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Initial supine abdominal radiograph demonstrate paucity of bowel gas. An inconspicuous, distended, fluid filled, loop of duodenum can be inferred by the valvulae conniventes. A left lateral decubitus radiograph demonstrate air fluid level within the D2 segment of the duodenum.
Water soluble contrast was used for the examination. The patient was positioned in the right lateral position with 30 degrees caudal tilt of the examination table to assist contrast passage into the duodenum. The patient was unable to assume an erect position due to bilateral lower limb ulcers. Initial fluoroscopic image take at 30 mins shows minimal contrast passage into the D1 segment of the duodenum (not shown)
Subsequent supine abdominal radiograph performed 1 hour after contrast ingestion demonstrate abrupt termination of the D3 segment of the duodenum as it cross midline at the level of L3/L4. This is associated with dilatation of the proximal portion of the D3 segment. There is paucity of oral contrast in the proximal jejunum with significant quantity of contrast retained in the stomach.
Supine abdominal radiograph performed 2.5 hours after shows contrast opacification of the remaining small bowel and the ascending colon.