We report the case of a 22-year-old man, asthenic, pale and thin, who repeatedly visited our health center during the last month for postprandial epigastric pain associated with vomiting.
The episodes have been present for 7 years, reason why he has consulted the emergency services on multiple occasions, without ever having found acute pathology.
He was admitted 3 years ago for one of these episodes, performing gastroscopy with gastric biopsy which was positive for H. pylori. He was treated with erradication with current triple therapy (meprazole, alien and clarithromycin).
Due to persistence of symptoms, treatment with antiemetics and multiple proton pump inhibitors was instituted, with no long-term response.
Upon admission, the patient was assessed by the Mental Health Service, since the symptoms of acute pain persisted and he was on vomiting, being diagnosed with anxiety-depressive syndrome with poor follow-up and therapeutic non-compliance.
She had no food or drug allergies.
Currently, the pain was in a genupectoral position and with cannabis consumption.
On examination we found a patient with stable constants, with a BMI of 17.7.
The abdomen is lying flat, tympanic, blanding and slightly tender for deep fixation, without palpable masses, adenopathies or enlargement.
Analytical analysis showed no alterations; absence of anemia, negative markers of inflammatory response, without liver alterations or electrolyte disturbances, total proteins 5.8 g/dl (normal value of 6.4 to 8.3 g/dL).
Abdominal X-ray showed no signs of intestinal obstruction.
In our consultation, a total abdominal ultrasound was performed in the supine position, with no evidence of relevant findings. In 8 cases, we consulted the gastroenterology service for continuous compression i.e., continuous compression i.e. slowing of the distal segment.
Because of this finding, an abdominal CT angiography was performed, resulting in a vascular clamp that produced compression of the duodenum in its third portion.
The pinch mes affected the duodenum and the left renal vein, producing pre- and post-compression compression and dilatation.
