A 65-Year-Old Man Is Evaluated in the Clinic Due to Several

A 65-year-old man is evaluated in the clinic due to several months of abdominal pain and vomiting.  The pain starts 2 to 3 hours after meals, is characterized as crampy, and is often associated with bilious vomiting.  Lately, the patient has been tolerating only liquids and has consequently lost 12 lbs in the past 4 months.  On physical examination, he has mild epigastric tenderness on deep palpation.  Contrast-enhanced CT scan of the abdomen shows an irregular mass in the third portion of the duodenum that is infiltrating beyond the gut wall.  If this mass continues to enlarge, which of the following structures is most likely to be compromised in this patient?

A) Common bile duct
B) Gastroduodenal artery
C) Portal vein
D) Superior mesenteric artery
E) Ureter

Correct Answer:

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