PMC6710772_01
The upper gastrointestinal series demonstrates a high-grade obstruction of the third part of the duodenum across from the IVC filter.
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fig1
On POD#16/18 and with an IVC filter dwell time of 16 days, an upper GI study demonstrated an almost complete cut-off of the contrast flow beyond the second to third part of the duodenum (Figure 1).
This figure demonstrates the IVC filter posteriorly and the SMA and SMV anteriorly with the third part of the duodenum sandwiched in between.
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fig2
Computerized tomographic scan cross-sectional imaging shows a pinching mechanism between the right-sided IVC filter and the left-sided SMA with the third portion of the duodenum compressed between the two structures (Figures 2 and 3).
This figure demonstrates the relationship between the IVC filter and the subsequent dilatation of the more proximal second part of the duodenum as a result of the obstruction. Note a small glimpse of the nasogastric tube in the stomach for decompression and the absence of a duodenal hematoma.
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fig3
Computerized tomographic scan cross-sectional imaging shows a pinching mechanism between the right-sided IVC filter and the left-sided SMA with the third portion of the duodenum compressed between the two structures (Figures 2 and 3).
This is the CT scan obtained on the day of admission following the motor vehicle crash. Note the absence of any radiographic suggestion of duodenal obstruction by the SMA. Also note the relatively small size of the IVC as a reflection of volume depletion on presentation and the free blood in the right gutter.
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fig4
A review of the abdominal-pelvic CT scan on the day of admission (Figure 4) failed to show any preexisting evidence for SMA syndrome, and it was ascertained that there was no history of oral intake intolerance prior to the injury.
(a) This is the view on the upper endoscopy of the distal second part of the duodenum with partial obstruction. (b) This is the same upper endoscopy performed as in (a) at the level of the third part of the duodenum with edema and obstruction to the point where the endoscope could not be advanced beyond the obstruction.
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fig5
An upper endoscopy was performed five days after the IVC filter had been removed, yet the duodenal edema and obstruction persisted (Figures 5(a) and 5(b)) requiring NG tube decompression for another four days.
The IVC filter has been removed and the upper gastrointestinal series some 10 days later demonstrates complete resolution of the duodenal obstruction.
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fig6
At that point, an upper GI series was repeated (Figure 6) and that demonstrated complete resolution of the previously documented duodenal obstruction.