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Open Antrectomy, Duodenal Resection, and Gastrojejunostomy for a Multiple Endocrine Neoplasia Tumor

David Berger, MD
Massachusetts General Hospital

Abstract

Neuroendocrine tumors are rare and arise from hormone-producing neuroendocrine cells. They can form anywhere in the body, but most develop in the digestive tract, where they are called carcinoid tumors, in the pancreas, or in the lungs. Carcinoid tumors are most commonly seen in the ileum and are typically well-differentiated. Most are characterised by an indolent course; however, duodenal neuroendocrine tumors may have a higher rate of metastasis even if well-differentiated. Many tumors do not cause symptoms, but 10% secrete excess levels of hormones, which can result in a constellation of symptoms called carcinoid syndrome. An elevated serum 5-hydroxyindole acetic acid level is specific for patients with carcinoid syndrome. Tumors in the duodenum can be visualized and biopsied via esophagoduodenoscopy, while those in the distal ileum can be visualized and biopsied on colonoscopy. Endoscopic ultrasonography can yield additional information such as which layers of the intestinal wall are involved with the lesion.

The goal of surgical therapy for carcinoid tumors is the resection of all visible disease. Here, we present a female patient who was diagnosed with a neuroendocrine tumor in the first portion of the duodenum by endoscopic ultrasound and biopsy. The tumor gradually increased in size, warranting its removal. A midline incision was performed, followed by entry into the lesser sac and evaluation of the duodenum and pylorus. The gastric antrum and the first portion of the duodenum were resected with a subsequent gastrojejunostomy reconstruction.

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