Closed Loop Duodenal Obstruction Secondary to Pancreatic Carcinoma: A Case Report

Author(s): Zhihong Shen, Jianhua Yu, Haijun Tang, Baochun Lu*.

Journal Name: Combinatorial Chemistry & High Throughput Screening
Accelerated Technologies for Biotechnology, Bioassays, Medicinal Chemistry and Natural Products Research

Volume 22 , Issue 4 , 2019

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Abstract:

Background: Patients with pancreatic adenocarcinoma may develop into duodenal obstruction during the course of their disease. The diagnosis of obstruction can be generally achieved by means of imaging technologies.

Case and Outcome: We reported a rare case of pancreatic tumor with duodenal obstruction accompanied by obstructive symptoms, which was finally confirmed by laparotomy. A 68-year-old man was admitted to our department with a 3-day medical history of upper abdominal pain, nausea and vomiting. The diagnosis of duodenal obstruction was established by means of various imagings including computed tomography (CT) scan, gastroscopy and upper gastrointestinal imaging. Upper gastrointestinal imaging and magnetic resonance imaging (MRI) showed extrinsic tumor mass was noted at the second and third portion of the duodenum accompanied by duodenal obstruction and dilatation, respectively. Laparotomy confirmed a tumor mass arising from the head and uncinate process of pancreas, which had invaded the second and third portions of the duodenum and caused closed loop obstruction. A pancreaticoduodenectomy (Whipple procedure) was performed followed by therapeutic trade-off according to intraoperative exploration. Postoperative histopathology revealed pancreatic tumor only infiltrated duodenal wall, while resection margins of pancreas, common bile duct and duodenum were all negative. The patient was cured and discharged home 12 days after surgery.

Conclusion: The present case indicated radical operation in our study appeared to be the first choice treatment for patients with malignant duodenal obstruction.

Keywords: Duodenum, closed loop obstruction, pancreatic carcinoma, radical operation, treatment, tumor.

[1]
Kang, M.K.; Song, H-Y.; Kim, J.W.; Kim, J.H.; Park, J.H.; Na, H.K.; Lee, J.J.; Oh, S.J. Additional gastroduodenal stent placement: retrospective evaluation of 68 consecutive patients with malignant gastroduodenal obstruction. Acta Radiol., 2013, 54, 944-948.
[2]
Lee, J.M.; Han, Y.M.; Kim, C.S.; Lee, S.Y.; Lee, S.T.; Yang, D.H. Palliation of malignant gastric obstruction: Fluoroscopic-guided covered metallic stent placement. J. Korean Radiol. Soc., 2000, 42, 459-467.
[3]
Kaw, M.; Singh, S.; Gagneja, H.; Azad, P. Role of self-expandable metal stents in the palliation of malignant duodenal obstruction. Surg. Endosc., 2003, 17, 646-650.
[4]
Adler, D.G. Enteral stents for malignant gastric outlet obstruction: testing our mettle. Gastrointest. Endosc., 2007, 66, 361-363.
[5]
Siddiqui, A.; Spechler, S.J.; Huerta, S. Surgical bypass versus endoscopic stenting for malignant gastroduodenal obstruction: A decision analysis. Dig. Dis. Sci., 2007, 52, 276-281.
[6]
Shah, A.; Fehmi, A.; Savides, T.J. Increased rates of duodenal obstruction in pancreatic cancer patients receiving modern medical management. Dig. Dis. Sci., 2014, 59(9), 2294-2298.
[7]
Sweed, Y. Duodenal Obstruction. Pediatric Surgery; Springer, 2009, pp. 383-391.
[8]
Al-Salem, A.H. Congenital intrinsic duodenal obstruction: A review of 35 cases. Ann. Saudi Med., 2007, 27, 289-292.
[9]
Kim, S.Y.; Jeong, H.Y.; Song, J.K.; Songm, K.S. An unusual case of duodenal obstruction due to metastatic cervical cancer. Korean J. Helicobacter Up. Gastrointest. Res., 2012, 12, 128-131.
[10]
Espat, N.J.; Brennan, M.F.; Conlon, K.C. Patients with laparoscopically staged unresectable pancreatic adenocarcinoma do not require subsequent surgical biliary or gastric bypass. J. Am. Coll. Surg., 1999, 188, 649-657.
[11]
Warshaw, A.L.; Swanson, R.S. Pancreatic cancer in 1988. possibilities and probabilities. Ann. Surg., 1988, 208, 541.
[12]
Rothenberg, S.S. Laparoscopic duodenoduodenostomy for duodenal obstruction in infants and children. J. Pediatr. Surg., 2002, 37, 1088-1089.
[13]
Nagy, A.; Brosseuk, D.; Hemming, A.; Scudamore, C.; Mamazza, J. Laparoscopic gastroenterostomy for duodenal obstruction. Am. J. Surg., 1995, 169, 539-542.
[14]
Mehta, S.; Hindmarsh, A.; Cheong, E.; Cockburn, J.; Saada, J.; Tighe, R.; Lewis, M.P.; Rhodes, M. Prospective randomized trial of laparoscopic gastrojejunostomy versus duodenal stenting for malignant gastric outflow obstruction. Surg. Endosc., 2006, 20(2), 239-242.
[15]
Mittal, A.; Windsor, J.; Woodfield, J.; Casey, P.; Lane, M. Matched study of three methods for palliation of malignant pyloroduodenal obstruction. Br. J. Surg., 2004, 91, 205-209.
[16]
Park, K.B.; Do, Y.S.; Kang, W.K.; Choo, S.W.; Han, Y.H.; Suh, S.W.; Lee, S.J.; Park, K.S.; Choo, I.W. Malignant obstruction of gastric outlet and duodenum: Palliation with flexible covered metallic stents 1. Radiology, 2001, 219, 679-683.
[17]
Hosono, S.; Ohtani, H.; Arimoto, Y.; Kanamiya, Y. Endoscopic stenting versus surgical gastroenterostomy for palliation of malignant gastroduodenal obstruction: A meta-analysis. J. Gastroenterol., 2007, 42, 283-290.
[18]
Gaidos, J.K.; Draganov, P.V. Treatment of malignant gastric outlet obstruction with endoscopically placed self-expandable metal stents. World J. Gastroenterol., 2009, 15(35), 4365-4371.
[19]
Maire, F.; Sauvanet, A. Palliation of biliary and duodenal obstruction in patients with unresectable pancreatic cancer: Endoscopy or surgery? J. Visc. Surg., 2013, 150(3 Suppl.), S27-S31.
[20]
Huguet, F.; André, T.; Hammel, P.; Artru, P.; Balosso, J.; Selle, F.; Deniaud-Alexandre, E.; Ruszniewski, P.; Touboul, E.; Labianca, R.; de Gramont, A.; Louvet, C. Impact of chemoradiotherapy after disease control with chemotherapy in locally advanced pancreatic adenocarcinoma in GERCOR phase II and III studies. J. Clin. Oncol., 2007, 25(3), 326-331.


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Article Details

VOLUME: 22
ISSUE: 4
Year: 2019
Page: [280 - 286]
Pages: 7
DOI: 10.2174/1386207322666190411112412
Price: $58

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