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A previously fit 78-year-old man presented with a 2-month history of dysphagia, epigastric pain, bloating, intermittent vomiting and 1½ stone weight loss. There was no history of new medications or recent travel abroad. Oesophagogastroduodenoscopy (OGD) showed a ‘cup and spill’ stomach with mild gastritis. Oesophageal biopsies were normal. CT scan of abdomen/pelvis showed extensive small bowel dilatation to the caecum but no transition point (figure 1A). Exploratory laparotomy revealed dilated small bowel loops without mechanical obstruction. Initial duodenal biopsies showed non-specific flattened villi with thickening and eosinophilia of submucosal vessels. Autoimmune screen including tissue transglutaminase and anti-neuronal antibodies were negative. The patient had normal renal and cardiac function.
Contributors PSL, LJ and NPT wrote the manuscript. SJN provided the histology images, description of the key features and expert advice. All authors critically appraised and approved the final manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.
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