Carcinoma of the Duodenum

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Abstract
Primary duodenal carcinoma is an uncommon tumor that tends to be diagnosed late in its course because of a symptom complex compatible with many benign diseases. Five patients with duodenal adenocarcinoma treated at Norfolk General Hospital [Virginia, USA] from 1973-1983 were reviewed. Periampullary tumors were excluded. The most common symptom, nausea and vomiting, was present in 4 patients, all of whom had microcytic anemia; in 3, tests showed blood in stool specimens. The upper gastrointestinal [GI] series was suggestive of carcinoma in all patients. One of the lesions was proximal to the ampulla, while the other 4 were in the 3rd and 4th portions of the duodenum. Only 3 of the lesions could be seen on upper GI endoscopy; in only 1 of the 3 was the biopsy specimen positive for malignancy. At laparotomy, 2 patients had resectable lesions, but only segmental resection was done. Three patients had unresectable disease because of liver metastases and/or involvement of the root of the small bowel mesentery. Because delay in diagnosis of duodenal carcinoma may prevent successful resection, greater awareness of the possibility of these uncommon lesions, along with aggressive diagnostic work-up, may result in a higher percentage of cures.

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