A Case of Primary Adenocarcinoma in the Third Portion of the Duodenum Treated by Pancreas-sparing Partial Duodenectomy

Abstract

A 59-year-old man had tarry stools since 2007. Because upper and lower gastrointestinal endoscopy revealed no remarkable findings, the patient was followed. In June 2009, a type 2 tumor occupying almost the entire circumference of the third and fourth portions of the duodenum was detected on upper gastrointestinal endoscopy. Examination of a biopsy specimen revealed adenocarcinoma. Hypotonic duodenography demonstrated stenotic change in the third and fourth portions of the duodenum, and abdominal CT revealed an enhanced tumor without any metastasis or signs of local infiltration. The patient had a pancreas-sparing duodenectomy combined with lymph node dissection around the superior mesenteric artery. Reconstruction was achieved by side to side anastomosis, and an ileus tube was inserted beyond the anastomosis as an internal stent. On pathology, papillary adenocarcinoma was found at a site in the subserosa. There was no invasion of lymph and venous vessels. The postoperative course was uneventful. The patient is currently doing well without recurrence about four years after surgery. We describe this rare case of primary adenocarcinoma in the third portion of the duodenum with details of the surgical technique. The relevant literature is also disussed.