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Thickened muscularis in an asymptomatic DSH

Thickened muscularis in an asymptomatic DSH

Approximately 4 year old DSH presented one year ago for vomiting. Abdominal US performed at that time showed moderately increased muscularis and overall increased wall thickness:  duodenum=3.4mm thick, jejunum=4.9mm thick and ileum=3.2mm thick.  The gallbladder showed a slightly thickened wall and reactive fat was seen adjacent to the intestines.  Full thickness biopsies were recommended but…