Duodenal adenocarcinoma in a patient with celiac disease: a case report
Branko Bakula, Ivan Zoričić, Marko Sever, Marinko Marušić, Rosana Troskot-Perić, Martin Grbavac, Domagoj Štritof
Duodenal adenocarcinoma is extremely rare and is responsible for only about 1.3% of gastrointestinal or about 0.2% of all malignant tumors in humans. Most common malignant tumors of the small intestine are carcinoid (44%) and adenocarcinoma (33%). More than half of adenocarcinoma of the small intestine can be found in the duodenum. Diseases that increase the risk of this rare malignancy are familial adenomatous polyposis (FAP), hereditary nonpolyposis colorectal cancer (HNPCC), Peutz-Jeghers syndrome, Crohn’s disease and celiac disease. We present the case of a 43-year-old man, in childhood diagnosed with celiac disease, who was admitted to our hospital because of intense vomiting, up to about 30 times a day over the last few days, with weight loss of about 20 kg in a previous year and with the finding of minor anemia. Upper GI series, abdominal MSCT and enteroscopy revealed obstructing adenocarcinoma of horizontal duodenal segment. The tumor was resectable and the Whipple procedure was performed. Duodenal adenocarcinoma, although rare, is a fatal complication of celiac disease. Patients who did not adhere to a gluten-free diet and those with late diagnosis of celiac disease have a greater risk of developing cancer. Today we are witnessing an unacceptably low percantage of early diagnosed
patients with small bowel adenocarcinoma. We wish to emphasize the importance of a regular follow-up by experts as well as proper diet education, with low threshold for indicating additional endoscopic and imaging investigations in the case of worsening of symptoms or in the case of a noncompliant patient.
Branko Bakula, Domagoj Štritof, Ivan Zoričić, Marinko Marušić, Marko Sever, Martin Grbavac, Rosana Troskot-Perić