Hereditary Megaduodenum Presenting as Superior Mesenteric Artery Syndrome
Bibliographic record
Abstract
A 15-year-old boy presented with a 10-year history of intermittent vomiting and weight loss. The symptoms had significantly increased over the last few months and prior to presentation; the patient had postprandial abdominal pain relieved with vomiting. The patient had normal bowel function. He had a weight loss of 10 to 15 lbs over the four previous months. The patient’s past medical history and physical exam were unremarkable. An upper GI series and follow-through showed a dilated first and second portion of the duodenum with a sharply demarcated cut-off zone consistent with SMAS.3 The following day a laparotomy and duodenojejunostomy were performed. Post-operatively, the patient’s obstructive symptoms continued and he was treated with prokinetic agents to no effect. The patient was taken to the operating room two weeks later for a repeat gastroscopy and laparotomy. The esophagus was noted to have evidence of active esophagitis. At laparotomy, the duodenum was dilated beyond the superior mesenteric artery, a finding that was inconsistent with SMAS. At that time a duodenojejunostomy to the left of the mesenteric vessels was created. A third laparotomy and duodenojejunostomy were performed, proximal to the first. An appendectomy was also performed. Ten days later the anastomoses began to open up and the patient was able to tolerate a normal diet. Post-operatively the patient underwent a number of upper GI endoscopies that showed grade 3 esophagitis and severe gastroesophageal reflux. The patient was successfully managed with ranitidine. Complete healing of the esophagitis occurred; however, there was a ring of proximal migration of gastric epithelium along the site of previously inflamed esophagus suggestive of Barrett’s epithelium. Biopsies confirmed Barrett’s esophagus with no euplastic changes.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".