Primary adenocarcinoma of the duodenum with choledochoduodenal fistula.

BACKGROUND

Primary adenocarcinoma of the duodenum is an uncommon clinical entity. It has been associated with a dismal prognosis because it is rare and produces no distinctive symptoms until late in its course.

CASE SUMMARY

A 68-year-old man presented with a 6-month history of epigastralgia, anorexia, and progressive weight loss. Esophagogastroduodenoscopy showed a tumor mass in the deformed duodenal bulb with a fistula into the biliary tract. Upper gastrointestinal (UGI) barium studies and cholangiography confirmed a fistulous communication between the duodenum and biliary tree.

CONCLUSIONS

Aggressive evaluation of minor, yet refractory, UGI symptoms and a high index of suspicion offer the best hope for early diagnosis. Esophagogastroduodenoscopy and barium UGI study are the principal methods of diagnosis of these tumors. Early diagnosis would thus prevent metastasis and complications.