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From question on page 1219

The endoscopic picture was suggestive of ischaemic necrosis of the duodenal folds and the histological changes were consistent with ischaemic mucosal damage. Histological appearance of ischaemia in the duodenum is not pathognomic and therefore it is essential to provide the pathologist with a good history. Extensive haemoconcentration in Addisonian crisis seemed to have reduced mucosal blood circulation with subsequent necrosis. However, the endoscopic appearance after treatment underlines the pathophysiology of the mucosal damage. The patient was treated by rehydration and hydrocortisone replacement therapy and recovered well. To date, ischaemic duodenitis has been described only in patients with classical abdominal angina or severe atheromatous disease of the splanchnic arteries (

). To our knowledge, this case is the first description of ischaemic duodenitis in a patient with Addisonian crisis.

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