Emergency Pylorus-Preserving Pancreatoduodenectomy Followed by Second-Stage Pancreatojejunostomy for a Gastrointestinal Stromal Tumor of the Duodenum with an Intratumoral Gas Figure: Report of a Case

Abstract

We report a case of a duodenal gastrointestinal stromal tumor (GIST) necessitating urgent surgery because of a gas figure on computed tomography (CT). A 46-year-old woman, complaining chiefly of upper abdominal pain and tarry stools, consulted a local doctor. A gastrointestinal fiberscopy revealed an ulcer in the second part of the duodenum, and the patient was admitted to our hospital where a dynamic CT scan showed a hypervascular solid tumor in the pancreatic head. A repeat CT scan done 4 days later showed a gas figure in the tumor, necessitating an emergency pylorus-preserving pancreatoduodenectomy (PpPD). First, we performed a tube pancreatostomy for complete external drainage of the pancreatic juice, and planned a second-stage pancreatojejunostomy for the near future. Histopathologically, the tumor was diagnosed as a GIST originating in the duodenum. The patient was discharged on postoperative day 23 after an uneventful postoperative recovery. Her local doctor completed the second-stage pancreatojejunostomy.

The impact of preoperative etiology on emergent pancreaticoduodenectomy for non-traumatic patients

“…Table 2 presented 31 EPD accounting for 1.84% of all 2984 cases who underwent EPD for non-traumatic etiologies from the literature and the present series [8, 11, 14–22]. The rate of EPD for non-traumatic etiologies is similar between the present study and the other 3 series, ranging from 0.3 to 3%.…”

“…In order to minimize the complications caused by pancreaticojejunostomy, some authors proposed a “staged reconstruction” and obtained satisfying results [10]. Sakakima et al [11] reported a successful EPD with a similar concept of staged reconstruction of pancreaticojejunostomy. In contrast to reports focusing on operative management, there have been no reports regarding preoperative predictors for surgical outcomes of EPDs.…”

Emergency Pancreatoduodenectomy for Pancreatic Metastasis from Renal Cell Carcinoma in a Patient with von Hipple-Lindau Disease: A Case Report

“…Recently, the operative mortality in scheduled PD for pancreatic cancer was reported as less than 5% [13,14]. PD is therefore only undertaken as an emergency lifesaving procedure in exceptional situations, such as refractory infection, pancreatic injury, and hemorrhage from tumors and ulceration which cannot be controlled by conservative treatment [15][16][17][18]. To our knowledge, however, emergency PD for spontaneous hemorrhage from pancreatic tumors is extremely rare.…”

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

“…2,16 Two reports in the literature describe the performance of this procedure for duodenopancreatic complications after endoscopic and surgical interventions and also for an excision of a duodenal GI stromal tumor with central necrosis. 2,17 There is only one case report of a massive hemorrhage caused by a duodenal lymphoma, for which an emergency Whipple procedure was carried out by a Scandinavian team 25 years ago. 18 Although it has been well established that an emergency admission of the patient is signifi cantly predictive for the increased inhospital mortality, 12 we found no data regarding the mortality and morbidity rates for emergency Whipple operations because of the few number of such cases.…”