PMC3355678_01
Upper gastrointestinal series showing a reduction in gastric distension.
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F1
Upper gastro-intestinal series showed a marked stricture in the lower oesophagus associated with copious gastro-oesophageal reflux in the horizontal posture, reduction of gastric distension, and reduced gastro-duodenal peristalsis (fig. 1).
3D CT scan showing the narrow angle between the aorta and the SMA.
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F2
A CT scan showed a 3-cm-long stricture in the lower oesophagus with pre-stricture dilatation and liquid stagnation, oesophageal wall thickening associated with hyperdensity and hypervascularity of peri-oesophageal fat, dilatation of the stomach and duodenum (until the third portion) with sharp calibre reduction of the fourth duodenal portion, around the aorto-mesenteric tract (fig. 2, fig. 3).
Oesophagography showing the oesophageal canalization.
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F4
The Scope (TTS) (Boston ) balloon, allowing for an oesophageal canalization with a residual channel 6 mm large. The subsequent oesophagography with contrast showed the maintenance of the oesophageal canalization (fig. 4) as seen in the radiographic series performed during endoscopic dilatation (fig. 5). Thus it was confirmed that the stricture arose from the chronic acid reflux due to gastric hypomotility and was sustained by the duodenal stenosis due to the SMA syndrome.
Oesophageal lumen before the dilatation.
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F6
This showed duodenal compression in the presumed site of the SMA (fig. 6, fig. 7, fig. 8).
Endoscopic image of the narrow duodenal lumen due to the 'trapping phenomenon'.
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F8
This showed duodenal compression in the presumed site of the SMA (fig. 6, fig. 7, fig. 8).