What is probable diagnosis of a pt. with spinal POP cast presenting with bilious vomiting :
Ans. is 'b' Duodenal obstruction Reference Sabiston 18/e p1330 (17/e p1374)This is a patient with superior mesenteric syndrome or ' Wilkie's Syndrome ' the superior mesenteric artery compresses the 3rd portion of the duodenum as it passes over it. Superior mesenteric Artery arises from the Ant. aspect of Aorta, passes behind the neck of pancreas but in front of the uncinate process and crosses in front of the 3rd portion of the duodenum to enter the root of mesentery.The acute angle at which the superior mesenteric artery arises from the Aorta may compress the transverse portion of the duodenum between it and Aorta causing partial intestinal obstruction, a condition referred to as superior mesenteric artery compression syndrome.Predisposing conditionsplacement of body cast (Sometines called cast syndrome)Weight lossScoliosesisSupine immobilizationClinical featuresSymptoms of Duodenal obstruction (depending upon severity of obstruction)DiagnosisBy Barium upper G.I. series or Hypotonic duodenographyTreatmentInitially conservativeOperative t/t of choice --Duodenojejunostomy*
Acute dilation of stomach
Duodenal obstruction
Peritonitis
Acute pancreatitis
Benign Duodenal Disease