A Case Report on Laparoscopic Duodenal Segmentectomy for a GIST of the Horizontal Duodenal Limb

Abstract

The patient was a 73-year-old male. Endoscopic ultrasound (EUS) revealed a 22 mm extramural mass in the horizontal duodenal limb during the follow-up for a bifurcated intraductal papillary mucinous neoplasm at the Department of Gastroenterology. The patient was referred to our department for surgery after EUS-guided fine-needle aspiration. Contrast-enhanced computed tomography revealed a hyper-vascularized tumor in the horizontal duodenal limb ; therefore, laparoscopic segmental resection of the duodenum was performed. The duodenum was relocated through a retroperitoneal approach from the dorsal mesentery of the small bowel, with the intestinal tracts on the oral and anal sides of the tumor separated for specimen collection, followed by an intravitreal functional end-to-end anastomosis. The patient had a good postoperative recovery and was discharged on postoperative day seven. Histopathologically, the patient was diagnosed with a low-risk gastrointestinal stromal tumor (GIST), which was entirely resected without rupture. Duodenal GISTs are relatively rare, and due to their anatomical specificity, different surgical techniques are used depending on the location, size, and characteristics of the tumor. The laparoscopic segmental resection of horizontal duodenal limb GIST using a retroperitoneal approach, followed by reconstruction with a functional end-to-end anastomosis, is a useful option.