Which of the following have been used successfully to treat patients with vascular compression of the duodenum?

B. Total parenteral nutrition.

C. Division of the ligament of Treitz and duodenal mobilization.

E. Duodenojejunostomy.

DISCUSSION: Vascular compression of the duodenum is best treated initially with supportive care. Of paramount importance is supplying adequate nutrition, since most patients have significant weight loss with this syndrome. This can best be done with a nasojejunal feeding tube placed past the ligament of Treitz (and the obstructed area). Gastrostomy alone does not provide unobstructed enteral access. Parenteral nutrition may be used successfully when enteral access cannot be established. When operative therapy is needed, duodenojejunostomy has been the most common and successful operation and is the treatment of choice for adults. In the pediatric population, division of the ligament of Treitz and duodenal 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.