagus and is diagnosed if gastric emptying does not occur within 2 hours. Duodenal dysfunction is also present in a minority of patients with megaesophagus, sometimes involving only a dilated bulb, but usually causing dilatation of the entire duodenum to the ligament of Treitz. The jejunum and ileum are rarely dilated. Either acceleration or delay in transit time through the small bowel may sometimes be seen.

...

Fig. 4.15 Chagas' disease with megaduodenum in a 57-year-old Brazilian black man. The patient had epigastric burning and pain for 1 year unrelated to meals but improved with alkali agents. He also complained of occasional nausea and vomiting but no hematemesis or melena. Ten months later he had the same problems and an ECG showed sinus bradycardia. Serological test for Chagas' disease was positive. A gastrojejunal anastomosis was performed, and at surgery the duodenum was found to be dilated throughout its whole length, but there were no ulcers and no tension from adjacent aorticomesenteric vessels. (Courtesy of Dr. Clovis Simao, Sao Paulo).