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Duodenal ischaemia associated with atheromatous occlusion of the coeliac axis and superior mesenteric artery.

Chronic changes of ischaemia affecting the colon and small intestine have long been recognised radiologically (Lea Thomas, 1972; Windsor, 1972; Joffe et al, 1977; Bartram & Laufer, 1979). Because of its blood supply from separate arterial sources in the coeliac axis and superior mesenteric artery, the duodenum is well protected from ischaemic damage if one or other of these vessels is occluded, via the pancreatico-duodenal arcades. There have to date been no reports in the literature of radiological changes in barium studies of the duodenum resulting from athero-sclerotic arterial disease. A 47-year-old man presented in 1977 with abdominal pain which was described as typical of gall-bladder attacks. Oral cholecystography, however, was normal. Because of some weight loss, anorexia and a history of three previous cerebrovascular accidents, at a comparatively early age, from which he had made a good recovery, the question of mesenteric vascular insufficiency was raised.