2026 Volume 46 Issue 1 Pages 9-12
Gastrointestinal anastomotic ulcer is one of the late morbidities following pancreaticoduodenectomy (PD). Small intestinal metastasis from pancreatic cancer is rare, and there are no previously published reports of metastasis to the jejunum close to the site of the gastrojejunostomy after PD in patients with pancreatic cancer. We report a rare case of small bowel perforation caused by jejunal metastasis near the site of the gastrojejunostomy anastomosis in a patient who was receiving chemotherapy for recurrent pancreatic cancer after PD. A 60-year-old man presented to us with abdominal pain of acute onset while receiving chemotherapy for recurrent pancreatic cancer after PD. Abdominal CT revealed intraperitoneal free air, and we performed emergency surgery. Intraoperative exploration revealed a perforation measuring 10 mm in diameter on the anal side of the gastrojejunostomy, and we performed resection of the gastrojejunostomy together with the perforation site, followed by Roux-en-Y reconstruction. Postoperative histopathological findings revealed tumor cell proliferation at the site of perforation. The histopathological features of the tumor cells were consistent with those of the previously diagnosed pancreatic cancer, based on which we made the diagnosis of jejunal perforation secondary to metastasis from pancreatic cancer. In patients with malignant tumors undergoing chemotherapy who present with gastrointestinal perforation, an awareness of the possible involvement of the malignant tumor might help in selecting the appropriate surgical strategy intraoperatively.
