PMC3551515_01
(a) Ultrasound of mid abdomen shows superior mesentery vein (arrow) and superior mesentery artery to the left (b) The doppler flow study confirms arterial flow in the superior mesentery artery (arrowhead) and the venous flow in the uncompressed superior mesenteric vein (arrow).
JCIS-2-78-g002.jpg
PMC3551515_01_JCIS-2-78-g002.jpg
F1
The superior mesenteric artery (SMA) and superior mesenteric vein (SMV) were visualized with the SMA lying to the left of the SMV with normal anatomic alignment [Figure 1].
Single contrast upper gastrointestinal series shows on a single view plain radiograph the contrast abruptly cutting off approximately at the mid abdomen (arrow).
JCIS-2-78-g003.jpg
PMC3551515_01_JCIS-2-78-g003.jpg
F2
There was an abrupt cutoff with no contrast extending beyond approximately the mid abdomen [Figure 2].
Single contrast upper gastrointestinal series shows on delayed images with patient laying supine, contrast never extending beyond third portion of duodenum with persistent cutoff (arrow). Contrast is seen in antrum of stomach (star), proximal duodenum, and descending duodenum.
JCIS-2-78-g004.jpg
PMC3551515_01_JCIS-2-78-g004.jpg
F3
Delayed images were obtained while the patient was supine with contrast never extending beyond the third portion of the duodenum [Figure 3].
Delayed prone images demonstrated contrast in the proximal small bowel with persistent dilatation of the proximal duodenum.
JCIS-2-78-g005.jpg
PMC3551515_01_JCIS-2-78-g005.jpg
F4
Patient was subsequently placed prone for several minutes with eventual slight transit of contrast [Figure 4].
Additional delayed image following several minutes of prone position demonstrates a small amount of contrast progressing to the jejunum (arrow). There is persistent dilatation of the proximal duodenum (asterisk).
JCIS-2-78-g006.jpg
PMC3551515_01_JCIS-2-78-g006.jpg
F5
Thirty minute delayed prone images demonstrated contrast in the proximal small bowel, however proximal duodenum remained markedly dilated and contrast/debris filled [Figure 5].
Delayed abdominal radiograph following the upper gastrointestinal series after patient had been upright for greater than 30mins demonstrates further progression of contrast into the jejunum and ileum (star). Distal most extent of contrast near the cecum (arrow).
JCIS-2-78-g007.jpg
PMC3551515_01_JCIS-2-78-g007.jpg
F6
Additionally delayed overhead images demonstrated contrast extending to the distal small bowel after patient had been upright for greater than 30 minutes [Figure 6].
Computed tomography (CT) of the abdomen and pelvis shows dilated fluid filled duodenum (asterisk, a). Duodenum tented medially (black arrow, b) and downward (white arrow, c, black arrow, e). Duodenum severely narrowed as it crosses anterior to right femoral vein below the bifurcation (white arrow, d).
JCIS-2-78-g008.jpg
PMC3551515_01_JCIS-2-78-g008.jpg
F7
The duodenum was distended with the third part of the duodenum tented downward [Figure 7]. The duodenal/jejunal junction was severely narrowed and coursed distally anterior to the right common femoral artery below the bifurcation [Figure 7].