2015 Volume 40 Issue 6 Pages 1101-1106
The patient, a 60-year-old woman who was diagnosed as having a duodenal adenoma during a routine medical examination, was referred to our hospital in 2005. Esophagogastroduodenoscopy revealed a whitish elevated lesion measuring 35mm in the superior wall of duodenal bulb.
Biopsy showed low grade adenoma and hence the lesion was monitored. On endoscopic examination, the appearance and size did not change. In 2014, the tumor was identified carcinoma in situ by endoscopic biopsy and diagnosed as a cancer. We considered three therapeutic options for this tumor：partial resection of the duodenum, endoscopic submucosal dissection, or pancreatoduodenectomy. We performed partial resection of duodenum via laparotomy using intraoperative endoscopy. During the operation, the tumor was marked from the duodenal lumen by the endoscopist and confirmed by the surgeon from outside the duct. We safely resected the involved segment of the duodenum and sutured the ends. Histopathology revealed high grade adenoma including carcinoma in situ and the resected margins were free of tumor. We report that intraoperative endoscopy provides radical, safe, and minimally invasive therapy for partial resection of the duodenum.
