Extrinsic Pressure Defects on the Duodenal Loop in Mesenteric Occlusive Disease

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Abstract
Deformities of the duodenal loop caused by severe occlusive disease of the mesenteric circulation have been found by upper gastrointestinal barium study. These are characterized by straightening of the medial aspect of the descending duodenum, smooth filling defects producing double contour shadows in this region, and expansion of the duodenal loop. The deformities seem due to marked enlargement of the superior and inferior pancreaticoduodenal arteries as they become the major collateral pathway after occlusion of the celiac axis, superior mesenteric artery, or both. Their finding may be helpful in the early diagnosis of mesenteric vascular occlusive disease, leading to treatment before gangrene of portions of the gastrointestinal tract occurs. The features described must be differentiated from enlargement of the duodenal loop observed in carcinoma of the head of the pancreas, often one of the major differential diagnoses considered in such patients.

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