case_images: PMC10589007_01
case_images: Left side shows a push enteroscopy illustrating an apple core lesion in the distal duodenum/jejunum junction. The right side shows the surveillance endoscopy at 11 months, showing healed post-surgical anastomosis side.
case_images: jchim-13-04-065f1.jpg
case_images: PMC10589007_01_jchim-13-04-065f1.jpg
case_images: f1-jchim-13-04-065
case_images: He underwent outpatient evaluation with an upper gastrointestinal endoscopy [Fig. 1], which showed gastritis, but the study was suboptimal secondary to food in the stomach and duodenum.
case_images: Right side: Computed Tomographic (C.T.) enetrography, with evidnece of duodenitis without any evidence of gatric outlet obstruction. Left side: C.T. scan abdomen without oral/IV contrast showing gastric outlet obstruction.
case_images: jchim-13-04-065f2.jpg
case_images: PMC10589007_01_jchim-13-04-065f2.jpg
case_images: f2-jchim-13-04-065
case_images: Subsequently, he underwent computed tomographic (C.T.) enterography [Fig. 2], that showed a distal third portion of duodenum wall thickening with adjacent fat stranding read as duodenitis.
case_images: Right side: Positron emission tomography (P.E.T.) scan after duodenectomy showing no increased fluorodeoxyglucose (F.D.G) uptake in distal sites or lymph nodes. Left upper image: Small bowel series shows resolution of gastric outlet obstruction, contrast seen in the large bowel. Left lower image: colonoscopic biopsy showing invasive moderately differentiated adenocarcinoma.
case_images: jchim-13-04-065f3.jpg
case_images: PMC10589007_01_jchim-13-04-065f3.jpg
case_images: f3-jchim-13-04-065
case_images: Histology [Fig. 3], of endoscopic biopsy confirmed invasive moderately differentiated small intestinal adenocarcinoma (intestinal type) with resection margins negative for invasion. However, on postoperative day four, the upper gastrointestinal series [Fig. 3], showed a mild delay in the passage of contrast at the site of the duodenal jejunal anastomosis. At one month's outpatient follow-up, a positron emission tomography (PET) scan [Fig. 3] for metastasis workup showed mild fluorodeoxyglucose (FDG) uptake in the duodenum, likely inflammatory, without enlarged or FDG avid lymphadenopathy.