Gastrointestinal tract can be compressed by many vascular structures in the abdomen; such compressions may be incidentally found or may result in compression symptoms like abdominal pain and vomiting.
We illustrate an uncommon cause of extrinsic compression of the third part of the duodenum by jejunal branches of the superior mesenteric artery in an 18-year-old female, presented with dull-aching epigastric pain and vomiting. Contrast Enhanced Computerized Tomography (CECT) showed atypical origin of the jejunal branches of superior mesenteric artery with relative space narrowing between it and the aorta, causing significant compression on the third part of the duodenum. Barium follow-through confirmed indentation of the duodenal lumen at the same level of the aberrant vessel. Conservative treatment failed to control her symptoms, and the patient referred to the surgery.
High index of suspicion is required for diagnosis of atypical causes of upper abdominal pain and vomiting. CECT guided by a well-descriptive comment of the treating doctor is very helpful diagnostic tool for detecting such rare condition. Barium studies still have a valuable role for determining the level of obstruction and confirming the diagnosis of such rare cases.