RT Journal Article
SR Electronic
T1 Pancreatoduodenectomy for monomorphic epitheliotropic intestinal T-cell lymphoma with duodenal obstruction
JF BMJ Case Reports
JO BMJ Case Reports
FD BMJ Publishing Group Ltd
SP e248948
DO 10.1136/bcr-2022-248948
VO 15
IS 3
A1 Elizabeth J Olecki
A1 Kevin L Rakszawski
A1 June S Peng
YR 2022
UL http://casereports.bmj.com/content/15/3/e248948.abstract
AB We report an unusual case of a woman in her 60s diagnosed with monomorphic epitheliotropic intestinal T-cell lymphoma who required a pancreatoduodenectomy (Whipple procedure) for duodenal obstruction. The patient was initially treated with several cycles of chemotherapy, with persistent disease of the duodenum at D3. She was symptomatic with obstructive symptoms and positron emission tomography (PET)-CT showed disease localised to the duodenum without evidence of active disease elsewhere. The patient underwent pancreatoduodenectomy for both palliation of obstructive symptoms and potential oncological benefit. The patient had mild symptoms of delayed gastric emptying requiring promotility agents postoperatively, but otherwise recovered well after surgery. Unfortunately, surgical pathology revealed diffuse disease through the resected portion of the duodenum and jejunum, with positive proximal and distal margins. We suspect she has diffuse small bowel disease which was occult by CT and PET-CT. Based on this case, we recommend consideration of bypass rather than resection when possible for surgical palliation due to likelihood for extensive bowel involvement.