Presentation
Persistent vomiting.
Patient Data
The stomach and proximal duodenal loops are markedly dilated down to the level of the ligament of Treitz.
The third part of the duodenum is narrow across the anterior surface of the aorta and then becomes markedly dilated to the left of the aorta.
This left sided loop of jejunum appears to have a narrow beaked appearance on its efferent side and to be rotated around the superior mesenteric vessels.
The superior mesenteric vessels are deviated towards the left.
More distally a PEJ tube is in position and loops of small & large bowel are mildly dilated but contrast, assumed to have been introduced through the PEJ tube is present around to the rectum.
No diverticula are seen.
Conclusion:
The findings suggest a closed loop obstruction with rotation of the junction of the duodenum and jejunum around the superior mesenteric pedicle at the level of the ligament of Treitz.
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