Fig. 11

In a 68-year-old woman suffering from recurrent abdominal pain, nausea and 10-kg weight loss, abdominal radiographs (a) showed gastric overdistension by intraluminal stagnant fluid (+) despite fasting. Contrast-enhanced multidetector CT (b…d) confirmed overdistended stomach with normal mural thickness. The contracted pylorus and proximal duodenum showed circumferential hypoenhancing mural thickening (*) with mucosal hyperenhancement (thin arrows) focally interrupted at the site of an ulcer crater (arrows). Endoscopy confirmed moderate stricture of the proximal duodenum and post-pyloric ulcer (image in inset d) with fibrinous base, hyperaemic periphery, slightly irregular mucosal surface; biopsy excluded neoplastic changes. After PPI and anti-HP therapy, the patient ultimately required surgical treatment with duodenotomy, antrectomy and Roux-en-Y gastrojejunostomy [Adapted from Open Access ref. no [18]]