31 year man,
with cachexia, multiple intracranial AVM, and has underwent embolisation for the same.
has superior mesentric artery syndrome with frequent vomiting. also diarrhoea frequently.
persistent bradycardia (42 - 48 / min) with hypotension (80 / 50 mm Hg)
thrombocytopenia, anemia, hypoalbuminemia.
HIV negative. Serum iron low, Viamin B12 normal. Normal liver enzymes and creatinine.
gastroscopy reveals a dilated duodenum with narrowing at D3. duodenal biopsies normal.
colonoscopy is normal and with normal ileal and colonic biopsies.
CT scan reveals dilated duodenum with edematous small bowel wall.