A Case of Intramural Hematoma of the Duodenum with T1a Pancreatic Carcinoma

Akiyoshi Tanaka, Kiichi Honma, Kiichiroh Hashimoto and Takao Tamesa

Department of Surgery, Mine Municipal Hospital

We report difficult-to-diagnose a intramural hematoma of the duodenum and T1a carcinoma of the pancreatic head. A 66-year-old man with epigastric pain and vomiting was palpated with a fist-sized mass in the upper abdomen. Blood examination revealed high levels of pancreatic enzymes and tumor markers. Gastroendoscopy revealed no passage to the duodenum. Computed tomography (CT) of the abdomen disclosed a cystic mass, 8 cm at its greatest diameter containing an irregular solid lesion at the pancreatic head. From hospitalization day 10, the mass began to grow and its center became homogeneous in CT. After 1 month, drainage volume from the gastric tube remained unchanged. We conducted pancreatoduodenectomy due to elevated tumor marker levels, the results of cytological bile examination (class III), and suspected pancreatic head carcinoma. The mass was a hematoma situated in the muscle layer of the duodenum. In addition to the hematoma, a poorly differentiated tubular adenocarcinoma 1.5 cm in diameter was found near the main pancreatic duct at the pancreatic head.

Key words
intramural hematoma of the duodenum, pancreatic cancer

Reprint requests
Akiyoshi Tanaka Department of Surgery, Mine Municipal Hospital 1313-1 Oomine, Mine-city, 755-2212 JAPAN

Accepted
February 27, 2002

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