Abstract
A 34-yr-old female patient with juvenile onset diabetes developed atony and dilatation of both the bulb and loop of the duodenum, i.e. megaduodenum. She showed various symptoms of diabetic gastroenteropathy including constipation, nocturnal diarrhea and recurrent attacks of nausea and vomiting. Neurological examinations revealed diminished or absent reflexes and a sense of vibration of the extremities. The evoked EMG requision showed a low voltage and low duration. The ECG R-R interval requision revealed cardiac denervation. These findings suggested that she had peripheral diabetic neuropathy and autonomic neuropathy. X-ray examination of the upper gastrointestinal (GI) tract on her first admission revealed gastric atony, gastric retention, and disturbance of expulsion of the gastric contents without evidence of organic obstruction, i.e. functional pylorus stenosis. After 18 months, the upper GI series showed atony and dilatation of the duodenal bulb. Further, 5 years later, the X-ray findings for the duodenum revealed atony and dilatation of the duodenal loop in addition to the above findings. The patient was given ambenonium chloride (10 mg per day) as treatment for the atony and dilatation of the stomach and duodenum. An improvement of subjective symptoms was obtained, but no change was noted in the X-ray findings of the upper GI tract. Although no clear explanation of the pathogenesis of diabetic gastroenteropathy has yet been made, it seems likely that a close relation exists between gastrointestinal atony and diabetic neuropathy. It was thought of interest to report the present diabetic case with atony and dilatation of the duodenal loop, due to the rarity of this condition.
