A Duodenal Adenocarcinoma with Unpredictable Outcome in a Patient with Compensated Cirrhosis

Introduction

Malignant tumors of the small bowel have an exceedingly rare occurrence in clinical practice, specially duodenal neoplasms, that represents only 0.3% of all gastrointestinal tract tumors. Two decades back, the most common histological type of malignant tumor of the small bowel was adenocarcinoma. Recently, the proportion of patients with carcinoid tumors increased and surpassed adenocarcinomas, now becoming the most frequent histological type of small bowel cancer. Considering the tumor type distribution according to intestinal segment, the majority of the duodenal malignant tumors are represented by adenocarcinomas, followed by carcinoids, lymphomas, and leiomyosarcomas. Duodenal tumors are easily misdiagnosed in early stages because of the lack of symptoms and limited diagnostic tools. This type of malignancy shows nonspecific symptoms until the size increases when the patients present with obstruction, abdominal mass, or melena. Malignant duodenal obstruction can be suspected when symptoms like vomiting occurring late after the meals are associated with weight loss and cachexia. Complete tumor resection is the best therapeutic option in selected cases when local extension or metastatic disease is not detected. A case of duodenal adenocarcinoma in a patient with previously undiagnosed liver cirrhosis that presented severe complications after surgical resection is described here.

Abstract

Small bowel tumors are very rare digestive malignancies, accounting for approximately 1% of all gastrointestinal tumors. A certain predilection has been described for tumor location throughout the entire small intestine taking into account the histological type. Carcinoid tumors typically affect the ileum, sarcomas and lymphomas can develop throughout the entire small bowel, while adenocarcinoma is the most common malignant tumor affecting the duodenum. Unfortunately, duodenal tumors are asymptomatic in early stages, making it difficult to diagnose them under such circumstances. They become symptomatic in advanced cases, when commonly present with intestinal obstruction. We report the case of a male patient with compensated cirrhosis and surgically resected duodenal adenocarcinoma, who developed postoperatory potentially life-threatening complications, like upper and lower gastrointestinal hemorrhage.

Keywords

duodenal adenocarcinoma, liver cirrhosis, upper gastrointestinal hemorrhage, lower gastrointestinal hemorrhage