Abstract
A 52-year-old woman was referred to our hospital with complaints of nausea and bulging abdomen. Gastrointestinal fiberscopy revealed the villous tumor on the first to second portion of the duodenum and the histological examination resulted in group Ⅳ. The distance from the distal tumor margin to papilla of Vater was approximately 4 cm and from endoscopic ultrasonography we determined that the depth of the tumor was mucosa. From these observations, we diagnosed this patient as an early duodenal carcinoma of the duodenal bulb then decided to perform a surgical resection of the duodenum considering that complete endoscopic resection would be difficult. In other words, the carcinoma was still at the early stage and reductive surgery became more of an option rather than to take pancreaticoduodenectomy approach; distal gastrectomy and partial duodenectomy was performed. In order to take functionally conservative approach towards papilla of Vater, we inserted C-tube into the cystic duct and the dye was injected. After closing the duodenal stump, we confirmed the constant flow through the papilla of Vater during an intraoperative cholangiogram. Additionally, to avoid the duodenal stump leakage, we fixed the C-tube in the common bile duct and covered the duodenal stump with the omentum. The histological finding showed well differentiated tubular adenocarcinoma in adenoma and the stage in UICC category was T1N0M0, Stage Ⅰ. Three years and six months has past after the surgery however the patient is still alive with no recurrence.
