Abstract
A 68-year-old man was admitted to our hospital complaining of upper abdominal discomfort and body weight loss. Laboratory investigation revealed moderate elevation in the blood sedimentation rate and positive occult blood stool. X-ray examination of the stomach revealed a round well-difined filling defect with irregular surface on the posterior wall of the duodenal bulb. Endoscopic examination showed the tumor covered with the white coat in the bulb. Histological diagnosis of biopsy specimen was well differentiated adenocacinoma. Pancreaticoduodenectomy was performed. At surgical operation, a Borrmann II type cancer measuring 50×45 mm was seen on the posterior wall of the duodenum. There was the normal mucosa from the tumor to the pyloric ring and the tumor was distal to the ampulla of Vater by about 50 mm. At operation, one direct invasion in the liver, two hematogenous metastatic lesions and two regional lymphnode metastasis were found. Patient died of liver abscess after 3 months of the operation.
