HighlightsSuperior mesenteric artery syndrome is rare cause of duodenal obstruction.Superior mesenteric artery syndrome is caused by narrowing of aortomesenteric angle.High index of suspicion is needed for diagnosis.Most common cause is significant weight loss.Simple Contrast enhanced CT scan can help in reaching diagnosis.

Patients with periampullary tumours and well-compensated chronic liver disease should be routinely considered for PD at high volume centres with available expertise to manage liver cirrhosis. PD is associated with an increased risk of postoperative morbidity in patients with liver cirrhosis; therefore, it is only recommended in patients with Child A cirrhosis without portal hypertension.

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