Laparoscopic Segmental Resection of Bleeding Neurofibroma in the Fourth Portion of Duodenum

Osama Hamed, MBBS, Stephen Kavic, MD. University of Maryland School of Medicine


 Introduction: Gastrointestinal (GI) involvement in type 1 neurofibromatosis is rare. Neurofibromas in the GI tract can cause bleeding or obstruction and there is also a risk of malignant transformation. We present here the first reported case of laparoscopic resection of the fourth portion of  duodenum for bleeding neurofibromatosis.
Methods: A 54 year old female patient presented to our institution with a three day history of melena and dizziness. The patient was known to have Type 1 neurofibromatosis. Upper GI endoscopy with single balloon push enteroscopy demonstrated a mass in the fourth portion of duodenum with overlying clot.
Results : Upon laparoscopic exploration multiple masses in the wall of the fourth portion of the duodenum were identified. Exploration of the abdominal cavity revealed two other similar masses in the small bowel, one in the mid jejunum and one in the mid ileum. Laparoscopic segmental resection of the fourth portion of the duodenum was done after maximum mobilization to the lateral edge of the superior mesenteric artery. The patient recovered uneventfully and was discharged home on post operative day 3. Pathology showed plexiform neurofibromas in the wall of duodenum and small bowel, consistent with neurofibromatosis. All margins were negative and there was no evidence of malignancy
Conclusion: Neurfibromas of the GI tract is rare with risk of bleeding and malignant transformation. Laparoscopic resection of the fourth portion of duodenum is feasible after maximum mobilization.

Session Number: VidTV1 – Video Channel Rotation Day 1
Program Number: V072

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