A case of primary carcinoma of the duodenal bulb with gardner's syndrome, diagnosed 23 years after total gastrectomy with roux-en-y reconstruction

Abstract

We report a rare case of primary carcinoma of the duodenal bulb, diagnosed 23 years after total gastrectomy with Roux-en-Y reconstruction. A 57-year-old woman with Gardner's syndrome had undergone a total colectomy 26 years previously, followed by a total gastrectomy for a huge desmoid tumor 23 years previously. She was referred to our hospital because of an abdominal tumor. On physical examination, a hard elastic mass was palpable in the epigastric region of the abdomen. Computed tomography revealed a mass near the duodenal bulb, with invasion to the abdominal wall, liver, common bile duct, and pancreas. A percutaneous needle biopsy of the tumor showed adenocarcinoma. Surgery was performed under a diagnosis of primary carcinoma of the duodenum bulb. On intraoperative examination, the primary carcinoma was found to invade the abdominal wall, liver, common bile duct, and pancreas. The tumor and its invasive lesions were resected. Eight months after the operation, the patient received anticancer drugs because of liver metastasis. © 2013 The Japanese Society of Gastroenterological Surgery.