A Resected Case of Primary Adenocarcinoma of the Fourth Portion of the Duodenum

Hiroyuki Kinoshita, Katsutoshi Taniguchi, Takeshi Tsuji, Minoru Ochiai, Hironobu Onishi, Masaki Sahara and Hiroshi Tanimura

Department of Surgery, Wakayama Rosai Hospital

A 75-year-old man admitted for nausea and weight loss was found in upper gastrointestinal series and endoscopy to have a type-2 tumor with stenosis at the fourth portion of the duodenum, diagnosed as moderately differentiated adenocarcinoma by endoscopic biopsy. Abdominal computed tomography (CT) showed an extremely irregular thick wall at the fourth portion of the duodenum but without invasion to adjacent vessels. We examined lymph nodes around the pancreas head by intraoperatively and partially resected the duodenum and jejunum based on a diagnosis of negative swollen nodes and no macroscopic invasion toward the pancreas or proximal duodenal margin. The definitive diagnosis was primary adenocarcinoma of the fourth portion of the duodenum, T3, N0, M0, Stage II. We detail an extremely rare case of primary adenocarcinoma of the fourth portion of the duodenum and discuss surgical implications.

Key words
primary adenocarcinoma of the fourth portion of the duodenum, partial resection, lymph nodes dissection

Reprint requests
Hiroyuki Kinoshita Department of Surgery, Wakayama Rosai Hospital
435 Koya, Wakayama, 640-8505 JAPAN

Accepted
February 22, 2006

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