An Intriguing Cause of Intractable Nausea and Vomiting

DOI: 10.4103/1319-3767.114510 A 60‐year‐old lady with history of reflux disease and breast cancer status post‐lumpectomy and lymph node dissection followed by chemotherapy and now in remission, was admitted with progressively increasing nausea and vomiting of 2 months duration. She also described episodic epigastric abdominal pain, which increased on food intake and led to vomiting, which brought her instant relief. She had lost about 80 lbs of weight during her chemotherapy, which stabilized for few months but was now again falling because of her inability to eat. There was no alteration in bowel habits, fever or any other associated symptoms. She had two previous admissions for similar problems at a local hospital where symptomatic relief was achieved with dobhoff tube placement. She had been tolerating the tube feeds well, however, for last 2 days her symptoms reappeared raising concern of obstructed dobhoff and hence a gastroenterologist was consulted for endoscopic evaluation. Her blood‐work was normal. Barium swallow showed extrinsic compression of the 3rd portion of duodenum, at the level of superior mesenteric artery (SMA) crossing, causing partial obstruction as barium passes through the 3rd to 4th portion [Figure 1]. Computed tomography (CT) scan was obtained which was diagnostic [Figure 2]. Esophagogastroduodenoscopy revealed a patent 3rd part of duodenum.