Malignant Gastric Outlet Obstruction Caused by Duodenal Cervix Metastasis in a Young Woman: Rendezvous Technique

Abstract

Background: Malignant gastric outlet obstruction (MGOD) is an extremely rare expression of advanced extra-gastrointestinal cancer, such as squamous cell carcinoma (SCC) of the cervix, and only sixcases are described in the literature.Because of the short life expectancyand the high surgical risk involving these patients, less invasive approaches have been developed over time, such asthe use of an enteral stent or less invasive surgical techniques (i.e., laparoscopic gastrojejunostomy). However, MGOD could make it difficult to perform an endoscopic retrograde cholangio-pancreatography (ERCP) for standard endoscopic drainage, so in this case a combined endoscopic-percutaneous technique may be performed. This article, therefore, aims to highlight the presence in the doctor’s armamentarium of the “rendezvous technique”, few case reports of whichare described in the literature, and, moreover, this article aims to underline the technique’sfeasibility. Case Presentation: The case is that of a 38-year-old woman who presented with MGOD three years after the diagnosis of SCC of the cervix, who successfully underwent the rendezvous technique with the resolution of duodenal obstruction. Endoscopic enteral stenting treatment with the placement of a metal stent (SEMSs) represents the mainstay of MGOD treatment compared withsurgery due to its lower morbidity, mortality, shorter hospitalization and earlier symptom relief. However, in patients with both duodenal and biliary obstruction, a combined endoscopic–percutaneous approach may be necessary because of the difficulty in passing the duodenal stricture or in accessing the papilla through the mesh of the duodenal SEMS. Conclusion: The rendezvous procedure is a technicallyfeasible and minimally invasive approach to the double stenting of biliary and duodenal strictures. It achieves the desired therapeutic result while avoiding the need to perform more invasive procedures that could have a negative impact on the patient’sprognosis.

Gastric outlet obstruction in uncomplicated mesentero-axial gastric volvulus associated to hiatal hernia

“…Gastric outlet obstruction refers to a mechanical obstruction of the pylorus or the duodenum that may be cause by benign or malignant diseases [24] . In our case it was determined a mesenteroaxial gastric volvulus in hiatal hernia in an old woman, which was rare because it is more commonly reported in neonates, infants, and young children [ 25 , 26 ].…”

Carcinoma lobulillar infiltrante de mama metastásico a duodeno, a propósito de un caso

“…Yim y colaboradores, en una serie de casos de pacientes con síndrome pilórico, reportaron una etiología metastásica cercana al 27,6% (12) . También están descritas como presentaciones inusuales el compromiso metastásico por adenocarcinoma de ciego, carcinoma escamoso de cérvix y ano (12)(13)(14) , así como carcinoma pleomórfico pulmonar (15,16) . Respecto al compromiso duodenal por carcinomas de mama, se describen episodios de obstrucción del tracto de salida gástrico secundario o como primera manifestación de la neoplasia, como el reportado por Khairy y colaboradores (17) .…”

Endoscopic stenting for stenosing cancer and digestive canal structures

“…Отже, порівняно з іншими методами паліативної допомоги інкурабельним хворим з пухлинним стенозом стравоходу, шлунка і ДПК ендоскопічна реканалізація і стентування саморозправними металевими стентами є оптимальним варіантом комплексного лікування із задовільним клінічним і функціональним результатом, з тимчасовим поліпшенням якості життя і низькою частотою ускладнень [26,27].…”