Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 21, 2015; 21(31): 9437-9441
Published online Aug 21, 2015. doi: 10.3748/wjg.v21.i31.9437
Adenocarcinoma of the third and fourth portions of the duodenum: The capsule endoscopy value
Feliciano Chanana Paquissi, Ana Henriqueta Filipe Bunga Pimentel Lima, Maria de Fátima do Nascimento Vieira Lopes, Francisco Viamontes Diaz
Feliciano Chanana Paquissi, Department of Medicine, Clínica Girassol, Luanda 1215, Angola
Ana Henriqueta Filipe Bunga Pimentel Lima, Service of Clinical Pathology, Clínica Girassol, Luanda 1215, Angola
Maria de Fátima do Nascimento Vieira Lopes, Service of Gastroenterology, Clínica Girassol, Luanda 1215, Angola
Francisco Viamontes Diaz, Department of General Surgery, Clínica Girassol, Luanda 1215, Angola
Author contributions: Paquissi FC and Lima AHFBP designed the report; Lopes MFNV performed the analyses of endoscopic aspects of the report; Paquissi FC collected the patient’s clinical data; Lima AHFBP performed the analyses of pathological aspects of the report; Diaz FV performed the analyses of surgical aspects of the report; Paquissi FC and Lima AHFBP compiled the data and wrote the paper; all authors read and approved the final manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Feliciano Chanana Paquissi, MD, Resident of Department of Medicine, Clínica Girassol, Street Comandante Gika number 225, Luanda 1215, Angola. fepaquissi@gmail.com
Telephone: +55-11-949975972
Received: May 11, 2014
Peer-review started: May 12, 2014
First decision: June 10, 2014
Revised: July 8, 2014
Accepted: August 28, 2014
Article in press: August 28, 2014
Published online: August 21, 2015
Processing time: 466 Days and 4.9 Hours
Abstract

Primary adenocarcinoma of the small intestine occurs in over 50% of cases in the duodenum. However, its location in the third and fourth duodenal portions occurs rarely and is a diagnostic challenge. The aim of this work is to report an adenocarcinoma of the third and fourth duodenal portions, emphasizing its diagnostic difficulty and the value of video capsule endoscopy. A man, 40 years old, with no medical history, with abdominal discomfort and progressive fatigue, presented four months ago with one episode of moderate melena. The physical examination was normal, except for mucosal pallor. Blood tests were consistent with microcytic, hypochromic iron deficiency anemia with 7.8 g/dL hemoglobin. The upper and lower endoscopy were normal. Additional work-up with video capsule endoscopy showed a polypoid lesion involving the third and fourth portions of the duodenum. Biopsy showed a moderately differentiated adenocarcinoma. Abdominal computed tomography showed a wall thickening from the third duodenal portion to the proximal jejunum, without distant metastasis. The patient underwent segmental resection (distal duodenum and proximal jejunum) with duodenojejunostomy. The surgical specimen histology confirmed the biopsy diagnosis, with transmural infiltration, without nodal involvement. Conclusion: Adenocarcinoma of the third and fourth portions of the duodenum is difficult to diagnose and capsule endoscopy is of great value.

Keywords: Duodenum; Duodenal cancer; Adenocarcinoma; Endoscopy; Video capsule endoscopy

Core tip: Third and/or fourth duodenal portion adenocarcinoma is a rare disease, associated with a vague clinical picture and a diagnostic challenge. Capsule endoscopy has shown a higher accuracy compared to conventional endoscopic methods. This case reports the occurrence of adenocarcinoma of the third and fourth duodenal portions and the value of capsule endoscopy to minimize the diagnostic difficulty.