[MHS: Episode-75] Prologue: The Man Who Could Never Stop Vomiting

 

[MHS: Medical Human Story]-Episode 75

 Prologue | Part 1 | Part 2 | Part 3 | Part 4 & Epilogue

Prologue: The Man Who Could Never Stop Vomiting

"People break long before their diseases do."

Many believe that it is physical illness that ultimately defeats a person.

But after spending decades examining tens of thousands of CT scans, MRI studies, and ultrasound images—after witnessing not only the anatomy of the human body but also the joy, grief, hope, and despair hidden within those images—I have come to one unwavering conclusion.

People rarely collapse because of disease itself.

They are first undone by loneliness.

They crumble under the terror of pain that no one can explain.

And more than anything else, they are slowly destroyed during the endless years when no one believes their suffering.

"You're exaggerating."

"It's probably just stress."

"Nothing serious is wrong with you."

Those words can wound more deeply than any illness ever could.

Sometimes, a soul abandoned for years amid misunderstanding, self-doubt, and silent suffering is finally vindicated—not by words, but by a single diagnostic image.

---

"I... threw up again. I'm so sorry..."

He sat on the edge of the emergency department bed, his face drained of every trace of color, apologizing as though he had done something wrong.

He was thirty-two years old.

An ordinary office worker who simply tried a little harder than most people to live an honest life.

A beloved son.

A young man who might one day have become a devoted husband and a dependable father.

Yet for the past several years, there had been only one word cruel enough to define his life.

Vomiting.

---

At first, everyone dismissed it as nothing more than an inconvenience.

The weeks leading up to project deadlines meant endless overtime.

Business dinners, heavy drinking, and relentless workplace stress had become routine.

For office workers, heartburn caused by irregular meals felt almost like an occupational hazard.

"If I drink just a little too much, I throw up."

"If I eat anything greasy, my stomach refuses to digest it."

Whenever he visited a neighborhood clinic or the gastroenterology department of a general hospital, the diagnosis was almost astonishingly predictable.

"Stress-induced gastritis."

"Classic functional dyspepsia with excessive gastric acid secretion."

"Reduce your workload and eat regular meals."

The antacids and prokinetic medications worked almost like magic.

For a few days, his stomach settled.

Relieved, he returned to work.

Then, just as predictably, the symptoms returned.

He vomited.

He recovered briefly.

Then another violent episode would leave him clinging to a toilet through the night.

His entire youth had become trapped inside that endless nightmare—

an infinite loop with no escape.

---

His mother sighed helplessly.

"My son was simply born with a weak stomach.
That's just the way he is."

His supervisor shrugged without sympathy.

"Young people these days are mentally weak.
Managing stress is part of being a professional."

His friends laughed as they raised their glasses.

"Quit drinking so much.
How do you expect to stay healthy?"

No one knew the truth.

Deep inside his body—

far beyond the reach of physical examinations, questionnaires, or modern medicine's routine evaluations—

a congenital anatomical trap had been quietly waiting since before he was even born.

It had taken shape while he was still floating inside his mother's womb.

And for thirty-two years...

it had never once let go of its grip.

---

Two o'clock in the morning.

The automatic doors of the emergency department slid open once again.

He was wheeled in, his body writhing in agony.

This attack was unlike any before.

Even a single sip of normal saline...

Even a mouthful of cold water meant only to moisten his lips...

could not pass through his throat.

Everything erupted back out almost instantly, spraying forward like a fountain.

His abdomen was grotesquely distended, swollen tight as a balloon.

His pale face glistened with cold sweat, already displaying the unmistakable warning signs of impending shock.

The attending emergency physician moved quickly.

An intravenous line was secured.

Emergency laboratory tests were ordered.

At the same time, the physician urgently contacted the Department of Radiology.

"Order a contrast-enhanced abdominal CT immediately.
There's a high probability of bowel obstruction."

---

[Insert Figure]

[Medical Insight]

---

A few minutes later—

inside the CT suite.

The room was filled with the quiet hum of machinery and the sterile chill of conditioned air.

Sensing the patient's fear, the experienced radiologic technologist spoke in a calm, reassuring voice.

"All right, sir.
We're about to inject contrast material through your IV line.
You'll probably feel a sudden warmth spreading throughout your body.
That's completely normal.
Don't worry.
Just hold your breath when I tell you to."

The scanner's gantry began to rotate with its familiar low mechanical hum.

Clear, chilled contrast medium flowed through his veins, rapidly circulating throughout his body.

Only a few seconds passed.

Yet within those brief moments, hundreds of high-resolution cross-sectional images were acquired—

images that would become the decisive evidence capable of rewriting the entire history of this young man's suffering.

---

I sat before the high-resolution PACS workstation in the reading room and opened his examination.

The moment I scrolled through the first axial image, something immediately caught my eye.

The stomach was massively distended—

far beyond anything expected—

filled with an enormous volume of fluid and gas.

I advanced to the next slice.

The duodenum was abnormally dilated, ballooning into what looked almost like a giant pouch.

Then I reached the third image.

My finger froze on the mouse wheel.

Something...

was profoundly wrong.

[Insert Figure]

[Medical Insight]

---

Something...

was unmistakably, profoundly twisted.

Under normal anatomy, the small intestine occupies predominantly the central and left side of the abdominal cavity. At the same time, the colon frames the abdomen along the right and peripheral regions in a predictable configuration.

But this young man's abdominal anatomy had been completely rearranged.

Most of the small bowel lay crowded on the right side.

The colon had shifted almost entirely to the left.

Even the cecum—where the appendix normally resides in the right lower quadrant near the pelvis—had migrated far upward, resting beneath the liver.

Medical knowledge flooded through my mind like a cascading torrent.

A textbook example of abnormal anatomy.

And yet, before consciously assembling every clue, I already knew the answer to this bizarre puzzle.

That is the essence of radiology.

Its purpose is not speculation.

Its purpose is to reveal the truth—exactly as it exists.

People can lie to others.

They can even lie to themselves.

Memories fade.

Symptoms are subjective.

Patients often struggle to describe what they feel, and those descriptions can sometimes mislead even experienced physicians.

But a modern CT scanner never lies.

It faithfully preserves the evidence of developmental events that occurred long before memory itself existed.

Long before this patient ever took his first breath...

while his intestines were still rotating into position inside his mother's womb...

a subtle developmental error had occurred.

And for thirty-two years, the evidence had remained there, patiently waiting to be discovered.

Slice after slice, I advanced through the study, tracing the course of the superior mesenteric artery (SMA) and the superior mesenteric vein (SMV).

There it was.

A delicate twisting pattern surrounding the mesenteric vessels.

It was not an acute midgut volvulus with complete vascular occlusion.

The blood supply remained intact.

But neither was it remotely close to normal anatomical fixation.

The bowel had lived for decades in an unstable arrangement, balanced on the edge of catastrophe.

---

[Insert Figure]

[Medical Insight]

---

One finding stood out above all the others.

The third (horizontal) portion of the duodenum narrowed abruptly, bending at an unnaturally sharp angle.

The CT images could not directly visualize it.

But its presence was unmistakable.

A congenital fibrous peritoneal band...

compressing the duodenum from above.

Ladd's band.

At that instant, every scattered piece of the puzzle fell perfectly into place.

Years of relentless vomiting.

The upper abdominal fullness that appeared faithfully after every meal.

The unbearable pain.

The countless clinic visits ending with diagnoses of gastritis or indigestion.

The temporary improvement during good periods...

followed by inevitable relapse whenever stress or overeating increased intestinal distention.

None of it had ever been psychiatric.

None of it had been "just a sensitive stomach."

None of it had been functional dyspepsia.

The true culprit was hidden much earlier—

within the silent missteps of embryologic development.

A structural problem.

A mechanical problem.

A congenital anatomical defect that had existed since before birth.

And every symptom...

every unexplained year of suffering...

could now be explained by a single CT examination.

Without hesitation, I picked up the direct emergency line.

The sounds of hurried footsteps, monitor alarms, and the patient's strained groans echoed faintly through the receiver.

"Radiology speaking.
I've completed the interpretation of the emergency CT."

The emergency physician answered immediately.

"Yes, Professor.
His pain is becoming unbearable.
Are we dealing with a gastric perforation?"

"No."

I answered calmly.

"It is neither functional gastrointestinal disease nor simple gastritis."

A brief silence followed.

Even over the phone, I could sense the tension.

Then I spoke with quiet certainty.

"This is highly suspicious for adult intestinal malrotation with partial duodenal obstruction caused by a Ladd's band. Notify the on-call general surgeon immediately and prepare the patient for emergency surgery."

For a moment, the emergency medicine resident said nothing.

When he finally spoke, disbelief filled his voice.

"An... adult?
Isn't intestinal malrotation a pediatric disease?"

"It usually is."

I looked once more at the images glowing across my monitor.

"But rare does not mean impossible."

"My screen is showing thirty-two years of hidden truth."

"We don't have time to wait."

---

[Insert Figure]

[Medical Insight]- Principles and Therapeutic Effects of Ladd's Procedure

The patient lay quietly on his bed in the emergency department, completely unaware of the extraordinary truth unfolding inside his own body.

He had no idea that his intestines had failed to complete their normal rotation while he was still developing in his mother's womb.

He had no idea that they had remained twisted throughout his entire life, silently shaping every episode of pain, every sleepless night, every humiliating moment spent clinging to a toilet.

Nor did he know that the misery which had haunted him for the past thirty-two years had never been caused by workplace pressure, emotional stress, or an overly sensitive stomach.

The true cause had been with him since before he was born.

And he certainly did not know that, beginning today, his life was about to change completely.

---

I closed the final series on the PACS workstation.

The hundreds of CT slices remained glowing on the monitor behind me like constellations scattered across a midnight sky.

For a long moment, I sat in silence.

Radiology is often misunderstood as a discipline devoted merely to finding disease with sophisticated machines.

But that has never been its true purpose.

Radiology is the science of revealing truths that have remained invisible.

It is the bridge between silent anatomy and human suffering.

It is the moment when years of unanswered questions finally receive a name.

Sometimes, it rescues not only an organ...

but an entire life.

For decades, this young man had wandered through a labyrinth of unexplained pain.

He had been misunderstood by physicians.

Pitied by his family.

Judged by his employer.

And even he had begun to doubt himself.

He had gradually accepted the cruel possibility that perhaps everyone else was right—that perhaps he simply had a weak stomach, that perhaps the pain was exaggerated, that perhaps he was somehow responsible for his own suffering.

Yet none of those things had ever been true.

The CT images had spoken with absolute honesty.

Unlike human memory, they never forgot.

Unlike assumptions, they never deceived.

Unlike opinions, they never judged.

They simply revealed what had always been there.

A congenital anatomical error.

A silent developmental mistake preserved since fetal life.

A truth that had remained hidden for thirty-two years.

I have learned, after interpreting countless medical images throughout my career, that every examination tells two stories.

One is the biological story—the anatomy, the pathology, the diagnosis.

The other is the human story.

The years spent searching for an answer.

The hope that gradually fades after every reassuring but incomplete diagnosis.

The loneliness of living with pain that no one else can see.

The quiet despair of wondering whether anyone will ever believe you.

Every CT scan contains both stories.

Most people notice only the first.

Radiologists must learn to recognize the second.

Because behind every image is a human being.

Behind every diagnosis is a family.

Behind every shadow on a scan is a life waiting to be understood.

That night, a single CT examination accomplished something no medication, no reassurance, and no previous consultation had ever achieved.

It restored meaning to thirty-two years of unexplained suffering.

It transformed guilt into understanding.

It replaced uncertainty with truth.

And for the first time in his life, the young man who had wandered without answers was finally beginning the journey home.

Next Chapter ☞ Part I: The Beginning of the Disease