Duodenal adenocarcinoma

Case contribution: Dr Radhiana Hassan


  • An 83 years old man
  • Known case of DM and hypertension on medication
  • Presented with post prandial vomiting for one month
  • Associated with loss of appetite and loss of weight (lost 20 kg in one month)
  • No altered bowel habit
  • Clinical examination is unremarkable
  • OGDS: NO esophageal varices, pooling of bile in stomach about 1.2L sucked out, normal duodenum until second part, unable to go beyond second part as it coiled
Abdominal radiograph in AP supine view is unremarkable
Scanogram of CT abdomen done five days later
CT scan abdomen in axial planes soft tissue window post contrast

CT scan findings:

  • The stomach and proximal (1st and 2nd) part of the duodenum is grossly dilated
  • Air fluid levels are seen within this dilated part of bowel loops
  • Soft tissue lesion is seen in distal part of duodenum (red arrows)
  • No dilatation of bowel distal to this
  • No abnormal enlargement of paraortic or paracaval node
  • No ascites

Intra-operative findings:

  • Exploratory laparotomy, duodenojejunostomy, jejunojejunostomy bypass and mesenteric nodule biopsy done
  • Hard duodenal tumour near the duodenal jejunal junction, partly fixed with lesion over the neighbouring mesenteric/serosa of duodenum,
  • The proximal duodenum is dilated,
  • Multiple superficial liver nodule over the right lobe, peritoneal nodules over the visceral peritoneum distal to umbilicus

HPE findings: adenocarcinoma with metastasis to mesenteric nodes

Diagnosis: Duodenal adenocarcinoma


  • Small bowel malignancies are relatively rare accounting for only 2% of all GIT cancers
  • Among small bowel tumours, most malignancy arise from the ileum followed by duodenum and lastly the jejunum
  • Duodenal adenocarcinoma is a rare but aggressive malignancy
  • It comprises of less than 1% of all GIT cancers
  • The causative factors have not been clearly identified
  • Associated risk factors include duodenal adenomas and duodenal polyps

Progress of patient:

  • Complicated post operatively by left psoas collection and sepsis
  • Referred for palliative chemotherapy
  • However chemotherapy as patient is not fit for further treatment
  • On palliative care



Author: radhianahassan