Laparoscopic Gastrojejunostomy for the Treatment of SIRT-Induced Duodenal Ulcer Complicated by Gastric Outlet Obstruction

Abstract Selective internal radiation therapy (SIRT) is an emerging therapeutic modality in patients with unresectable hepatocellular carcinoma or liver metastases. However, complications can occur due to migration of microspheres such as gastrointestinal ulcer, cholecystitis, bleeding, pancreatitis, and many others. A 50-year-old woman stage IV breast cancer who underwent radioembolization for hepatic metastasis 6 months ago presented our hospital 1 month history nausea, vomiting, food intolerance, weight loss. Esophagogastroduodenoscopy showed large deep duodenal bulbar ulcer along antral ulcerations edematous gastropathy. Biopsies revealed typical black, yttrium-90 sphere, documenting injury. After she was discharged on proton pump inhibitor, the patient came back later exacerbation symptoms; computed tomography scan abdomen gastric outlet obstruction. Although there no consensus treating radiation-induced ulcers, physicians should be aware this complication SIRT presenting abdominal pain.