HIDING IN PLAIN SIGHT OR GOING BEYOND THE DUODENAL PAPILLA: A CASE SERIES

Abstract

Introduction. The tumours of the small intestine are rare findings. These tumours are more common in the duodenum than in the jejunum and ileum. The symptoms are vague and non-specific. A complete and thorough esophagogastroduodenoscopy plays a crucial role in the early diagnosis of small bowel tumours, especially those localized after the second part of the duodenum. Case presentations. The first case is of a 43-year-old man, who presented for important weight loss (19 kilograms in one year). The upper digestive endoscopy revealed a tumour in the third part of the duodenum, with a positive biopsy for non-Hodgkin’s lymphoma. The second case is of a 63-year-old male smoker patient, who presented to the emergency department for melena. While the emergency upper digestive endoscopy was non-diagnostic, a second evaluation highlighted a mass in the third part of the duodenum, that macroscopically and subsequently microscopically was confirmed to be a gastrointestinal stromal tumour. The third case is of a 59-year-old woman who presented for abdominal pain and in whom echo-endoscopy diagnosed a duodenal tumour. Conclusions. While many duodenal tumours become symptomatic when they are locally advanced, an incomplete upper digestive endoscopy may further delay the diagnosis and worsen the outcome. This highlights the importance of performing a complete esophagogastroduodenoscopy with the visualisation of the entire duodenum.

Keywords

• duodenum
• tumours
• esophagogastroduodenoscopy
• weight loss