Difficulties in diagnosing chronic duodenal obstruction due to mechanical obstruction at the level of the ligament of Treitz

Objective: To identify diagnostic difficulties and determine optimal surgical tactics for rare forms of distal duodenal obstruction of tumor origin. Materials and Methods: The authors describe a clinical case. Patient A., 53, with chronic duodenal obstruction, was observed. Results: Based on radiographic data from a gastric and duodenal contrast study, a diagnosis of "decompensated arterio-mesenteric duodenal compression syndrome" was made, but the exact cause of the distal duodenal obstruction at the level of the ligament of Treitz was not determined. Only during surgery was the true cause of the disease discovered - a small jejunal tumor in the area of the ligament of Treitz, measuring 3.0 x 2.5 cm. Following an intraoperative rapid biopsy, which revealed adenocarcinoma, a radical tumor resection with lymph node dissection and side-to-side duodenojejunostomy was performed. The postoperative period was uneventful, and the patient was discharged home in satisfactory condition. He is currently under the care of an oncologist and undergoing adjuvant chemotherapy. Conclusion: Intraoperative finding: the true cause of the distal duodenal obstruction was identified as a small jejunal tumor located in the area of the ligament of Treitz.