41. Which of the following have been used successfully to treat patients with vascular compression of the duodenum?A. Subtotal gastrectomy and Roux-en-Y gastrojejunostomy.B. Total parenteral nutrition.C. Division of the ligament of Treitz and duodenal mobilization.D. Percutaneous endoscopic gastrostomy.E. Duodenojejunostomy.Answer: BCEDISCUSSION: Vascular compression of the duodenum is best treated initially with supportive care. Of paramountimportance is supplying adequate nutrition, since most patients have significant weight loss with this syndrome. This canbest be done with a nasojejunal feeding tube placed past the ligament of Treitz (and the obstructed area). Gastrostomyalone does not provide unobstructed enteral access. Parenteral nutrition may be used successfully when enteral accesscannot be established. When operative therapy is needed, duodenojejunostomy has been the most common and successfuloperation and is the treatment of choice for adults. In the pediatric population, division of the ligament of Treitz andduodenal mobilization has also proved successful. Gastrojejunostomy has been used, but with a lower overall success rate.Distal gastrectomy usually worsens duodenal obstruction by preventing duodenogastric reflux.
42. Which of the following statements about the anatomic basis for the syndrome of vascular compression of theduodenum are true?
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43. Numerous epidemiologic associations have been made between (1) environmental and dietary factors and (2) theincidence of gastric cancer, including all except:
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DISCUSSION: Numerous epidemiologic studies support the role of certain foods in the development of gastric cancer. Salt,
