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EDITOR’S QUIZ: GI SNAPSHOT

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From question on page 222

Barium contrast studies disclosed the straight line cut off in the third portion of the duodenum with an intact mucosal pattern and proximal dilatation (fig 1), characteristic hallmarks of superior mesenteric artery (SMA) syndrome. This disorder, also known as cast syndrome or Wilkie’s syndrome, is a rare entity that results from compression of the third portion of the duodenum by the aorta and SMA. Causative factors precipitating narrowing of the aortomesenteric angle are thin body build, depletion of mesenteric fat by rapid catabolic states (for example, malignancy and burns), and spinal diseases (for example, lordosis, vertebral fractures, and scoliosis surgery). The differential diagnosis includes anorexia nervosa and chronic idiopathic intestinal pseudo obstruction. Conservative treatments, including nasogastric decompression, intravenous fluids, enteral feeding, and appropriate positioning (the left lateral decubitus, prone, or knee-chest position), can be effective. Surgical intervention such as duodenojejunostomy may be indicated when medical treatments fail. Our patient was treated conservatively and remains well.

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