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Abstract

Case Presentation: A 27-year-old woman came to the emergency department because of abdominal pain, food intolerance, and vomiting for 3 days. She had a history of obesity and had initially been examined in our endocrine clinic 2 years previously. At that time, her weight was 103 kg, and her height was 1.68 m (body mass index [BMI] 36 kg/m2). She was prescribed a 1,500-kcal diet but was lost to follow-up. During the next few months, her weight increased to 115 kg (BMI 41 kg/m2), at which point she decided to begin a diet on her own. Her weight declined steadily and was 45 kg (BMI 16 kg/m2) when she was seen in the emergency department. Physical examination revealed a distended and painful abdomen with no peristaltic sounds. A plain film of the abdomen (Fig. 1) showed dilatation of proximal small bowel loops and absence of gas in the distal small bowel. A computed tomographic scan of the abdomen (Fig. 2) disclosed a substantial distention of the stomach (asterisk) as well as the first and second parts of the duodenum (asterisk), in conjunction with collapse of the third part of the duodenum at the level of the aortomesenteric crossing (arrowhead). (The aorta and superior mesenteric artery are denoted by arrows.) What is the diagnosis?