A 61-year-old man was admitted with the chief complaints of nausea and vomiting. Abdominal CT revealed dilatation of the second and third portions of the duodenum, and a tumor compressing the inferior vena cava. Duodenography revealed obstruction at the third portion of the duodenum. Endoscopy revealed a type 2 tumor causing stenosis of the third portion of the duodenum. The distance between the papilla of Vater and the tumor was 10mm. Biopsy revealed a moderately differentiated adenocarcinoma.
A stomach tube was inserted after admission. The volume of drainage from the stomach tube was about 5000-8000ml/day, and consequently, the patient developed marked hypochloremia. To correct this electrolyte abnormality, we performed percutaneous endoscopic gastrostomy and enterostomy via a laparotomy, and connected the two so as to allow the digestive juices to flow from the stomach into the intestinal tract. After two weeks, the marked hypochloremia was corrected. Pyloruspreserving pancreaticoduodenectomy was then performed. The resected specimen revealed a type 3 carcinoma in the third portion of the duodenum. Histopathological findings revealed a moderately differentiated adenocarcinoma. No postoperative complications occurred.
Thus, connecting the gastrostomy with the enterostomy so as to allow the digestive juices to flow from the stomach into the small intestine proved to be a very useful measure to correct the electrolyte abnormality.