Clinical Dynamics from Biliary Obstruction to a Duodenal Adenocarcinoma: A Rare Presentation on Definitive Management with Whipple Procedure
Alif Luthfian Humairoh
*
Faculty of Medicine, Muhammadiyah Surabaya University, Surabaya, Indonesia.
Agung Budi Lemuel
Department of Surgery, General Surgery Division, Faculty of Medicine, Muhammadiyah Surabaya University, Surabaya, Indonesia.
*Author to whom correspondence should be addressed.
Abstract
Background: Duodenal adenocarcinoma is a rare gastrointestinal malignancy with an aggressive clinical course and often nonspecific symptoms, leading to delayed diagnosis. This disease accounts for a small proportion of gastrointestinal and is often diagnosed at an advanced stage due to its vague clinical presentation, which overlaps with other hepatobiliary disorders.
Aim: This case report explores about Clinical Dynamics from Biliary Obstruction to a Duodenal Adenocarcinoma
Case Presentation: A 59-year-old man presented with complaints of progressive abdominal pain, nausea, and jaundice. Abdominal ultrasound revealed dilation of the common and intrahepatic bile ducts. Upper endoscopy identified a mass in the ampulla of Vater region, and histopathological biopsy confirmed adenocarcinoma. The patient underwent placement of a choledochohepatic stent as a biliary decompression measure prior to a pancreaticoduodenectomy (Whipple procedure) as the definitive surgical intervention.
Postoperative histopathological examination showed no malignant cell infiltration in the lymph nodes or liver metastases, indicating that the lesion was still localised. Postoperatively, the patient’s condition remained stable with clinical improvement following biliary decompression and radical tumour resection.
Conclusion: Duodenal adenocarcinoma requires a comprehensive diagnostic and therapeutic approach. The integration of endoscopic evaluation, radiological imaging, and definitive surgical intervention is crucial in determining the success of therapy. The Whipple procedure remains the standard of care.
Keywords: Duodenal adenocarcinoma, whipple procedure, obstructive jaundice, gastrointestinal malignancies