Reporting female patient 57 years old

Refer from internal medicine department

With clinical information : duodenal mass suspected metastasis of pankretic cancer

Amamnesa:
The patient have the Chief Complain right upper quadrant abdominal pain, getting worse
since 2 months a go, intermittently. The pain feels penetrating to the back, not referred to
the hand or neck.
The patient also complain Nausea and vomiting every 30 minutes until 1 hour after eating.
Vomiting consists of food that is ingested, no blood contain
The patient feel Right upper quadrant mass, not painful, since 2 months a go
Decreased body weight, around 10 kgs in this 2 months and also decreased appetite
Stool is normal, sometimes black and liquidy

Patient was underwent ultrasound examination in Ratu Ebo general hospital on 16 april
2018 with result :

Suggest intraluminar mass in the right upper quadrant abdomen, next to the liver, about 9
cm, suspect carcinoma colon transversum dd duodenal mass

And abdominal ct-scan in the same hospital on 17 april 2018 with result :

Suggest mass that comes from duodenum, size 7,1x5,5x8,3 cm, probable infiltrating the
head of pancreas, whether the mass comes from the head of pancreas still can’t be
removed because the border of the pancreas is not clear
pancreatic duct is slightly widened
No infiltration to the abdominal wall

From Upper gastrointestinal Study we got:

Plain foto :
There is no dilatation of bowel gas in the abdominal cavity
The Bones seem good
Contrast study :
The patient is asked to drink water and she does not choke
Approximately 100 cc of Barium contrast in dilution was drunk by the patient
The contras fill esophagus pars proximal, medial, distal and gaster then contras fill
duodemum part descendent, tranversum, ascendant and part of jejenum.
There is irregular narrowing in the 2nd and 3rd part of duodenum measuring about
approximately 6,8 cm in length and with the contrast passage remain normal
There is no contras leakage

Our conclution :
Irregular narrowing in the 2nd and 3rd part of duodenum which didn’t cause delayed passage
nor apparent obstruction suggesting an extraluminal mass of duodenum