Case Report
1 General Surgery Department, West Hertfordshire Hospitals NHS Trust, UK
2 General Surgery Department, Fayoum University Hospital, Cairo, Egypt
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Sherif Monib
West Hertfordshire Hospitals NHS Trust, St Albans City Hospital, 56 Waverly Road, St Albans, AL3 5PN,
UK
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Article ID: 101173Z01SM2020
Introduction: Adenocarcinoma of the fourth part of the duodenum is rare, and patients often present with a long history of non-specific symptoms, sometimes with advanced disease.
Case Report: We report the case of a 41-year-old male patient presenting with symptoms of upper gastrointestinal obstruction. Investigations included upper gastrointestinal (GI) endoscopy, barium follow-through, ultrasound, and computed tomography, which indicated gastric outlet obstruction. The precise nature of the lesion was subsequently revealed following diagnostic laparoscopy and laparotomy where an obstructing mass involving the duodenojejunal junction was identified. Segmental resection with a 2 cm safety margin, end to side anastomosis, and feeding jejunostomy was performed, and the lesion was confirmed as adenocarcinoma with free surgical margins. The patient made a good postoperative recovery with one year follow-up oesophagogastroduodenoscopy (OGD) and computed tomography (CT) scan, excluding local or nodal recurrence.
Conclusion: A high index of suspicion coupled with appropriate investigation and early surgical resection is necessary to manage the disease and improve prognosis.
Keywords: Adenocarcinoma, Angle of Treitz, Gastric outlet obstruction
Sherif Monib - Substantial contributions to conception and design, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Mohamed Elkorety - Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Edward Renaudon-Smith - Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Hany Habashy - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Final approval of the version to be published
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
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