Duodenal Adenocarcinoma – A Rare Encounter and Management in a Young Male

Abstract

Duodenal Adenocarcinoma (DA) is a rarely encountered tumor. It usually resides in the elderly, diagnosed at an average age of 60 years. The malignancy has a poor outcome with 5-year survival at 30%. DA along with peritoneal dissemination in a subset of the younger population has not been well reported in the literature review so we intend to report this case. We report a case of a patient with Duodenal Adenocarcinoma (DA). The carcinoma was diagnosed in the third segment of the duodenum with associated peritoneal carcinomatosis. The patient presented with abdominal pain, nausea, weight loss, and other symptoms with a history of cholecystectomy for his prior abdominal complaints. A large obstructive ulcerated mass in the third segment of the duodenum (D3) confirmed the presence of a DA. A palliative gastrojejunostomy was performed with a subsequent Whipple procedure ahead concomitantly with hyperthermic intraperitoneal chemotherapy (HIPEC). After surgery, the patient presented with post-operative complications including pelvic and abdominal ascites with perforation of the sigmoid colon. On subsequent follow-ups, he did well but with a recurrence in the form of lung nodules a year after the Whipple’s procedure. DA is one of the rarest malignancies ever encountered and is significantly scarce in the younger subset. The key to a successful outcome involves an aggressive approach with an early diagnosis. Lymph node assessment has been pivotal as an important prognostic factor. No positive correlation has been established between adjuvant chemotherapy and survival rates. Peritoneal dissemination from DA appears to be sparse. HIPEC, although a reasonable therapeutic strategy for disseminated peritoneal carcinomatosis, resulted in sigmoid perforation.