Duodenal obstruction induced by retroperitoneal progression of bladder cancer: a report of two cases

  • Koji TokunagaEmail author
  • Akihiro Furuta
  • Shigeki Arizono
  • Yuki Teramoto
  • Hiromitsu Negoro
  • Aki Kido
  • Hiroyoshi Isoda
  • Kaori Togashi
Special Section: Distinguished Papers from JSAR


Bladder cancer usually forms a papillary structure. Progression along the cavity or membranous structures surrounding the bladder, rectum, or retroperitoneum without formation of a discrete mass is rare. We here present two patients with duodenal obstruction caused by retroperitoneal progression of bladder cancer, in both of whom computed tomography revealed bladder and rectal wall thickening with a malignant target sign, thickened mesorectal fascia with abnormal tissue stranding, and increased perirectal fat density. Both cancers progressed despite treatment, as indicated by faint abnormal tissue stranding and increased retroperitoneal fat density along the retromesenteric plane from the pelvis to the duodenum. Subsequently, both patients developed obstruction in the horizontal portion of the duodenum, still without formation of a mass lesion. These two patients highlight the challenges associated with retroperitoneal invasion by bladder cancer in the absence of a mass lesion and underscore the importance of considering cancer progression in patients with bowel obstruction, even when there is no obvious mass lesion and/or only minor retroperitoneal findings. Progression along the retromesenteric plane may be the key pathway via which progressive bladder cancer results in duodenal obstruction without or with a minor mass lesion.


Bladder cancer Retroperitoneal progression Duodenal obstruction Retromesenteric plane 



This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

The requirement for written informed consent was waived for this case report on the basis of the opt-out system of our institution.


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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Diagnostic Imaging and Nuclear MedicineKyoto University Graduate School of MedicineKyotoJapan
  2. 2.Department of Diagnostic PathologyKyoto University Graduate School of MedicineKyotoJapan
  3. 3.Department of UrologyUniversity of Tsukuba HospitalTsukubaJapan

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