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An unusual cause of gastric outlet obstruction
  1. A M Smith1,
  2. R Mackey2,
  3. R M Walsh2
  1. 1Academic Surgical Unit, Castle Hill Hospital, Cottingham, East Yorkshire, UK
  2. 2Department of Surgery, A80 Crile Building, Cleveland Clinic Foundation, Euclid Avenue, Cleveland, Ohio, USA
  1. Correspondence to:
    MrA M Smith
    Academic Surgical Unit, Castle Hill Hospital, Cottingham, East Yorkshire HU16 5JQ, UK; malvernhome{at}hotmail.com

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Clinical presentation

A 70 year old female presented with a four week history of epigastric pain, nausea, bilious vomiting, and weight loss of 20 lb. Forty years ago she had undergone a proctocolectomy for familial adenomatous polyposis (FAP). On examination she was apyrexial, tachycardic (120), normotensive, and dehydrated. Her abdomen was soft with a succussion splash. She was initially rehydrated and her stomach was decompressed with a nasogastric tube. She then underwent a computed tomography scan.

Question

What is the abnormality marked with the arrows in fig 1? What is the diagnosis and management?

Figure 1

 Computed tomography scan.

See page 977 for answer

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Footnotes

  • Robin Spiller, Editor

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