[A Case of Intra-Abdominal Desmoid Tumor with Acute Abdominal Pain].

A 70-year-old man was admitted to our hospital with acute abdominal pain. Abdominal CT showed a 6-cm-sized tumor near the third portion of the duodenum, and a duodenal GIST was suspected. Although the abdominal pain was intense and the tumor was suspected to be ruptured, the vital signs were stable; therefore, we initially planned to perform an elective surgery. However, because the pain could not be controlled, the surgery was performed on the 6th day of hospitalization. The tumor appeared to be a duodenal GIST because it was pulling the third portion of the duodenum inwards. It had a strong tendency to infiltrate the surrounding organs; therefore, forced resection of the right colon, which is the surrounding organ, was performed. Pathological findings showed that the resected specimen was a desmoid tumor and the surgical margins were negative. The postoperative course 1 year after surgery was favorable, and no tumor recurrence occurred. We report a case of desmoid tumor, which caused acute abdominal pain.

[Pancreatic Head Cancer Invading the Ascending Part of the Duodenum with Difficulty in Diagnosis-A Case Report].

A 61-year-old man visited our hospital because of nausea and vomiting. Abdominal CT revealed a severe stenosis of the ascending part of the duodenum but no evidence of tumors in the duodenum or pancreas. Upper gastrointestinal endoscopy showed severe stenosis of the ascending part of the duodenum with an ulcerative lesion. A biopsy of the site showed no evidence of malignancy. Nevertheless, duodenal and/or pancreatic cancer(s)could have caused the stenosis; therefore, we decided to perform an operation for the diagnosis and treatment of the obstruction. The surgery revealed severe stenosis of the ascending part of the duodenum with scar tissue. We performed subtotal stomach-preserving pancreaticoduodenectomy. Pathological findings showed pancreatic head cancer invading the ascending part of the duodenum. In this case, the diagnosis was difficult to make preoperatively because of the lack of an obvious neoplastic lesion. We believe duodenal invasion by pancreatic cancer without recognizing any tumor mass on CT is rare.