Gastric outlet obstruction—with a difference

Abstract

Self-assessment corner 823 radiologically, it may be difficult to convince oneself that a trivial act like coughing could inflict such a serious injury. Radionuclide bone scanning has been found to be effective in highlighting the fracture sites as regions of abnormal accumulation of activity.9 Final diagnosis Cough-induced rib fractures.

A comprehensive review of superior mesenteric artery syndrome

“…The angle is maintained, by the left renal vein, the uncinate process of the pancreas and the retroperitoneal The SMA leaves the aorta at an acute angle that is sustained by the left renal vein and the uncinate process of the pancreas embedded in retroperitoneal fat and lymph tissue lymphatics and fat tissue (Fig. 2) [1,8]. The duodenum suspended within the vascular angle by the ligament of Treitz is vulnerable to be twinged in between the SMA anteriorly and the aorta and vertebral column posteriorly [4,6].…”

“…The condition is habitually relieved by vomiting, crouching, and postural drainage, when the mesenteric root along with the SMA falls anteriorly away from the aorta, thus relieving the obstruction as in: prone, knee chest and left lateral positions. The compression can also be relieved by applying the Hayes maneuver, where pressure is applied below the umbilicus in a cephalad and dorsal direction thereby, releasing the tension on the small bowel mesentery by elevating it [4,8,22,27].…”

“…a) Severe debilitating illnesses or chronic wasting diseases: causing prolonged best rest and asthenic built like malignancy, cerebral palsy, paraplegia, juvenile rheumatoid arthritis [1], drug abuse [6], secondary to cardiac cachexia [14], AIDS [15,16]; b) Trauma: polytrauma patients in ICU [5,10,12], extensive burn injury [1,10,12], brain and spinal cord injury [12,13,17]; c) Dietary disorders: causing severe weight loss; malabsorption syndrome [12], anorexia nervosa (psychiatric disorder) [13]; d) Postoperative states: bariatric surgery [1,7,18], esophagectomy [7], aortic aneurysm repair, and traumatic mesenteric arteriovenous fistula following abdominal aortic aneurysm repair [4,12], spinal instrumentation, scoliosis with sagittal kyphosis causing severe trunk collapse, in vertebral fractures or external compression by a body cast (hence the name 'Cast Syndrome') [7], proctocolectomy, and ileoanal pouch anastomosis [4,19], Nissen fundoplication [20]; e) Local pathology: neoplastic growth in mesenteric root, dissecting aortic aneurysm [4], traumatic aneurysm of the SMA after a stab wound [12], a flaccid abdominal wall with visceroptosis [8,12], associated with peptic ulcer disease [12], in connective tissue disorders [21], unfrequently associated with coeliac axis compression syndrome [22], compression by a huge mycotic abdominal aortic aneurysm [23]; f ) Other conditions: increased lumbar lordosis as in pregnancy [2], in hyperthyroidism [4], weight loss due to ch...…”