Segmental Distal Duodenectomy With Duodenojejunostomy and Gastrojejunostomy Reconstruction for Duodenal...

An 83-year-old man was admitted to the emergency department of our hospital with a chief complaint of melena. A computed tomography revealed a hypervascular tumor approximately 3 cm in size near the duodenojejunal flexure. On diagnosis of bleeding from the gastrointestinal stromal tumor (GST), emergency surgery was performed. At laparotomy, a whitish tumor measuring approximately 3 cm in diameter was identified on the serosal surface along the mesenteric border of the duodenojejunal flexure. Considering the need for secure hemostasis, a segmental duodenectomy including resection of the feeding vessels to the affected bowel segment was performed. For reconstruction, considering that anastomosis posterior to the superior mesenteric artery (SMA) was avoided and instead performed primary closure of the duodenal stump. To provide duodenal drainage, a Roux-en-Y jejunal limb was constructed and anastomosed to the 2^nd part of the duodenum. Additionally, a gastrojejunostomy in the Billroth II configuration was performed. The patient was discharged on postoperative day 15, with no complications.