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328 Ho et al. | Journal of Clinical and Translational Research 2023; 9(5): 327-331
need for pancreatic enzyme replacement therapy, with potentially an ascending colon mass, and histology revealed a colonic
improved quality of life following cancer survivorship [5]. adenocarcinoma. A staging computed tomography (CT) scan of
Despite being accepted as a valid option in patients with selected the thorax, abdomen, and pelvis showed a 9 × 8 cm ascending
pathologies, PSDR remains an uncommon surgical procedure. colon mass involving the anterior abdominal wall and right
Although PSDR is uncommon, it is one of the mainstream adnexa with no distant metastases. Carcinoembryonic antigen was
procedures for benign duodenal lesions and is widely commented high at 160 µg/L (normal range: 0–2.5 µg/L). An open D2 right
on. Two broad classification systems describe PSDR – one hemicolectomy was performed (Figure 1), and the final histology
related to duodenal resection (total or partial) and another revealed pT4bN1bM0 colon adenocarcinoma with 2/27 positive
related to the management of the ampulla of Vater (resection or lymph nodes. All the resection margins were free of the tumor,
preservation) [6,7]. Cantalejo-Díaz et al. performed a systematic with the tumor invasion limited to Gerota’s fascia. Capecitabine-
review in 2019 and reported only 30 studies with 211 patients based adjuvant chemotherapy was started.
managed by PSDR with total duodenectomy [8]. In a single-center A surveillance CT scan of the abdomen and pelvis done at
study over 14 years, Mitchell et al. reported that only 19 patients 1 year showed a bulky necrotic tumor with an invasion of the
had underwent a PSDR with distal duodenectomy for various third part of the duodenum (Figure 1 and 2). A magnetic resonance
infra-papillary duodenal pathologies [9]. In a systematic review imaging scan of the pancreas confirmed duodenal invasion with
including 53 patients with locally advanced colon cancer invading the proximity of the tumor to the uncinate process or head of the
the duodenum, Cirocchi et al. reported 14 patients managed by pancreas (Figure 1). After a discussion with the multidisciplinary
synchronous duodenal resection along with colectomy – ten with team, the decision was made for a PSDR.
pedicled ileal flap duodenal reconstruction and four with direct The patient was counseled for multi-visceral resection, revision
suture repair of the duodenum [10]. As the majority of PSDR of ileocolic anastomosis, possible stoma creation, and a possible
reports include primary duodenal pathologies or synchronous pancreaticoduodenectomy. Patient consented for the procedure
duodenal resection along with a colectomy for local duodenal and this case report was obtained. At exploratory laparotomy, the
invasion, PSDR in metastatic duodenal pathologies is rare [11-14]. recurrence was noted to involve the second and third part of the
We report a PSDR in a patient diagnosed with local recurrence of duodenum and was close to, but not involving, the uncinate process
a right colon adenocarcinoma with the invasion of the duodenum of the pancreas. A PSDR was performed with excision of the
following a right hemicolectomy performed a year before. recurrent tumor en bloc, including the ileocolic anastomosis, along
2. Case Presentation with densely adherent small bowel loop and a cholecystectomy
(Figure 1). The second and third parts of the duodenum up to the
A 74-year-old lady presented with the right iliac fossa pain, duodenojejunal flexure were resected, preserving the ampulla of
unintentional weight loss, and appetite loss on a background Vater, pancreas, and uncinate process. Most of the small bowel
of hypertension and diabetes mellitus. She did not smoke was resected, leaving about 120 cm of the remnant small bowel.
nor consume alcohol and had no family history of colorectal Reconstruction was performed by duodenojejunostomy at the
cancer. Abdominal physical examination was unremarkable junction of the first-second part of the duodenum and a new
with no masses or organomegaly noted. A colonoscopy noted ileocolic anastomosis.

Figure 1. Timeline showing interventions performed on the patient.
Abbreviation: OGD: Oesophago-gastro-duodenoscopy
DOI: http://dx.doi.org/10.18053/jctres.09.202305.22-00228