Vascular Compression of the Duodenum, Operative and Non-Operative Treatment

stress. On examination she was emaciated with a large tender tympanitic swelling which occupied the left side of the abdomen. Plain abdominal radiograms showed a dilated stomach and duodenum with the characteristic 'double bubble' of distal duodenal obstruction; nasogastric aspiration obtained 2600 ml of bile-stained fluid. A barium meal defined a linear vertical obstruction to the third part of the duodenum (Figure 1). At laparotomy the stomach and duodenum were found to be dilated proximal to the superior mesenteric artery, which compressed the underlying duodenum against the spine. Gastrojejunostomy was performed, and the patient made an uneventful postoperative recovery. She gained weight rapidly but has subsequently suffered intermittent gastritis related to bile reflux. Case 2 A 13-year-old boy was admitted for neurosurgical assessment. Two weeks previously he had developed back pain, lower limb parasthesia and weakness. He was initially thought to have viral meningitis Figure 1