Palliative management of a patient with gastric outlet obstruction (GOO) due to caput pancreatic cancer during COVID-19 pandemic

Abstract

Background: Pancreatic cancer is associated with a poor prognosis and high cancer-related deaths in developed and developing countries because most of the patients are symptomatic until the advanced stage. A small percentage of pancreatic cancer could develop gastric outlet obstruction (GOO) when the tumor causes intestinal obstruction. This case report aimed to highlight the palliative management of GOO due to caput pancreatic cancer. Case presentation: A 48 years-old male was admitted to Dr Soetomo General Academic Hospital in Surabaya during coronavirus disease 2019 (COVID-19) pandemic with complaint of severe heartburn and pain for the last two months with lump around the upper right abdomen. The pain was not related to diet and only slightly relieved by pain relievers and ulcer medication. The patient also complained of nausea and vomiting after eating and drinking with significant weight loss. Unclear borders mass was palpable. The magnetic resonance imaging (MRI) of upper abdomen yielded the mass of head pancreatic that invaded the duodenum, the involvement of the superior mesenteric artery and multiple lymphadenopathies in the paraaortic. Pathology examination confirming the malignant, ductal adenocarcinoma. With other examinations, the patient was diagnosed as GOO due to T4N1M0 head pancreatic cancer. The tumor was unresectable. The patient underwent urgent double bypass biliodigestive laparotomy as part of palliative management. loop gastrojejunostomy, cholecystectomy and choledocujejunostomy Roux en Y was performed. Celiac plexus block was performed to reduce the cancer pain in the patient. Conclusion: This case highlights that the GOO case's selected management depends on the stage disease and evaluation of multidisciplinary involvement even in the COVID-19 pandemic. Therefore, collaboration between surgeons, medical oncologists, gastroentero-hepatologist, radiologists, and supportive and palliative care specialists is required to reduce mortality.