A novel surgical strategy for the resection of duodenal gastrointestinal stromal tumours located close to the duodenal ampulla: a case report

• Published in: Annals of the Royal College of Surgeons of England Vol. 102; no. 2; pp. e29 - e32
• Main Authors: Kono, S, Kumamoto, T, Kurahashi, Y, Niwa, H, Ishida, Y, Shinohara, H
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01-02-2020; Royal College of Surgeons
• Subjects: Aged; Ampulla of Vater; Antigens; Biopsy; Duodenal Neoplasms - diagnostic imaging; Duodenal Neoplasms - pathology; Duodenal Neoplasms - surgery; Endoscopy; Endoscopy, Digestive System; Gastrectomy - methods; Gastrointestinal Stromal Tumors - diagnostic imaging; Gastrointestinal Stromal Tumors - pathology; Gastrointestinal Stromal Tumors - surgery; Hospitals; Humans; Lymphatic system; Male; Online Case Report; Quality of life; Tomography, X-Ray Computed; Tumors; Ultrasonic imaging; Japan; Pancreaticoduodenectomy; Duodenum; Surgery; Gastrointestinal stromal tumour
• ISSN: 0035-8843; 1478-7083
• DOI: 10.1308/rcsann.2019.0112

Although the optimal surgical procedure for the resection of duodenal gastrointestinal stromal tumours has not yet been characterised due to the low prevalence of these tumours and the anatomical complexity of the duodenopancreatic region, difficult surgical procedures such as pancreaticoduodenectomy are often proposed for stromal tumours located in the second portion of the duodenum. Our case report highlights a novel surgical strategy that can be implemented as an alternative to pancreaticoduodenectomy for such tumours close to the duodenal ampulla. A 70-year-old man incidentally diagnosed with a stromal tumour close to the duodenal ampulla in the second portion of the duodenum underwent local resection guided by an endoscopic nasobiliary drainage tube with primary closure. This tube was converted to a percutaneous trans-small intestinal biliary drainage tube during the procedure to prevent biliary leakage biliary stasis due to swelling of the duodenal ampulla. He also underwent a simple distal gastrectomy with Roux-en-Y reconstruction. This resulted in successful R0 resection. There were no procedure-related complications or post-surgery weight changes. Our simple novel surgical strategy may therefore be useful for avoiding pancreaticoduodenectomy and maintaining quality of life in patients with stromal tumours close to the duodenal ampulla.