International Surgery Journal | October-December 2016 | Vol 3 | Issue 4 Page 2358 International Surgery Journal Gawade H et al. Int Surg J. 2016 Nov;3(4):2358-2361 http://www.ijsurgery.com pISSN 2349-3305 | eISSN 2349-2902 Case Report Duodenal tuberculosis mimicking superior mesenteric artery syndrome Harshad Gawade*, Gurjit Singh, Iqbal Ali, Abhijit Patil, Amit Chandan INTRODUCTION Abdominal tuberculosis is the sixth most common site of extra pulmonary tuberculosis. 1 TB may affect any portion of the GI tract however, in 85% of cases ileocecal region is affected whereas gastroduodenal region is involve only 0.3-2.3% of TB cases of abdominal TB. 2 When gastroduodenal TB is seen without any other lesion of TB in body it is known as primary gastroduodenal TB, which is very rare and only few cases had been reported in the literature. 3,4 Duodenal obstruction due to TB is very rare and needs high index of suspicions for diagnosis; and usually it is suspected on intraoperative findings. 5 Strictures of duodenum are very rare and could be due to tuberculosis. Superior mesentric artery compression has been suggested as a cause of obstruction to the third part of duodenum. CASE REPORT Twenty eight years old male presented to the emergency department with complain of intermittent colickypain all over the abdomen of four months duration with aggravation after food intake. This forced him to reduce his food intake which was mainly liquid. During past 10 days he had 4-5 daily episodes of non-bilious, non- projectile vomiting. Patient had history of constipation since last2 months and loss of appetite and significant loss of weight (13kgs) during last 4 months. There was no history of fever, cough, evening rise of temperature, hematemesis or malena. Patient was diagnosed to have peptic ulcer disease, 8 years back for which he had takenconservative treatment for one month and was relieved. Patient had no history of tuberculosis (TB) in the past and no contact history of TB. Examination revealed a grossly malnourished patient with BMI of 16.6 kg/m 2 . His vital signs were within normal limits. Examination of abdomen revealed visible ABSTRACT Tuberculosis of stomach and duodenum is quite uncommon. Its preoperative diagnosis still remains a challenging problem for surgeons. Herein, we report the case of isolated abdominal tuberculosis in a 28 years old male presenting with features of gastric outlet obstruction due to stricture in duodenum. Oesophagogastroscopy revealed doubtful extrinsic compression of first part of duodenum with mild gastritis. CECT abdomen showed pronounced dilatation of stomach, 1 st and 2 nd part of duodenum with narrowing and compression of 3rd part of duodenum between superior mesentric artery and aorta; suggesting superior mesenteric artery syndrome (SMA). He was taken up for exploration which revealed peritoneal, small and large bowel mesentery and mesocolon seedlings. Mesenteric lymphadenopathy was seen and duodenum showed narrowing between 1 st and 2 nd part of duodenum with proximal dilated and distal narrow duodenum without any compression by SMA. Duodeno-duodenostomy was done. Histopathological examination of biopsied mesenteric lymph node was consistent with the features of tuberculosis. Patient was started on anti-tubercular therapy. His symptoms were relieved and he gained weight rapidly. Keywords: Gastrointestinal, Superior mesenteric artery, Tuberculosis Department of Surgery, Dr. D. Y. Patil Medical College, Pimpri, Pune, Maharashtra, India Received: 26 August 2016 Accepted: 27 September 2016 *Correspondence: Dr. Harshad Gawade, E-mail: harshgawade99@gmail.com Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. DOI: http://dx.doi.org/10.18203/2349-2902.isj20163636