Duodenal Compression by the Mesenteric Root in Acute Pancreatitis and Inflammatory Conditions of the Bowel

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Abstract
Localized compression of the third part of the duodenum is shown to occur in several apparently unrelated acute conditions. These are exemplified by cases of acute pancreatitis, duodenal ulcer, inflammatory conditions of the bowel, and bowel infarction. The appearances are similar to those of "chronic intermittent arteriomesenteric duodenal occlusion", but the distinguishing radiological and clinical features are emphasized. In these cases compression of the duodenum, in its restricted space between the aorta and the mesenteric root, appears to be due to mechanisms other than a decrease in the intervening angle. Inflammatory thickening of the mesenteric root or swelling of the duodenal wall seem to be the operative mechanisms. The association of these duodenal changes with a variety of acute abdominal conditions becomes more readily understandable as a secondary phenomenon. In the acute abdominal situation, where barium studies have excluded intrinsic bowel pathology, the phenomenon is a valuable indication of acute pancreatitis. A simplified descriptive terminology is urged to avoid misleading concepts of pathogenesis.