Man finally free after doctor finds key to stomach pain

Born at just 5½ months on Christmas day and weighing less than 500 grams, Peter Erasmus came into the world in a different era of medicine, faced with a long road of healthcare challenges. Now, 49 years later he has at last received the diagnosis and treatment that has eluded him most of his life.

Suffering from severe abdominal pain on and off for decades, alongside several other identified conditions, Erasmus was recently diagnosed with the extremely rare Dunbar syndrome, also known as median arcuate ligament syndrome.

According to Dr Keona Lakey, a general surgeon at Netcare Sunward Park Hospital: “It is a congenital condition, which means Erasmus had been suffering with it since birth and it is quite unique for a person to receive the diagnosis at this stage of life, as it is usually identified earlier.

“However, Erasmus had a very complex medical history of numerous other healthcare issues.

“Furthermore, this syndrome is a challenging disease to diagnose because it is so rare and because the diagnosis must be done by exclusion.

“There are many other conditions that share symptomatic similarities, such as gastritis, gallstone and reflux disease, pancreatitis and others. It is therefore necessary to rule out any other possibilities before proceeding with surgical treatment.”

Dunbar syndrome affects the main artery supplying the upper part of the abdomen, the celiac artery, which normally feeds blood supply through the area. With Dunbar syndrome it is compressed by the diaphragm.

This can cause long-term chronic stomach pain and general discomfort.

‘I felt like I was dying’

Erasmus has been dealing with poor health all his life.

“I had a rocky start, being born so underweight and with certain of my internal organs on the outside of my body. I spent my first three years on Earth in hospital and have been in and out of medical facilities since then.

“I have always had numerous conditions, but my stomach began to give me more severe trouble in my 20s and after a number of tests and scopes, I still did not have a clear answer as to what the problem might be. It then eased off and for some time I did not experience such terrible pain.

“However, both my mother and my father recently passed away, which was very stressful, and this seemed to trigger the problem again, only this time the pain after eating was so severe that I felt like I was dying,” says Erasmus.

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Lakey says a scope was done to eliminate other issues but knowing the pain was directly related to eating made it easier to pinpoint the problem and after a CT scan, the condition was formally diagnosed.

“The only way to treat this condition is with surgery and traditionally that would mean open surgery, which would have required a very large incision and dissection of the abdomen.

“An endovascular approach might have been considered with angioplasty and/or stent placement to keep the artery open, however this would not solve the cause of the problem, which is the compression of the artery by the diaphragm.

“We opted for laparoscopic surgery [sometimes known as ‘key hole surgery’ or ‘minimally invasive surgery’], which meant the artery was far easier to see, there would be a great deal less trauma to Erasmus, he would experience a quicker healing period and better outcomes all round.

“I invited my colleague Dr Imraan Sardiwalla – a hepatobiliary surgeon who heads up the surgical gastroenterology hepatobiliary unit at Dr George Mukhari Academic Hospital and with whom I completed my fellowship training – to conduct the surgery with me, as it was such a rare condition and in these cases two heads are often better than one.

“We had to consider all possible challenges when undertaking the procedure.

“We knew we might run into some scar tissue in Erasmus’ abdomen, as he had such a complicated medical history, which would have made the operation particularly difficult.

“Fortunately, we had a clear path when opening the anatomy and working between the liver and the stomach to identify the blood vessels connected to his celiac artery. Because the condition had not been attended to until now the constriction was very tight and we needed to work our way backwards, gradually releasing the nerve fibres, of the celiac plexus, which had become enlarged.

“We then released all the nervous tissue and the diaphragmatic fibres around the artery and ensured that it was completely free.

“Such a complex operation requires extremely thorough knowledge and experience of the anatomy in that area, as you are dealing with the main blood supply coming off the aorta and any incorrect incisions could result in catastrophic bleeding.

“Caution is therefore key in safely freeing a blood vessel like this, which is also part of the reason why we felt laparoscopic surgery was the best option, as it can be so much more precise than open surgery,” says Lakey.

Following just a few days in hospital, Erasmus went home and experienced immediate relief.

No more stomach pain

“I no longer feel any pain or discomfort in my stomach and my day-to-day life is just easier to get through. I better manage my diabetes, as I can eat a proper, healthy diet. Honestly, I am just so glad to have had this condition diagnosed and treated at long last. It is a relief,” he says.

Lakey said laparoscopic surgery can make all the difference in the life of a patient, highlighting it should be considered wherever possible as it can be used for numerous conditions.

“There is a great deal of international research supporting the fact that a laparoscopic approach is equally effective, if not more so, than open surgery.

“I have certainly seen the positive results of this minimally invasive method among my patients for conditions ranging from colonic cancers and resections to hiatus and abdominal hernias and appendix removals…

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“Laparoscopic surgery also means a far lower risk of future complications, which is not only beneficial to patients like Erasmus – who have already been through a lot – but for anyone needing to go under the knife.

“Best possible patient outcomes are always the surgeon’s ultimate goal, not only at the time of operating but also into the future.

“Thanks to modern laparoscopic interventions it is so much easier to achieve this and make an impact in the lives of people needing surgical care,” he concludes.

– news@citizen.co.za