Clinical Dynamics from Biliary Obstruction to a Duodenal Adenocarcinoma: A Rare Presentation on Definitive Management with Whipple Procedure

Abstract

Background: Duodenal adenocarcinoma is a rare gastrointestinal malignancy with an aggressive clinical course and often nonspecific symptoms, leading to delayed diagnosis. This disease accounts for a small proportion of gastrointestinal and is often diagnosed at an advanced stage due to its vague clinical presentation, which overlaps with other hepatobiliary disorders. Aim: This case report explores about Clinical Dynamics from Biliary Obstruction to a Duodenal Adenocarcinoma Case Presentation: A 59-year-old man presented with complaints of progressive abdominal pain, nausea, and jaundice. Abdominal ultrasound revealed dilation of the common and intrahepatic bile ducts. Upper endoscopy identified a mass in the ampulla of Vater region, and histopathological biopsy confirmed adenocarcinoma. The patient underwent placement of a choledochohepatic stent as a biliary                    decompression measure prior to a pancreaticoduodenectomy (Whipple procedure) as the definitive surgical intervention. Postoperative histopathological examination showed no malignant cell infiltration in the lymph nodes or liver metastases, indicating that the lesion was still localised. Postoperatively, the patient’s condition remained stable with clinical improvement following biliary decompression and radical tumour resection. Conclusion: Duodenal adenocarcinoma requires a comprehensive diagnostic and therapeutic approach. The integration of endoscopic evaluation, radiological imaging, and definitive surgical intervention is crucial in determining the success of therapy. The Whipple procedure remains the standard of care.