Primary carcinoma of the duodenum

: The authors describe the case of a 70-year-old man with primary adenocarcinoma of the fourth segment of the duodenum. Due to the infrequency of the condition there was diagnostic and therapeutic uncertainty. After the endoscopic and bioptic diagnosis three months elapsed before an incorrectly indicated derivation operation and only after another month the tumour was resected. The exhausted patient developed postoperative pancreatitis with subsequent multiorgan failure to which he succumbed. The disease should be suspected even if the symptomatology is poor. The patient suffered only from nausea and anaemia. From the diagnostic aspect endoscopic examination is most useful for the oral segment of the duodenum and double contrast examination for the aboral one. The method of treatment is duodenopancreatectomy for the upper part and segmental resection for the distal part of the duodenum.