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Crohn’s disease of the duodenum is an uncommon condition. Our case was an extremely rare manifestation of Crohn’s disease, who presented with obstruction of the pylorus and the first and the second parts of the duodenum. Because of the severity of the obstruction, he underwent laparoscopic pancreaticoduodenectomy. Postoperative pancreatic leakage and bowel fistula were not observed, and there was no morbidity during the follow-up period. There was also no disturbance in digestive function, postoperatively. This is the first case employing laparoscopic pancreaticoduodenectomy to cure benign lesions leading to duodenal obstruction. Minimally invasive laparoscopic pancreaticoduodenectomy technology shows a very big advantage in treating this rare benign Crohn’s disease.
A 27-year-old man was admitted to our hospital with a chief complaint of epigastric pain and vomiting for 6 months. Laboratory tests were all within normal limits. Upper gastrointestinal endoscopy revealed a dilated stomach and stenosis of the pylorus and duodenal bulb. The endoscope was unable to traverse the second part of the duodenum because of the stenosis (Fig. 1a). Endoscopic biopsies were obtained from the pylorus and duodenal bulb. Pathological findings revealed inflammation and intestinal metaplasia and ruled out malignancy (Fig. 1b). Upper gastrointestinal tract iodinated contrast imaging revealed gastric dilation and strictures in the pylorus and the first and the second parts of the duodenum by a tumor (Fig. 2b). Abdominal CT scan (Fig. 2a) revealed retention of contrast in the stomach, pylorus, and duodenal bulb wall thickening and a coarse serosal surface with increased size of the surrounding mesangial lymph nodes; all indications of inflammation.
Non-operative therapy did not relieve the patient’s symptoms and surgical resection of the tumor was planned. Pancreaticoduodenectomy was the only option to completely resect the tumor and after careful consideration, we chose a minimally invasive approach. Laparoscopic pancreaticoduodenectomy was performed and an infiltrative tumor (10.5 cm in length and 4.5 cm greatest diameter) was seen at the pylorus and the first and the second parts of the duodenum. Frozen section examination revealed that the tumor was an inflammatory benign lesion. Primary CHILD anastomosis was performed following tumor excision. The mass was sent for paraffin section and histopathological examination revealed mucosal ulceration with dense transmural infiltration of inflammatory cells, including plasma cells, lymphocytes, and eosinophils, and lymphoid follicle formations with a predominance of inflammation in the mucosa and submucosa (Fig. 2c).
The patient had an event-free hospital course. His postoperative course was also uneventful and he has remained asymptomatic during the 6-month follow-up period.
The authors declare that they have no competing financial interests.
This study was funded by The National Natural Science Foundation of China (No. 81272659 to R.Y.Q.), Research Fund of Young Scholars for the Doctoral Program of Higher Education of China (No. 20110142120014 to R.Y.Q., No. 20120142110055 to M.W.), and Projects of Science Foundation of Hubei Province (No. 2012FFB02401 to F.Z.).