Duodenal Cancer
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Primary adenocarcinoma of the small intestine occurs in over 50% of cases in the duodenum. However, its location in the third and fourth duodenal portions occurs rarely and is a diagnostic challenge. The aim of this work is to report an... more
Primary adenocarcinoma of the small intestine occurs in over 50% of cases in the duodenum. However, its location in the third and fourth duodenal portions occurs rarely and is a diagnostic challenge. The aim of this work is to report an adenocarcinoma of the third and fourth duodenal portions, emphasizing its diagnostic difficulty and the value of video capsule endoscopy. A man, 40 years old, with no medical history, with abdominal discomfort and progressive fatigue, presented four months ago with one episode of moderate melena. The physical examination was normal, except for mucosal pallor. Blood tests were consistent with microcytic, hypochromic iron deficiency anemia with 7.8 g/dL hemoglobin. The upper and lower endoscopy were normal. Additional work-up with video capsule endoscopy showed a polypoid lesion involving the third and fourth portions of the duodenum. Biopsy showed a moderately differentiated adenocarcinoma. Abdominal computed tomography showed a wall thickening from the third duodenal portion to the proximal jejunum, without distant metastasis. The patient underwent segmental resection (distal duodenum and proximal jejunum) with duodenojejunostomy. The surgical specimen histology confirmed the biopsy diagnosis, with transmural infiltration, without nodal involvement. Conclusion: Adenocarcinoma of the third and fourth portions of the duodenum is difficult to diagnose and capsule endoscopy is of great value.
PRIMARY DUODENAL ADENOCARCINOMA The primary carcinoma of the duodenum constltutes 0.3 to 0.5% of ali the digestive neoplasms and 33 to 45% of those of the small intestine. The authors descrlbe the case of a 68-year old man who had... more
PRIMARY DUODENAL ADENOCARCINOMA
The primary carcinoma of the duodenum constltutes 0.3 to 0.5% of ali the digestive neoplasms and 33 to 45% of those of the small intestine. The authors descrlbe the case of a 68-year old man who had presented itching for three
month and fever and vomlting for one month. At hospitalizatlon, he had neither jaundice nor a palpable mass.
Bilirubinemia levels were normal, the alkaline phosphatase was increased and the transaminase and GT levels were slightly altered. Ecography showed dllation of ali the billary tract without gallstones. The CT scan was negative.
At hypotonic duodenography, the contrast medium did not completely fili the second portlon of the duodenum near the papllla extendlng to the lower knee. After opening the duodenum, a vegetatlng mas In the second portion of the duodenum was found. The Intraoperative cholanglography
showed a marked dllatlon of the billary ducts. The patient was therefore submitted to a duodenocephalopancreatectomy.
The histological examination showed a dlfferentiated adenocarcinoma from an originai viilous adenoma. The patlent dled on the 41st day of an atrlal flutter and serlous thrombocytopenla, reslstant to Intensive and transfuslonal therapy. The atyplcal characteristlcs of the symptoms of thls case are stressed. The dlagnostics is based on the ecography, hypotonic duodenography and endoscopy.
The treatment calls for the duodenocephalopancreatectomy wlth radical intents or a palliatlve gastrojejunal bypass.
The primary carcinoma of the duodenum constltutes 0.3 to 0.5% of ali the digestive neoplasms and 33 to 45% of those of the small intestine. The authors descrlbe the case of a 68-year old man who had presented itching for three
month and fever and vomlting for one month. At hospitalizatlon, he had neither jaundice nor a palpable mass.
Bilirubinemia levels were normal, the alkaline phosphatase was increased and the transaminase and GT levels were slightly altered. Ecography showed dllation of ali the billary tract without gallstones. The CT scan was negative.
At hypotonic duodenography, the contrast medium did not completely fili the second portlon of the duodenum near the papllla extendlng to the lower knee. After opening the duodenum, a vegetatlng mas In the second portion of the duodenum was found. The Intraoperative cholanglography
showed a marked dllatlon of the billary ducts. The patient was therefore submitted to a duodenocephalopancreatectomy.
The histological examination showed a dlfferentiated adenocarcinoma from an originai viilous adenoma. The patlent dled on the 41st day of an atrlal flutter and serlous thrombocytopenla, reslstant to Intensive and transfuslonal therapy. The atyplcal characteristlcs of the symptoms of thls case are stressed. The dlagnostics is based on the ecography, hypotonic duodenography and endoscopy.
The treatment calls for the duodenocephalopancreatectomy wlth radical intents or a palliatlve gastrojejunal bypass.