The duodenum caught in a vise: a case report of high obstruction due to vascular compression

Obstruction of the duodenum by an abdominal aortic aneurysm (AAA) has been rarely reported. It presents with symptoms of upper gastrointestinal tract obstruction. We report the case of an 81-year-old male with a history of infrarenal AAA previously treated by endovascular aneurysm repair (EVAR). Computed tomography imaging revealed compression of the third portion of the duodenum by an aneurysmal sac measuring 9 cm, leading to luminal obstruction. A nasogastric tube was placed, allowing for decompression and resolution of the obstructive episode. Aortoduodenal syndrome is a rare cause of intestinal obstruction, with fewer than 40 cases reported. Surgical intervention is indicated in all patients except those who are too debilitated to withstand any intervention. Before the advent of aortic surgery, therapy consisted primarily of palliative gastric bypass. Resection of the aneurysm and graft replacement is the procedure of choice.