SMA (Wilkie) syndrome
Young woman with SLE. Bed-bound. Extreme vomiting despite nasogastric tube.
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Thin, bed-bound, and with a chronic systemic disorder (SLE), the patient shows a markedly fluid-filled dilatation of the stomach and proximal duodenum (despite the presence of an NG tube) with tapered narrowing of the 3rd part of duodenum as it passes between the SMA and vertebral column. Duodenum and jejunum are collapsed distal to this "nutcracker" effect.