PMC7673945_01
Initial CT scan showing mass in the duodenum.
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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).
MRI abdomen confirming duodenal mass in both (a) sagittal and (b) coronal sections.
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A magnetic resonance imaging showed a heterogeneous mass in the duodenum measuring 13.1 x 5.9 x 7.5 cm (Figure 2).
Invasive moderately differentiated adenocarcinoma with extracellular mucin production.
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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).
A group of malignant columnar shaped epithelioid cells in a background of abundant necroinflammatory debris.
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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).
Malignant cells are positive for MOC-31 stain.
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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).
CT abdomen showing extravasation of contrast material.
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A follow-up CT scan of the abdomen revealed an anastomotic leak at the surgical site (Figure 6).
CT showing drainage catheters at the anastomotic site.
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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).
Endoscopic images of misplaced drainage catheter in the lumen of the duodenum.
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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).
Drainage catheter in the lumen of the duodenum.
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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).
Fistulous tract opening in the lumen.
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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).
Closure of the tract by placing hemoclips.
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The closure of the tract was achieved by placing over the scope hemoclips (Figure 11).
Follow-up CT scan showing resolution of anastomotic leakage.
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A follow-up CT scan of the abdomen and pelvis showed resolution of the anastomotic leak (Figure 12).