Carcinoma of the duodenum.

Abstract

Primary malignant neoplasms of the duodenum are relatively uncommon, some 602 authentic cases having been reported up to 1961 (lovine andTsangaris, 1961 Ewing (1931) states that the incidence of malignant tumours of the small intestine is 3% of neoplasms of the gastrointestinal tract. Shallow, Eger, and Carty (1944) reported the incidence of primary carcinoma of the duodenum in a study of 350,286 necropsies as 003%; the duodenum is affected in 45.6 % of cases of small intestinal neoplasms. In this series care was taken to exclude undifferentiated neoplasms of the ampulla of Vater and of the biliary and pancreatic systems, all of which are mixed with the figures for the incidence of duodenal carcinoma throughout its history. Ficarra and Marshall (1945) state that in order of frequency the duodenum is the commonest site for carcinoma of the small bowel if carcinoma of the ampullary region is included, and hence special attention must be paid to the pathology to establish the primary site and obtain true figures for its incidence. Spinazzola and Gillesby (1963) give the distribution of duodenal neoplasms for the first part of the supraampullary region as 18-23%, for the second part as 50-65%, and for the third part as 15-200%.

Carcinoma of the third part of the duodenum

“…3, 4) were irregular polypoid filling defects narrowing the third part of the duodenum associated with rigidity of the duodenal wall and some dilatation of the proximal duodenum-the typical features of a duodenal tumour. Review of the literature shows that it is common to miss duodenal tumours even when they are advanced, and Kreel and MacIntosh (1968) suggest that if there is a suspicious area in the duodenum on conventional barium-meal examination, gasdistension duodenography is helpful.…”

Duodenal Carcinoma Diagnosed by Hypotonic Duodenography and Small Bowel Enema

“…The lesion is seldom diagnosed preoperatively (Forty, 1956) because symptoms develop late (Devlin et al, 1968), thus it poses a diagnostic challenge to the clinician. Conventional barium meal examination is often unhelpful in establishing its presence (Keats and Sakai, 1955; Kreel and Mackintosh, 1968). This report describes a patient with an adenocarcinoma of the junction of the third and fourth parts of the duodenum, diagnosed by a radiographic technique of combined hypotonic duodenography and small bowel enema.…”