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

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