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JAMA Surgery Clinical Challenge |

Gastric Outlet Obstruction QUIZ

Vincent E. de Meijer, MD, PhD1; Casper H. J. van Eijck, MD, PhD2; Bas Groot Koerkamp, MD, PhD2
[+] Author Affiliations
1Department of Hepatobiliary Surgery and Liver Transplantation, University Medical Center Groningen, Groningen, the Netherlands
2Erasmus MC, University Medical Center Rotterdam, Department of Hepatobiliary and Pancreatic Surgery, Rotterdam, the Netherlands
JAMA Surg. 2016;151(6):577-578. doi:10.1001/jamasurg.2016.0232.
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A 72-year-old woman presented with a 6-month history of a dull, epigastric pain, 10 kg weight loss (from 52 kg to 42 kg), and nausea and vomiting. What is your diagnosis?

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Figure 1.

A, Coronal upper gastrointestinal series demonstrate subtotal occlusion in the second part of the duodenum. B, Axial computed tomography image shows intraluminal narrowing of the duodenum without signs of a mass (arrowhead).

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Figure 2.

An annular pancreas was found as cause of obstruction without signs of malignancy.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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