case_images: PMC7673945_01
case_images: Initial CT scan showing mass in the duodenum.
case_images: CRIGM2020-8835437.001.jpg
case_images: PMC7673945_01_CRIGM2020-8835437.001.jpg
case_images: fig1
case_images: However, computed tomography (CT) abdomen and pelvis with intravenous and oral contrast showed eccentric thickening of the third and fourth part of the duodenum (Figure 1).
case_images: MRI abdomen confirming duodenal mass in both (a) sagittal and (b) coronal sections.
case_images: CRIGM2020-8835437.002.jpg
case_images: PMC7673945_01_CRIGM2020-8835437.002.jpg
case_images: fig2
case_images: A magnetic resonance imaging showed a heterogeneous mass in the duodenum measuring 13.1 x 5.9 x 7.5 cm (Figure 2).
case_images: Invasive moderately differentiated adenocarcinoma with extracellular mucin production.
case_images: CRIGM2020-8835437.003.jpg
case_images: PMC7673945_01_CRIGM2020-8835437.003.jpg
case_images: fig3
case_images: An esophagogastroduodenoscopy (EGD) was performed to obtain the biopsy of the mass which turned out to be adenocarcinoma of the small bowel (Figures 3-5).
case_images: A group of malignant columnar shaped epithelioid cells in a background of abundant necroinflammatory debris.
case_images: CRIGM2020-8835437.004.jpg
case_images: PMC7673945_01_CRIGM2020-8835437.004.jpg
case_images: fig4
case_images: An esophagogastroduodenoscopy (EGD) was performed to obtain the biopsy of the mass which turned out to be adenocarcinoma of the small bowel (Figures 3-5).
case_images: Malignant cells are positive for MOC-31 stain.
case_images: CRIGM2020-8835437.005.jpg
case_images: PMC7673945_01_CRIGM2020-8835437.005.jpg
case_images: fig5
case_images: An esophagogastroduodenoscopy (EGD) was performed to obtain the biopsy of the mass which turned out to be adenocarcinoma of the small bowel (Figures 3-5).
case_images: CT abdomen showing extravasation of contrast material.
case_images: CRIGM2020-8835437.006.jpg
case_images: PMC7673945_01_CRIGM2020-8835437.006.jpg
case_images: fig6
case_images: A follow-up CT scan of the abdomen revealed an anastomotic leak at the surgical site (Figure 6).
case_images: CT showing drainage catheters at the anastomotic site.
case_images: CRIGM2020-8835437.007.jpg
case_images: PMC7673945_01_CRIGM2020-8835437.007.jpg
case_images: fig7
case_images: TPN, and broad-spectrum antibiotics, his clinical condition continued to deteriorate. Two 8 French pigtail drainage catheters were placed around the anastomosis leak which continued to have high output over the next few days (Figure 7).
case_images: Endoscopic images of misplaced drainage catheter in the lumen of the duodenum.
case_images: CRIGM2020-8835437.008.jpg
case_images: PMC7673945_01_CRIGM2020-8835437.008.jpg
case_images: fig8
case_images: A repeat EGD was performed, and the tip of one of the catheter was found in the lumen of the duodenum forming a fistulous tract (Figures 8-10).
case_images: Drainage catheter in the lumen of the duodenum.
case_images: CRIGM2020-8835437.009.jpg
case_images: PMC7673945_01_CRIGM2020-8835437.009.jpg
case_images: fig9
case_images: A repeat EGD was performed, and the tip of one of the catheter was found in the lumen of the duodenum forming a fistulous tract (Figures 8-10).
case_images: Fistulous tract opening in the lumen.
case_images: CRIGM2020-8835437.010.jpg
case_images: PMC7673945_01_CRIGM2020-8835437.010.jpg
case_images: fig10
case_images: A repeat EGD was performed, and the tip of one of the catheter was found in the lumen of the duodenum forming a fistulous tract (Figures 8-10).
case_images: Closure of the tract by placing hemoclips.
case_images: CRIGM2020-8835437.011.jpg
case_images: PMC7673945_01_CRIGM2020-8835437.011.jpg
case_images: fig11
case_images: The closure of the tract was achieved by placing over the scope hemoclips (Figure 11).
case_images: Follow-up CT scan showing resolution of anastomotic leakage.
case_images: CRIGM2020-8835437.012.jpg
case_images: PMC7673945_01_CRIGM2020-8835437.012.jpg
case_images: fig12
case_images: A follow-up CT scan of the abdomen and pelvis showed resolution of the anastomotic leak (Figure 12).