RESUMO
MEDICAL HISTORY: In a 13-year-old girl regurgitation, constipation and postprandial abdominal pain developed, with decreased nutrient uptake and severe weight loss (BMI 12,6) following a gastroenteritis 2 years before. An eating disorder had been strongly suspected but this diagnosis was not accepted by the family. DIAGNOSTICS: Initial investigations including physical investigation, elaborate laboratory tests and imaging techniques showed normal results, but we found transit disturbances and hypotensive motility of the upper gastrointestinal tract. Therapy and course of disease: During prokinetic treatment the girl was asymptomatic for about 9 months, but then the symptoms recurred and no longer responded to drug treatment. Feeding via a jejunal tube because of severe malnutrition was not tolerated either. Refractory vomiting and life-threatening hypokalemia and alkalosis occurred. Imaging techniques now showed marked dilatation of the proximal duodenum. Laparotomy was performed because a Wilkie's syndrome was suspected. However, during the operation mesenterial malrotation was found with adhesive fixation of the distal ileum in the upper left abdomen and compression of the proximal jejunum. The malrotation had been possible because the proximal colon was hypermobile. Following correction of the anatomical situation and retroperitoneal fixation of the colon, oral nutrition was well tolerated. The girl gained weight and remained symptom-free. CONCLUSIONS: Not only eating disorders but also defined gastroenterological disturbances may cause weight loss and abdominal symptoms in adolescent girls, even in patients with suggestive symptoms and without pathological findings with routine diagnostics.
