Abstract
A 59-year-old man presented to our hospital with chief complaints of epigastric distress and loss of appetite. Abdominal computed tomography revealed an enhanced tumor in the fourth part of the duodenum, with dilatation of the stomach and the oral side of the duodenum. Upper gastrointestinal endoscopy led to the diagnosis of carcinoma originating in the fourth part of the duodenum, for which laparotomy was performed. Intraoperative findings revealed a single peritoneal dissemination in the transverse mesocolon. Hence, we performed duodenojejunal segmental resection along with dissection of the lymph nodes around the superior mesenteric artery and segmental resection of the transverse colon including the peritoneal dissemination. Histopathological findings revealed well-differentiated adenocarcinoma, pSS, ly0, v0, and no lymph node metastasis. The patient showed good postoperative progress, and was discharged on day 15 of hospitalization. Following discharge, the patient received S-1 + CDDP therapy. He is currently doing well without recurrence 17 months after the surgery. Reports of cases with carcinoma originating in the fourth part of the duodenum are extremely rare, and there is no established curative surgical procedure or lymph node dissection range. In conclusion, we treated a case with primary duodenal carcinoma originating in the fourth part of the duodenum. In this report, we discuss the appropriate management for duodenal adenocarcinoma of the fourth portion.
