A case of wedge resection of duodenum for massive gastrointestinal bleeding due to duodenal metastasis by renal cell carcinoma
Gastrointestinal bleeding due to duodenal metastasis from renal cell carcinoma is extremely rare. Several previous reports have shown that embolic therapy or pancreatoduodenectomy (radical surgical resection) could be effective in controlling this type of clinical complication. Management is entirely dependent on the general condition and concurrent metastases at other sites. Optimizing the therapeutic strategies thus deserves further discussion and exploration.
In this report, we describe a patient with severe co-morbidities who underwent successful palliative wedge resection of duodenum and direct duodenal wall defect repair without reconstruction of duodeno-jejunostomy for acute upper digestive tract hemorrhage caused by duodenal metastasis from renal clear cell carcinoma.
The patient recovered uneventfully and did not experience rebleeding and frequent vomiting after surgery. Since then (1.5 years) he has had no evidence of rebleeding.
Gastrointestinal bleeding due to duodenal metastasis of RCC may benefit from emergent resection even in the presence of severe co-morbidities, and for palliative treatment.
- Cohen HT, McGovern FJ: Renal-cell carcinoma. N Engl J Med 2005, 353:2477–2490. CrossRef
- Chung PH, Srinivasan R, Linehan WM, Pinto PA, Bratslavsky G: Renal cell carcinoma with metastases to the gallbladder: four cases from the National Cancer Institute (NCI) and review of the literature. Urol Oncol 2012, 30:476–481. CrossRef
- Saitoh H: Distant metastasis of renal adenocarcinoma. Cancer 1981, 48:1487–1491. CrossRef
- Sivaramakrishna B, Gupta NP, Wadhwa P, Hemal AK, Dogra PN, Seth A, Aron M, Kumar R: Pattern of metastases in renal cell carcinoma: a single institution study. Indian J Cancer 2005, 42:173–177.
- Fidelman N, Freed RC, Nakakura EK, Rosenberg J, Bloom AI: Arterial embolization for the management of gastrointestinal hemorrhage from metastatic renal cell carcinoma. J Vasc Interv Radiol 2010, 21:741–744. CrossRef
- Brener ZZ, Zhuravenko I, Jacob CE, Bergman M: An unusual presentation of renal cell carcinoma with late metastases to the small intestine, thyroid gland, nose and skull base. Nephrol Dial Transplant 2007, 22:930–932. CrossRef
- Eo WK, Kim GY, Choi SI: A case of multiple intussusceptions in the small intestine caused by metastatic renal cell carcinoma. Cancer Res Treat 2008, 40:97–99. CrossRef
- Cherian SV, Das S, Garcha AS, Gopaluni S, Wright J, Landas SK: Recurrent renal cell cancer presenting as gastrointestinal bleed. World J Gastrointest Oncol 2011, 3:99–102. CrossRef
- Meyer HA, Tolle A, Jung M, Fritzsche FR, Haendler B, Kristiansen I, Gaspert A, Johannsen M, Jung K, Kristiansen G: Identification of stanniocalcin 2 as prognostic marker in renal cell carcinoma. Eur Urol 2009, 55:669–678. CrossRef
- Nabi G, Gandhi G, Dogra PN: Diagnosis and management of duodenal obstruction due to renal cell carcinoma. Trop Gastroenterol 2001, 22:47–49.
- Leslie KA, Tsao JI, Rossi RL, Braasch JW: Metastatic renal cell carcinoma to ampulla of Vater: an unusual lesion amenable to surgical resection. Surgery 1996, 119:349–351. CrossRef
- Schneider JJ, Shroff S, Moser AJ: Palliative segmental duodenectomy for bleeding, erosive endometrial cancer. Gynecol Oncol 2005, 97:246–248. CrossRef
- A case of wedge resection of duodenum for massive gastrointestinal bleeding due to duodenal metastasis by renal cell carcinoma
- Open Access
- Available under Open Access This content is freely available online to anyone, anywhere at any time.
World Journal of Surgical Oncology
- Online Date
- September 2012
- Online ISSN
- BioMed Central
- Additional Links
- Gastrointestinal bleeding
- Wedge resection
- Renal clear cell carcinoma
- Author Affiliations
- 1. Department of Hepatobiliary Surgery, Xinqiao Hospital, Third Military Medical University, Xinqiao Street, Chongqing, 400037, China
- 2. Division of Immunology &Inflammation, Department of Medicine, Imperial College, Hammersmith Campus, Du Cane Road, London, W12 0NN, UK