Food bolus obstruction to duodenal stent for carcinoma of the pancreas

Case contributed by Chris O'Donnell
Diagnosis certain

Presentation

Past history of carcinoma of pancreas treated with duodenal and biliary stents for duodenal and CBD obstruction. Now presents with abdominal pain and vomiting.

Patient Data

Age: 60 years
Gender: Male

Biliary stent in situ with non-dilated, gas-filled intra-hepatic ducts,  food-distended stomach with food in the 2nd part duodenal stent (arrows on coronal image) and a collapsed 3rd part of duodenum.  Pancreatic head not markedly enlarged at the site of tumor.

Case Discussion

As in distal esophageal carcinoma, metallic stents can be inserted into the duodenum under endoscopic control in order to overcome mechanical bowel obstruction.  These stents have issues of migration, perforation, hameorrhage and obstruction by tumor and (as in this case) food bolus.

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