A 46-year-old man presented with nausea, vomiting, and upper abdominal pain of 2 days’ duration. He had undergone vagotomy and pyloroplasty for peptic ulcer disease 14 years earlier. He was thin, and mild epigastric tenderness was elicited. CT disclosed a gastric bezoar, dilation of the proximal duodenum, and an obstructing bezoar in the duodenum at the level of the superior mesenteric artery (A). The duodenal bezoar was fragmented endoscopically (B). After it had passed, a second endoscopic examination disclosed prominent pulsations extrinsic to the duodenal wall at the site of the previous obstruction. Through 4 months’ follow-up, the patient had no further symptoms.
Michael A. Fuhrman, MD, David M. Felig, MD, Mark E. Tanchel, MD
Hackensack University Medical Center, Hackensack, New Jersey
Published in issue: Gastrointestinal Endoscopy, Volume 57, Issue 3, Page 387, March 2003