David J Berler, MD, Sheila Rustgi, MD, Nikhil Kumta, MD, MS, Anthony J Vine, MD, FACS. Icahn School of Medicine at Mount Sinai
This is the case of a 60-year-old man who presented with syncope and melena. He was found on EGD to have a 1cm lesion in the first portion of the duodenum. Biopsy was consistent with neuroendocrine tumor, and metastatic workup was negative. Following an unsuccessful attempt at endoscopic submucosal dissection, the patient was brought for laparoscopic antrectomy with partial duodenectomy and gastrojejunostomy, the video of which is included.
Critical steps of the operation which are shown include performing a wide Kocher maneuver to permit duodenal mobilization and eventual transection, localization of the lesion with intraoperative endoscopy, and identification of the bile duct to define its relationship to the tumor and the distal margin. The duodenal stump must be definitively hemostatic, or there is an increased incidence of leak.
The incidence of neuroendocrine tumors has increased drastically over the last 35 years. Most such tumors are found within the terminal ileum, however, and duodenal carcinoid is quite rare (2% of all gastrointestinal carcinoids), making our case unique. The management of such tumors will range from limited duodenal resection with gastrojejunostomy or Roux-en-Y reconstruction for tumors within the first portion, to pancreaticoduodenectomy for lesions within the second portion with involvement of the ampulla of Vater.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87929
Program Number: V235
Presentation Session: Thursday Video Loop (Non CME)
Presentation Type: VideoLoop