DUODENAL OBSTRUCTION - DIAGNOSIS BY GASTRODUODENAL MANOMETRY

Establishing the diagnosis of adenocarcinoma of the distal duodenum is often difficult based on findings on barium radiography and routine e ndoscopy of the upper gastrointestinal tract. A characteristic manomet ric pattern of simultaneous, prolonged contractions of the small intes tine after a meal has been associated with mechanical obstruction of t he small intestine. Herein we describe a 68-year-old woman who had a 4 -month history of nausea, vomiting, and weight loss. Findings on endos copy of the upper gastrointestinal tract and a barium contrast examina tion of the stomach, duodenum, and small bowel were interpreted as nor mal. A radionuclide scan suggested mildly delayed gastric emptying. Ga stroduodenal manometry revealed high-amplitude, simultaneous contracti ons in the third and fourth portions of the duodenum but not in the je junum, findings highly suggestive of a mechanical obstruction in the d istal duodenum. At laparotomy, an obstructing adenocarcinoma of the du odenum proximal to the ligament of Treitz was resected. Subtle abnorma lities were detected retrospectively on the barium contrast study of t he small bowel. In patients with features suggestive of intestinal obs truction, gastroduodenal manometry may be helpful in distinguishing me chanical causes from pseudo-obstruction.