Case Report: Successful staged multidisciplinary management of concurrent duodenal papilla adenocarcinoma and cholelithiasis: a rare case in primary hospital.

BACKGROUND

Duodenal papillary adenocarcinoma is a rare malignant tumor. Its early symptoms are often insidious and frequently coexist with common biliary diseases such as cholelithiasis, leading to missed or delayed diagnosis. Radical pancreaticoduodenectomy is the standard treatment, but postoperative complications like lymphatic leakage and gastroparesis are common and challenging to manage. Currently, clinical reports on the diagnosis and treatment of duodenal papillary adenocarcinoma combined with gallstones in primary care hospitals are relatively scarce.

CASE DESCRIPTION: This article reports the case of a 71-year-old female patient who presented with upper abdominal pain. Imaging suggested gallstones and common bile duct stones with biliary obstruction, alongside a mass at the duodenal papilla. The patient declined preoperative ERCP biopsy. The treatment team adopted a staged strategy: Stage one involved laparoscopic common bile duct exploration with stone extraction and cholecystectomy, with intraoperative biopsy confirming duodenal papillary adenocarcinoma (moderately to well-differentiated); Stage two consisted of radical pancreaticoduodenectomy, with partial transverse colectomy performed due to suspected tumor infiltration. Postoperatively, the patient developed persistent lymphatic leakage and gastroparesis syndrome. Through multidisciplinary collaboration, a combination of traditional Chinese medicine acupuncture, enhanced nutritional support, anti-infection therapy, and the innovative application of digital subtraction angiography lymphangiography and targeted embolization successfully controlled the lymphatic leakage. After three months of individualized comprehensive treatment in a primary care hospital, the patient was discharged in stable condition.

CONCLUSIONS

For patients with duodenal papillary adenocarcinoma combined with acute biliary obstruction, staged surgery is a feasible individualized strategy. The management of complex complications following radical pancreaticoduodenectomy is crucial. It requires a multidisciplinary integrated diagnosis and treatment model in primary care hospitals, combining traditional supportive therapies with modern precision interventional techniques to improve patient outcomes. This case provides a reference for the diagnosis and treatment of such rare and complex situations.