Abstract
We report a case of a 66-year-old man who was given a diagnosis of pancreatic head cancer with involvement of the superior mesenteric vein and nerve plexus around the superior mesenteric artery. We started combined chemotherapy of S-1 (tegafur, gimeracil, oteracil potassium) and gemcitabine as neoadjuvant chemotherapy. The patient was seen at the hospital because of severe anemia after one course, and upper gastrointestinal endoscopy showed duodenal bleeding. Chemotherapy was stopped, and curative resection was performed. Histopathological examination revealed the penetration of the necrotic tumor at the bleeding site, possibly resulting from chemotherapy. To the best of our knowledge, this is the first report of a resected case of pancreatic cancer with perforation or penetration to the gastrointestinal tract during neoadjuvant chemotherapy or chemoradiotherapy. An oncologic emergency should be taken into consideration when neoadjuvant treatment is applied to the patient with pancreatic cancer.
