Primary duodenal carcinoma presenting as subacute intestinal obstruction: Diagnostic and surgical challenge

Primary duodenal carcinoma is considered one of the rare forms of malignancy. Due to its rarity and nonspecific presentation, it often poses a diagnostic and therapeutic challenge. A 45-year-old female presented with features suggestive of subacute intestinal obstruction along with a 3 month history of dyspepsia, notable weight loss and overall health decline. An oesophagogastroduodenoscopy (OGD) followed by biopsy confirmed the diagnosis of an adenocarcinoma in the distal portion of the second part of the duodenum. Further imaging with Contrast Enhanced Computed Tomography (CECT) of the abdomen delineated a resectable growth. The patient underwent a pancreaticoduodenectomy/ Whipple's procedure as a part of curative resection. Owing to its rarity and insidious clinical presentation, primary duodenal carcinoma is often misinterpreted as a benign gastrointestinal disorder, resulting in delayed diagnosis. This case highlights the importance of maintaining a high index of suspicion and undertaking a thorough diagnostic evaluation in patients with persistent gastrointestinal symptoms to enable early identification of rare malignancies such as duodenal carcinoma.