An Unusual Case of Duodenal Obstruction due to Metastatic Cervical Cancer

Metastatic Cervical Cancer to the Duodenum: A Learning Point

An elderly woman was admitted to the hospital with generalised abdominal pain and bowel obstruction symptoms in a background of renal cell carcinoma and cervical cancer. Investigations showed a degree of gastric outlet obstruction with mild distension of the small bowel loops with no lead point seen and a raised alkaline phosphatase (ALP). Oesophago-gastroduodenoscopy (OGD) showed a stricture at D1/D2; therefore, an enteric stent was inserted. Biopsies showed metastatic cervical cancer. A few cases of metastatic cervical cancer to the duodenum have been reported. Obstructive bowel symptoms in the background of cervical cancer should raise the possibility of metastases in future practice.

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

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.