A 46-year-old woman was presented in the ED with abdominal pain, persistent nausea, and vomiting of undigested food that had begun 3 months earlier. This woman has a 7-year history of systemic sclerosis and used methotrexate for its treatment. Examination Her skin was dry and had lost normal elasticity. Dry eyes, and had decreased oral aperture. Physical examination of the abdomen was normal. Upper GI endoscopy showed no evidence of mechanical obstruction or esophageal damage A barium swallow endoscopy showed duodenal distention of 8 cm in diameter (refer attached figure).
However, no mechanical obstruction was observed. Assessment of the other conditions like amyloidosis, Chagas’ disease, and Whipple’s disease, was ruled out. What could be the possible etiology for the distention of the duodenum? *This case is from Docplexus editorial team for educative purpose only. Source: NEJM
