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Abstract: 77-year-old Master Cao came to the clinic with complaints of poor appetite, accompanied by stomach pain and occasional vomiting. 3 days ago, he noticed yellowing of the whites of his eyes and dark yellow skin, etc. After examination, a malignant tumor of the duodenum was initially suspected. After being hospitalized for surgical treatment, the postoperative pathology suggested that it was duodenal adenocarcinoma. Due to the high malignancy of the disease, the disease recurred six months after surgery, and then gastrojejunostomy was performed. After the surgery, the lesion was removed, and the discomfort symptoms such as abdominal pain and nausea disappeared, and the disease was temporarily controlled and stabilized.
Basic information】Male, 77 years old
Disease Type】Adenocarcinoma of the duodenum
Hospital】The First Affiliated Hospital of Kunming Medical University
Date of Consultation】August 2021
Treatment plan】Selective duodenectomy and gastrojejunostomy
Treatment Period】1 week after admission, followed up every 3 months
Effectiveness】The lesion was removed, abdominal pain, nausea and other uncomfortable symptoms disappeared, and the disease was temporarily controlled and stabilized.
I. Initial consultation
He had a mild hypertension, a poor appetite, stomach pain and occasional vomiting. 3 days ago, he found yellowing of the whites of his eyes and dark yellow skin, and gradually developed back pain. The patient was initially considered to be a gastrointestinal tumor pressing on the bile duct. The patient was given relevant examinations, and the tumor marker carcinoembryonic antigen was elevated, ultrasound examination showed occupancy of the duodenal papilla, dilated bile ducts inside and outside the liver, and cholecystitis.
II. Treatment process
After communicating with the patient and his family about his condition and treatment plan, the patient expressed his willingness to actively cooperate with the treatment, so selective duodenectomy was performed. The pathological examination showed that the superficial duodenal glands showed tubular villous adenoma with low differentiation and high malignancy, thus confirming the diagnosis of duodenal adenocarcinoma. Six months after the operation, the patient’s condition recurred, and after communication between the doctor and the patient, a gastrojejunostomy was performed and the entire duodenum was removed.
III. Treatment effect
After duodenectomy, the patient’s jaundice was reduced, and he was discharged from the hospital 7 days after admission. However, the jaundice worsened again 3 months later with paroxysmal abdominal pain, which was progressively aggravated, and the residual duodenal adenocarcinoma was found to have recurred on review. In order to avoid further tumor spread and metastasis, gastrojejunostomy was performed. After surgery, the patient’s lesion was removed, and the abdominal pain, nausea and other uncomfortable symptoms disappeared, and the condition was temporarily controlled and stabilized. The patient was instructed to follow up every 3 months.
IV. Precautions
After two operations, the patient’s abdominal pain and nausea disappeared and his condition was temporarily controlled and stable, which was a slight relief to the attending physician. However, it should be noted that because of the patient’s own age, the surgery will bring certain trauma, so the patient should be given sufficient nutritional support and supplementation after the surgery to ensure sleep and sufficient rest to enhance the patient’s physical fitness. In addition, attention should be paid to ensure the cleanliness of the wound after surgery to avoid secondary infection, which may lead to aggravation of the disease. Family members and friends should give encouragement to patients to help them build up confidence in fighting cancer and maintain an optimistic attitude.
V. Personal insight
The etiology of duodenal adenocarcinoma is unknown, and surgical resection is the only effective radical treatment method, and there is no specific therapeutic drug. Therefore, patients should be treated as soon as possible to avoid delaying the disease. As the disease is prone to recurrence, it is important to follow the doctor’s instructions for regular review after surgery. If there are symptoms such as yellowing of the skin, emaciation, nausea, vomiting, etc., it is important to pay attention to them and not to delay them, which may aggravate the disease and make treatment more difficult.