Tumors of the duodenum

Team statistics M. A. Suharinskogo, 127 201 opening cancer duodenum met 44 times that is 0,035%. The predominant localization cancer is a downstream division of the duodenum. "In the duodenum most frequent tumor infiltrating character with ulcerous surface, much stenozirutaya the bowel lumen, with otvergali valikoobraznye edges. Large exophytic tumors are extremely rare" (B. L. Bronstein, 1962). Resnik and Cooper (1958) according to the literature for 1948-1956 he gathered 361 case of cancer of the duodenum. In our clinic for the period of the 1950s-1970s was observed in 4 patients with cancers of the descending part of the duodenum. It should be noted that during the same time period was observed 145 patients with cancer defeat of Vater's nipple. Localization at the first place the cancer of the descending part of the duodenum, and cancer of the upper and lower horizontal part occurs much less frequently. The location of the cancer in the area of Vater nipple allows you to think about the connection with the initial lesion of the distal part of the common bile duct and the subsequent transition into the duodenum.
Symptoms when the cancer location in the initial part of the duodenum is very similar to that in cancer pyloric stomach: the phenomenon is gradually developing stenosis.
When cancer downward Department of the duodenum to the forefront jaundice due to compression of Vater's papilla and the terminal segment of the bile duct. Regular companion of obstructive jaundice in cancer downward Department of the duodenum is a symptom Courvoisier (apparently, painless, hard gallbladder). For early diagnosis of cancer of the downward Department of the duodenum is advisable to use x-ray studies, in particular duodenografii, in the state of artificial hypotension. Cancer of the lower horizontal part of the duodenum starts clinically apparent when it comes narrow its clearance. Simultaneously, there are pain in the upper part of the abdomen, then join vomiting bile.
As for the surgical treatment of cancer on the duodenum, then when you localize it in the upper horizontal part of the tactics of the surgeon is the same as in cancer gatekeeper, i.e. resection of the distal stomach and the initial part of the duodenum to the place of entry of the common bile duct.
When the cancer location in the district of Vater's papilla and the descending part of the duodenum radical surgery will be pancreatoduodenal resection, the removal of all duodenal ulcers with distal part of the common bile duct and the pancreatic head. In the localization of cancer in the lower horizontal part of the duodenum possible more limited resection only this Department colon, followed by the restoration of its terrain, stitching end-to-end duodenal ulcers with the beginning of the jejunum.
Forecast quo ad vitam et quo ad valitudinem with cancer of the duodenum is much less favourable than in stomach cancer.
Sarcoma of the duodenum occur only rarely. All the literature describes 43 cases sarcoma duodenum. These tumors have infiltrative growth, can be very large, causing compression of the duodenum and phenomena stenosis it (Winston, Ewans, 1966).
In our clinic was observed in one patient with reticulocytosis downward Department of the duodenum. In the clinical course this patient noted profuse gastrointestinal bleeding due to ulceration of the tumor and mechanical jaundice.
In the duodenum benign tumor and polyps are extremely rare. Predominant localization of benign tumors is Tatarov nipple. Adenoma of the latter is accompanied by itching of the skin, undulosa jaundice, bilirubinemia.
Adenoma of Vater nipple is saving operation: opening of the duodenum and resection of adenoma. The forecast is favorable.