Koc Oguz, Duzkoylu Yigit, Sari Yavuz Selim, Bektas Hasan, Uzum Gungor, Tunali Vahit, Pasaoglu Esra
General Surgery Department, Istanbul Education and Research Hospital, Org, Abdurrahman Nafiz Gurman Street, Fatih Istanbul, 34096, Turkey.
J Med Case Rep. 2013 Apr 25;7:115. doi: 10.1186/1752-1947-7-115.
About 70% of well-differentiated endocrine tumors arise from the gastrointestinal tract. Duodenal well-differentiated endocrine tumors account for only 2.6% of all neuroendocrine tumors. Following the first two case reports of somatostatin-secreting tumors in 1977, fewer than 200 cases of somatostatinoma have been reported. These tumors of the duodenum are usually silent and asymptomatic, but can cause gastrointestinal symptoms. Depending on the localization of the tumor, multiple surgical procedures can be performed, ranging from local resection to pancreaticoduodenectomy.
Here, we report a case of a submucosal duodenal mass in a 42-year-old Turkish White man presenting with nausea, vomiting, fatigue and abdominal pain. The treatment decision of pancreaticoduodenectomy made preoperatively was later altered to intraoperative removal via local resection with sphincteroplasty.
Tumors of the periampullary region are considered highly malignant, and the Whipple operation is usually the only procedural treatment. In the current case, we decided not to perform pancreaticoduodenectomy but to excise the mass intraoperatively, and consequently avoided unnecessary resection of the pancreas and anastomosis to undilated hepatic and pancreatic ducts. This protective strategy prevented duodenum- and pancreas-related morbidity.
约70%的高分化内分泌肿瘤起源于胃肠道。十二指肠高分化内分泌肿瘤仅占所有神经内分泌肿瘤的2.6%。自1977年首次报道两例分泌生长抑素的肿瘤病例以来，生长抑素瘤的报道病例数不足200例。这些十二指肠肿瘤通常无明显症状，但可引起胃肠道症状。根据肿瘤的位置，可进行多种手术，从局部切除到胰十二指肠切除术。
在此，我们报告一例42岁土耳其白人男性的十二指肠黏膜下肿块病例，该患者表现为恶心、呕吐、乏力和腹痛。术前决定的胰十二指肠切除术治疗方案后来改为术中通过局部切除加括约肌成形术切除肿块。
壶腹周围区域的肿瘤被认为恶性程度高，Whipple手术通常是唯一的手术治疗方法。在本病例中，我们决定不进行胰十二指肠切除术，而是在术中切除肿块，从而避免了不必要的胰腺切除以及与未扩张的肝胰管吻合。这种保护策略预防了与十二指肠和胰腺相关的并发症。
