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Segmental resection of the duodenum for gastrointestinal stromal tumor (GIST).

Mennigen R, Wolters HH, Schulte B, Pelster FW - World J Surg Oncol (2008)

Bottom Line: The biological appearance of these tumors reaches from small lesions with benign appearance to aggressive sarcomas.A 29-year-old man presented with an acute upper gastrointestinal bleeding from a submucosal tumor located in the proximal part III of the duodenum, 3 cm distal of the papilla of Vater.Therefore no adjuvant therapy with Imatinib was initiated.

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Affiliation: Department of General and Visceral Surgery, Muenster University, Muenster, Germany. rudolf.mennigen@uni-muenster.de

ABSTRACT

Background: Gastrointestinal stromal tumors (GIST) are the most frequent mesenchymal tumors of the gastrointestinal tract. The biological appearance of these tumors reaches from small lesions with benign appearance to aggressive sarcomas. Only 3-5% of GISTs are localized in the duodenum. There is a controversy, if duodenal GISTs should be treated by a duodenopancreatectomy or by a limited resection of the duodenum.

Case presentation: A 29-year-old man presented with an acute upper gastrointestinal bleeding from a submucosal tumor located in the proximal part III of the duodenum, 3 cm distal of the papilla of Vater. After an emergency laparotomy with ligation of tumor-feeding vessels in a primary hospital, definitive surgical therapy was performed by partial resection of the duodenum with a duodenojejunostomy. Histology revealed a GIST with a diameter of 2.5 cm and <5 mitoses/50 high power fields, indicating a low risk of malignancy. Therefore no adjuvant therapy with Imatinib was initiated.

Conclusion: GISTs of the duodenum are a rare cause of upper gastrointestinal bleeding. Partial resection of the duodenum is a warranted alternative to a duodenopancreatectomy, as this procedure has a lower operative morbidity, while providing comparable oncological results.

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Operative technique. Reconstruction by a lateroterminal duodenojejunostomy at the level of the ampulla of Vater. P: pancreas, V: ampulla of Vater, T: tumor, J: jejunum.
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Figure 3: Operative technique. Reconstruction by a lateroterminal duodenojejunostomy at the level of the ampulla of Vater. P: pancreas, V: ampulla of Vater, T: tumor, J: jejunum.

Mentions: A relaparotomy was performed. The tumor was located in the proximal third portion of the duodenum, 3 cm distal of the ampulla of Vater (Figure 2). It originated from the duodenal wall and protruded as a roundly shaped mass into the near of the pancreatic head. No infiltration of the pancreas or other adjacent organs was found, there were no suspicious lymph nodes. There were no signs of duodenal ischemia related to the haemostatic vessel ligation done at the first emergency operation. The tumor was treated by a limited resection of the distal second, third and fourth part of the duodenum, the proximal resection margin was located just distal of the ampulla of Vater. The bowel continuity was reconstructed by a latero-terminal duodenojejunostomy (Figure 3) located opposite to the ampulla of Vater in order not to induce a stricture of the papilla.


Segmental resection of the duodenum for gastrointestinal stromal tumor (GIST).

Mennigen R, Wolters HH, Schulte B, Pelster FW - World J Surg Oncol (2008)

Operative technique. Reconstruction by a lateroterminal duodenojejunostomy at the level of the ampulla of Vater. P: pancreas, V: ampulla of Vater, T: tumor, J: jejunum.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2567321&req=5

Figure 3: Operative technique. Reconstruction by a lateroterminal duodenojejunostomy at the level of the ampulla of Vater. P: pancreas, V: ampulla of Vater, T: tumor, J: jejunum.
Mentions: A relaparotomy was performed. The tumor was located in the proximal third portion of the duodenum, 3 cm distal of the ampulla of Vater (Figure 2). It originated from the duodenal wall and protruded as a roundly shaped mass into the near of the pancreatic head. No infiltration of the pancreas or other adjacent organs was found, there were no suspicious lymph nodes. There were no signs of duodenal ischemia related to the haemostatic vessel ligation done at the first emergency operation. The tumor was treated by a limited resection of the distal second, third and fourth part of the duodenum, the proximal resection margin was located just distal of the ampulla of Vater. The bowel continuity was reconstructed by a latero-terminal duodenojejunostomy (Figure 3) located opposite to the ampulla of Vater in order not to induce a stricture of the papilla.

Bottom Line: The biological appearance of these tumors reaches from small lesions with benign appearance to aggressive sarcomas.A 29-year-old man presented with an acute upper gastrointestinal bleeding from a submucosal tumor located in the proximal part III of the duodenum, 3 cm distal of the papilla of Vater.Therefore no adjuvant therapy with Imatinib was initiated.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of General and Visceral Surgery, Muenster University, Muenster, Germany. rudolf.mennigen@uni-muenster.de

ABSTRACT

Background: Gastrointestinal stromal tumors (GIST) are the most frequent mesenchymal tumors of the gastrointestinal tract. The biological appearance of these tumors reaches from small lesions with benign appearance to aggressive sarcomas. Only 3-5% of GISTs are localized in the duodenum. There is a controversy, if duodenal GISTs should be treated by a duodenopancreatectomy or by a limited resection of the duodenum.

Case presentation: A 29-year-old man presented with an acute upper gastrointestinal bleeding from a submucosal tumor located in the proximal part III of the duodenum, 3 cm distal of the papilla of Vater. After an emergency laparotomy with ligation of tumor-feeding vessels in a primary hospital, definitive surgical therapy was performed by partial resection of the duodenum with a duodenojejunostomy. Histology revealed a GIST with a diameter of 2.5 cm and <5 mitoses/50 high power fields, indicating a low risk of malignancy. Therefore no adjuvant therapy with Imatinib was initiated.

Conclusion: GISTs of the duodenum are a rare cause of upper gastrointestinal bleeding. Partial resection of the duodenum is a warranted alternative to a duodenopancreatectomy, as this procedure has a lower operative morbidity, while providing comparable oncological results.

Show MeSH
Related in: MedlinePlus