Oxaliplatin/5-fluorouracil/leucovorin [FOLFOX4] regimen as an adjuvant chemotherapy in the treatment of advanced jejunal adenocarcinoma: a report of 2 cases

To present our clinical experience of 5-fluorouracil/leucovorin/oxaliplatin [FOLFOX4] regimen administered as an adjuvant chemotherapy to 2 patients with advanced jejunal adenocarcinoma. Case Presentation and Intervention: A 55-year-old woman presented with recurrent upper abdominal pain, nausea and vomiting. A small bowel series as well as the abdominal computed tomography scan revealed an irregular narrowing lesion at the proximal jejunum. The patient then underwent an exploratory laparotomy and the jejunal adenocarcinoma with localized peritoneal metastasis was found [R0 resection, T3N1M1, stage IV]. Chemotherapy with FOLFOX4 regimen of 12 cycles was initiated after the curative resection. No adverse event was observed during the period of chemotherapy. She has been well without evidence of recurrence for over 20 months postoperatively. The second case was a 77-year-old female presenting with mechanical ileus. Surgical exploration revealed a proximal jejunal adenocarcinoma with regional lymph node involvement [R0 resection, T3N1M0, stage III]. She also received the FOLFOX4 chemotherapy of 12 cycles with an uneventful course. No obvious toxicity developed except for temporary grade I peripheral neuropathy and skin eruption. This patient has survived well and has been free of this disease for over 12 months since the operation. This report showed that adjuvant chemotherapy with FOLFOX4 regimen seems effective and well tolerated in these 2 patients with advanced jejunal adenocarcinoma. Further investigation of a large number of patients with long-term follow-up is needed to confirm these findings

Intramural duodenal hematoma and hemoperitoneum in anticoagulant therapy following upper gastrointestinal endoscopy

To report the unusual occurrence of intramural duodenal hematoma in a case on anticoagulant therapy, presenting as a complication of gastrointestinal endoscopy. A 74-year-old female patient developed nausea, vomiting and abdominal pain, and subsequently hypovolemic shock, 2 days after fiberoptic upper gastrointestinal endoscopy. The patient's international normalized ratio value was 2.7. A computed tomographic scan of the abdomen demonstrated duodenal wall thickening with intramural hematoma, as well as hematoma in the pararenal space and pelvic cavity. The patient was treated by conservative treatment that included correction of clotting abnormalities, blood transfusion, nasogastric decompression, hydration, and parenteral nutrition support. She resumed oral intake after 10 days of support treatment, recovering uneventfully. This case shows the possibility of development of an intramural duodenal hematoma in patients on anticoagulant therapy, without biopsies being taken