A laparoscopic duodenojejunostomy for a duodenal obstruction from lymphoma

Abstract

Abstract. A patient with lymphoma in one-third of the duodenum causing a duodenal obstruction is described. The patient had a partial response with chemotherapy, but still was obstructed and unable to eat. He was losing weight, and chemotherapy had to be stopped. A gastrostomy tube was inserted for drainage because the stomach was quite distended. A jejunostomy tube was passed through the gastrostomy tube for feeding, but the patient did not tolerate the feeding. A laparoscopic bypass of the duodenumduodenal obstruction (from duodenum to jejunum) for this patient is shown on a video. The patient did very well after this bypass was provided. He was able to tolerate an oral diet on postoperative day 2, and on postoperative day 4, he was discharged home. He has since resumed chemotherapy, and is doing well, at this writing, 2 months after surgery.

Laparoscopic duodenojejunostomy for malignant stenosis as a part of multimodal therapy: A case report

“…However, the indication for LDJ for unresectable malignancies remains uncertain since reports of LDJ performed on malignant stenosis are scarce[ 6 ]. LDJ is a method of palliative care, and so the absence of postoperative complications is crucial for prolonging survival of cancer patients by means of chemotherapy[ 16 , 17 ].…”

“…Laparoscopic duodenojejunostomy (LDJ) has become the standard surgical procedure for superior mesenteric artery syndrome (SMAS) due to its sufficient short- and long-term outcomes in terms of safety and symptom relief[ 4 , 5 ]. However, there are only a few reports about LDJ for malignant stenosis[ 6 ] and its indication remains uncertain.…”

Laparoscopic duodenojejunostomy requiring a side-to-side jejunojejunostomy in malignant stenosis of the gastrojejunal anastomosis in jejunal cancer: A case report

“…Single-center case series show no mortality, no anastomotic leaks, and a mean post-operative length of stay ranging from 4.5 to 7.5 days [ 1 , [9] , [10] , [11] , [12] , [13] ] ( Table 1 ). There are also literature reports on laparoscopic duodenojejunostomy performed on malignant duodenal strictures, in which food intake was achieved within a week [ 2 , 8 ]. In our case, oral feeding seemed to have been achieved within a week, but ended in cyclic vomiting, which was thought to be due to limited bowel movement from opioid use.…”

“…Laparoscopic duodenojejunostomy has been reported as a surgical intervention for strictures of the 3rd portion of the duodenum, mostly caused by superior mesenteric artery syndrome [ 1 ] but also malignant conditions such as locally recurring pancreatic cancer [ 2 ]. This method has been shown to be effective in the treatment of SMA syndrome, but there are also reports on poor results at 6-month follow-up [ 8 ]. In addition, patients treated with opioids for cancer-related pain can have opioid-induced bowel dysfunction with limited gut motility and segmentation [ 3 ], which may interfere with oral intake despite surgical treatment of the mechanical obstruction.…”

Laparoscopic Treatment of Duodenal Obstruction: Report on First Experiences in Latin America

“…The approach to duodenal malformations is commonly a right transverse incision, followed by a Kocher maneuver, Ladd's lysis, and a diamondshaped duodeno-duodenostomy, with excellent long-term results. Most of the current literature on the laparoscopic management of duodenal obstruction focuses on the adult population, usually with a secondary surgical complication [2,3]. There are only few reports on the laparoscopic management of the condition in children [1,4,7,12,13].…”