Novel deployment of a covered duodenal stent in open surgery to facilitate closure of a malignant duodenal perforation
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BioMed Central
Open Access
Case report
Novel deployment of a covered duodenal stent in open surgery to facilitate closure of a malignant duodenal perforation Philip F Lung, Adrian B Cresswell, Josephine Psaila and Ameet G Patel* Address: Department of Hepatobiliary Surgery, King's College Hospital, London, UK Email: Philip F Lung - [email protected]; Adrian B Cresswell - [email protected]; Josephine Psaila - [email protected]; Ameet G Patel* - [email protected] * Corresponding author
Published: 27 October 2009 World Journal of Surgical Oncology 2009, 7:79
doi:10.1186/1477-7819-7-79
Received: 17 February 2009 Accepted: 27 October 2009
This article is available from: http://www.wjso.com/content/7/1/79 © 2009 Lung et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract Background: Its a dilemma to attempt a palliative procedure to debulk the tumour and/or prevent future obstructive complications in a locally advanced intra abdominal malignancy. Case presentation: A 38 year old Vietnamese man presented with a carcinoma of the colon which had invaded the gallbladder and duodenum with a sealed perforation of the second part of the duodenum. Following surgical exploration, it was evident that primary closure of the perforated duodenum was not possible due to the presence of unresectable residual tumour. Conclusion: We describe a novel technique using a covered duodenal stent deployed at open surgery to aid closure of a malignant duodenal perforation.
Background With locally advanced intra-abdominal malignancy the surgeon is faced with the dilemma of attempting a palliative procedure to debulk the tumour and/or prevent future obstructive complications against limiting the impact of any surgical procedure on remaining quality of life. Unfortunately it remains extremely difficult to assess tumours which are adherent to local structures and the decision must be made whether to continue anatomical dissection or to leave the main tumour bulk in-situ and perform a simple bypass procedure.
Case presentation A 38 year old Vietnamese man was admitted with a 10 month history of epigastric pain, fatigue, 10 kg weight loss and recent onset jaundice. He had no other significant medical history. Clinical examination demonstrated anaemia and a tender mass in the right upper quadrant of the abdomen. A computerised tomography (CT) scan of
the abdomen revealed a 7 × 5 cm thick-walled, complex mass adjacent to the second part of the duodenum, which contained fluid and air and abutted the hepatic flexure of the colon. The working diagnosis was a collection secondary to a colonic perforation and he was treated with intravenous antibiotics. He improved with conservative management and was discharged a month later for outpatient colonoscopy. The colonoscopy revealed a lesio
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