A CASE OF PRIMARY CARCINOMA OF THE DUODENAL BULB WITH PYLORIC STENOSIS

A case of primary carcinoma of the duodenal bulb with pyloric stenosis is reported with some considerations of the literature in Japan. A 65-year-old woman was admitted to the hospital because of upper abdominal distension. On admission, upper gastrointestinal series revealed pyloric stenosis because the stomach was fully expanded. Endoscopic examination of the upper gastrointestinal tract revealed an elevated lesion like a Bormann's type 1 tumor in the posterior wall of the duodenal bulb, which was adenocarcinoma histopathologically by biopsy. Abdominal CT showed a wall thickening of the duodenum, but no metastatic lesions were found. From these findings, a primary duodenal cancer was strongly suspected. Distal gastrectomy, partial duodenectomy including the tumor and lymph node dissection with Billroth II reconstruction were carried out. Gross appearance of the resected specimen showed a duodenal tumor, measuring 6.0cm in diameter, in the posterior wall of the doudenal bulb which had spread to and covered the pyloric ring. Histology demonstrated well differentiated papillotubular adenocarcinoma and mucinous adenocarcinoma of the duodenal bulb. Duodenal carcinomas are uncommon. This patientpresented with symptoms due to pyloric stenosis had a rare carcinoma of the duodenal bulb. Our experience with this case would emphasize the importance that we should entertain a possible presence of duodenal carcinoma for treating pyloric stenosis, leading to early detection and improved prognosis of the disease.