Flávio Silano1*, Rodolfo Carvalho Santana1, Ricardo Bandeira de Melo Amaral1, Vanessa Costa Neves1, Patrícia Sodré Dias Barreto2 and Paulo Cezar Galvão do Amaral1
1Department of Surgery of the Upper Digestive System, Hospital da Cidade, Brazil
2Department of Pathology, Pathological Anatomy Laboratory of the Fundação José Silveira, Brazil
Background: Sporadic nonampullary duodenal adenoma is a rare lesion and is almost exclusively an incidental finding on endoscopy. Its potential for malignant transformation is not negligible; therefore, resection should always be considered. Some techniques for the removal of these lesions have been proposed based on preoperative staging; all of these techniques require extremely qualified expertise because of the lesion site acting as a limiting factor for the resection technique and the duodenum’s complex, peculiar anatomy. Case Summary: We present a case of asymptomatic 61-year-old woman with an endoscopic finding of a sporadic nonampullary duodenal adenoma and high-grade dysplasia. Staging ruled out metastatic disease, but endoscopic ultrasound revealed the involvement of deep duodenal layers. Endoscopic resection was contraindicated due to the site and depth of the lesion. Further, the enhanced recovery after surgery multimodal protocol was applied to the patient. Therefore, the lesion was surgically resected through pancreatoduodenectomy with the preservation of pylorus and pancreatic-gastric anastomosis. The patient progressed with no complications, related or unrelated to the surgical site, and transfusion of blood derivatives was not required. On 3rd day after surgery, the abdominal drain was removed. The patient was discharged on 11th day after surgery with prescribed bland oral diet, no abdominal pain, and normal bowel movements. Histopathological examination of the surgical specimen confirmed high-grade dysplasia without adenocarcinoma, despite invasion of the mucosa, and lesion-free surgical margins. Conclusion: Sporadic nonampullary duodenal adenoma should be managed by a multidisciplinary team in centers with experience in duodenal lesion resection.
Silano F, Santana RC, de Melo Amaral RB, Neves VC, Dias Barreto PS, Galvão do Amaral PC. Sporadic Nonampullary Duodenal Adenoma: A Surgical Case Report and Literature Review. Clin Surg. 2022; 7: 3505..