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- W2130301172 abstract "When a diagnosis of duodenal ileus is made by the radiologist, the condition referred to is that first described by Rokitanski in 1861 (5) and more recently by Wilkie (9) and others. This implies partial or complete obstruction of the duodenum in its third part by extrinsic pressure from the overlying superior mesenteric artery at the point where the third part of the duodenum passes between this vessel and the underlying aorta. The concepts of this reasoning are: (a) The obstruction is at the anatomic site of the superior mesenteric artery. (b) The extrinsic pressure is linear in a vertical direction as might be expected from such pressure. (c) In certain patients, particularly if there has been recent loss of weight, a naturally narrow aortomesenteric angle may become more acute secondary to loss of mesenteric fat and possibly displacement of small bowel into the pelvic cavity. This may explain the association between loss of weight or of prolonged immobilization and the onset of symptoms from duodenal ileus. (d) A high fixation of the ligament of Treitz, perhaps associated with some degree of malrotation of gut, may be a further factor involved. The diagnosis is made radiologically in the presence of dilatation of the first and second parts of the duodenum, with marked “to-and-fro” peristalsis, with delay in transit of barium, and with evidence of a characteristic vertical linear extrinsic pressure defect in the third portion of the duodenum. With more marked symptoms of high obstruction there may be gastric dilatation. Before the diagnosis of superior mesenteric artery pressure can be considered, other causes of duodenal ileus (a dilated duodenum) must be weighed. Causes of Duodenal Ileus (3) 1. Paralytic or adynamic ileus secondary to inflammatory disease, such as duodenal ulcer, cholecystitis, pancreatitis, or the Zollinger-Ellison syndrome (6) 2. Neuromuscular disorders, such as postvagotomy state, vitamin B deficiency, and porphyria 3. Aganglionic segment, known as megaduodenum (1) 4. Collagenous diseases such as scleroderma and dermatomyositis 5. Occlusion secondary to extrinsic pressure (a) Superior mesenteric artery compression (b) Adhesive bands and acute angulation of ligament of Treitz (c) Edema of mesenteric root of small bowel secondary to inflammatory disease (d) Extrinsic pressure from adjacent masses (inflammatory or neoplastic) 6. Intrinsic narrowing of the duodenum from congenital stenosis, tumor, or other acquired disease. Most of the causes listed above—for example, associated inflammatory disease, peptic ulceration, and malignancy—will be revealed either by the history and physical examination or by a gastrointestinal series. The possibility of malrotation of gut should be remembered, but no evidence of this was found in this series of cases (Table I)." @default.
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- W2130301172 date "1966-02-01" @default.
- W2130301172 modified "2023-09-24" @default.
- W2130301172 title "Duodenal Ileus with Special Reference to Superior Mesenteric Artery Compression" @default.
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- W2130301172 doi "https://doi.org/10.1148/86.2.305" @default.
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