[Personal treatment of a case of gastrointestinal autonomic nerve tumour of the second duodenal segment].
Gastrointestinal autonomic nerve tumours are an uncommon form of gastrointestinal stromal tumours. Since both gastrointestinal stromal tumours and gastrointestinal autonomic nerve tumours are potentially malignant, radical surgical excision is always required. We report a case of a gastrointestinal nerve tumour measuring about 5 cm in diameter and arising from the medial wall of the second portion of the duodenum about 1.5 cm below the papilla of Vater. Because of this rare location a very invasive procedure (duodenocephalo-pancreatectomy) might have been required for tumour resection. We avoided this operation and implemented an alternative solution. Endoscopic ultrasonography was very helpful for this purpose, revealing that the tumour was confined within the duodenal wall and separated from the papilla. We employed a non-conventional surgical technique consisting in a duodenal resection comprising the tumour and a direct TT anastomosis of the duodenal stumps. Two technical devices were of fundamental importance for carrying out this procedure: (i) Ligasure which made dissection between the pancreatic head and duodenal wall a safe manoeuvre with little bleeding; and (ii) Valtrac, which allowed us to perform a large anastomosis without any tension on the duodenal stumps. Intraoperative endoscopy was also important. No anastomotic leakage occurred. At follow-up at 12 months the patient is in good health and CT scan and endoscopic ultrasonography have shown no recurrence of disease.
I Divisione di Chirurgia Generale e Gastroenterologica, Facoltà di Medicina e Chirurgia, Seconda Università degli Studi di Napoli.
Vincenzo
V
Napolitano
Gianluca
G
Russo
Vincenzo
V
Maffettone
Gianluca
G
Rossetti
Luigi
L
Brusciano
Guido
G
Sciaudone
Alberto
A
del Genio
D000714:Anastomosis, Surgical / Q000379:methods; D001341:Autonomic Nervous System; D004379:Duodenal Neoplasms / Q000601:surgery*; D004386:Duodenum / Q000601:surgery*; D019160:Endosonography; D005260:Female; D006801:Humans; D008875:Middle Aged; D016577:Pancreaticoduodenectomy; D010524:Peripheral Nervous System Neoplasms / Q000601:surgery*