Primary mucinous adenocarcinoma of the duodenum is rare. Here we report a case we recently encountered, and we review 16 cases reported in Japan. An 82-year-old Japanese woman was admitted to our hospital complaining of abdominal pain and heartburn. An endoscopic examination revealed a Type 2 tumor in the descending limb of the duodenum, and endoscopically obtained specimens revealed a poorly differentiated adenocarcinoma. We performed a curative pancreatoduodenectomy with lymph node resection, and the surgical specimen revealed that the duodenum was the primary site of the mucinous adenocarcinoma. The patient is currently alive ＞ 1 year after the operation without any evidence of recurrence. Of the 16 patients reviewed, all patients had advanced tumors those depth were T3-T4. 9 patients had lymph node metastasis and 4 patients had peritoneal dissemination at the time of surgery. Since mucinous adenocarcinoma of the duodenum is often progressive cancer at a diagnosis, which is tend to have a worse prognosis than other histological types.
A 36-year-old Japanese man known to have incomplete Behçet's disease (oral aphthous ulcers, genital ulcers, skin lesions, and esophageal and ileocecal ulcers) was admitted to our hospital in January 2011 for abdominal pain. We administered corticosteroids and immunosuppressants. Two months later, we performed an ileocecal resection to control gastrointestinal bleeding from the ileocecal ulcers. High fever persisted after this surgery, and upper gastrointestinal endoscopy demonstrated ulcer penetration between the lower and abdominal esophagus. Eighteen days after the initial ileocecal resection, we performed a lower esophagus resection, gastric tube reconstruction and enterostomy, during which we confirmed a 5-mm-dia. perforated site at the posterior wall of the abdominal esophagus. Postoperative anastomotic leakage and empyema occurred, but they were relieved by thoracic drainage and empyema dissection.