Emergency Pancreatoduodenectomy (Whipple Procedure) for Massive Upper Gastrointestinal Bleeding Caused by a Diffuse B-Cell Lymphoma of the Duodenum: Report of a Case

Abstract

We herein report a rare case of a massive upper gastrointestinal (GI) bleeding, caused by high-grade diffuse B-cell lymphoma of the duodenum, secondary to immunoproliferative small intestinal disease (IPSID) and treated with an emergency partial pancreatoduodenectomy. A 42-year-old man was admitted to our hospital because of hematemesis. Upper GI endoscopy was unrevealing because of the copious bleeding. Initially, the patient underwent conservative treatment, thus resulting in the temporary cessation of the bleeding. Later, the hemorrhage massively relapsed. An urgent abdominal ultrasound raised the suspicion of a large, possibly bleeding, neoplasm of the duodenum, which was finally confirmed by abdominal computed tomography. The patient underwent an emergency laparotomy, during which a partial pancreatoduodenectomy was performed (Whipple procedure). Histologically, the tumor was a high-grade B-cell lymphoma of the duodenum. The nearby small intestinal mucosa was suggestive of IPSID. A massive upper GI hemorrhage from a high-grade B-cell non-Hodgkin lymphoma of the duodenum, which develops secondary to IPSID, is a very rare clinical demonstration of this disease. Our case is one of the few reports in the English literature, for which the Whipple procedure has been performed as a curative treatment.

Emergency pancreatic surgery—demanding and dangerous

“…These publications have shown that salvage resections are associated with increased morbidity and mortality compared to elective procedures. In contrast, very few data are available on primary emergency pancreas resections as these procedures are rarely performed [10][11][12][13][14]. In the present study, we could show that emergency pancreas operations account to a frequency below 1 % in a tertiary referral center with a high overall number of pancreatic operations and full 24/7 emergency service.…”

“…Most publications on primary emergency pancreatic operations are dealing with the management of pancreatic injuries following blunt or penetrating abdominal trauma [6][7][8][9]. Beyond these publications on trauma patients, the available literature mainly includes case reports or small patient series [10][11][12][13][14] and show that there is heterogeneity in the indications leading to emergency pancreas operations as well as in the performed surgical procedures [10,11]. However, considerable morbidity and mortality rates have been reported.…”

Emergency pancreaticoduodenectomy: When is it needed? A dual non-trauma centre experience and literature review

“…Successful isolated EPD have been also reported for bleeding from duodenal varices [41], diffuse B-Cell Lymphoma of the duodenum [42], giant GIST of the duodenum [43], duodenal paraganglioma [44], and for high flow biliary fistula resulting from a prior right nephrectomy by lumbar approach [45], rupture of a mucinous cystic neoplasm in a pregnant woman [46], ampullary tumor with spontaneous perforation of an aberrant bile duct totally laparoscopically treated [47], and in association with oesophagogastrectomy for caustic injury [48]. Moreover, a large series of 18 patients affected by caustic injuries in which an EPD was associated with oesophagogastrectomy has been reported by Lefrancois, with a mortality rate of 39% (N ¼ 7/18) [49].…”

Massive Upper Gastrointestinal Bleeding Caused by Diffuse Large B-Cell Lymphoma

“…Shum et al have presented a case with diffuse large B-cell gastric lymphoma who has arrived to emergency clinic with shortness of breath [8]. In another case by Stratigos et al a 42-year-old man with diffuse large B-cell of the duodenum was admitted to emergency clinic because of massive hematemesis [9]. …”