[Segmental duodenectomy (D3, D4) for angiosarcoma].

UNLABELLED: A 66-year-old patient was admitted to the Department of Surgery at the Na Bulovce Hospital (First Faculty of Medicine, Charles University in Prague) following an episode of bleeding into the gastrointestinal tract. Gastroscopy found a large, wide-based sessile polypoid mass, exulcerated at its top and filling a major part of the intestinal lumen. Conclusion based on biopsy: malignant mesenchymal tumour - sarcoma. An abdominal CT scan revealed, besides this tumour, also metastases in the spleen. With regard to the malignant nature of the tumour and from fear of gradual bleeding out, we performed segmental resection of the third and fourth part of the duodenum with complete removal of the tumour. The descending (second) part of the duodenum was sewn end-to-end, about 4 cm underneath the ampulla of Vater, with the first loop of the jejunum, with anastomosis using atraumatic, two-layer continuous suture. Splenectomy was performed at the end of the operation. Post-operative course was without complications, the patient was discharged with regular diet and with restored bowel passage on the eleventh day after surgery.

FINAL DIAGNOSIS: high-grade duodenal angiosarcoma, multiple metastases from this tumour in the spleen.