The first documented case of duodenal carcinoma was described by Hamburger in 1746. Primary adeno-carcinoma of duodenum is rare. Malignant tumors of the small bowel are reported to account for about 1% of all gastrointestinal carcinoma. The autopsy incidence of duodenal adenocarcinoma is about 0.3% of all malignancy. The second and third portions of the duodenum are the usual sites of adenocarcinoma. Cancer in the duodenal bulb is exceedingly rare. Most of them revealed an intraluminal mass or wall thickening. But we have experienced a case of exophytic growth pattern adenocarcinoma such as the fistula of duodenal bulb in 49 year old male patient with hematemesis. For its great rarity, we report this case with review of literatures.
Adenocarcinoma* ; Autopsy ; Duodenum ; Fistula* ; Hematemesis ; Humans ; Incidence ; Male ; Middle Aged

BACKGROUND: There are increasing reports of hepatic abscess cause by K. pneumoniae, especially in Asia and its more frequent occurrence in diabetes mellitus but the reason remains unclear. This study was conducted to clarify the different clinical presentations between patients with K. pneumoniae (KP group) and those with non-K. pneumoniae (non-KP group) hepatic abscess. METHODS: A retrospective clinical survey was done from April 1997 to February 2001. The medical records of 20 adults with culture-confirmed pyogenic liver abscess who had attended Chonbuk National University hospital were reviewed. RESULTS: Hepatic abscess caused by K. pneumoniae accounted for 10 (50%) of 20 patients with pyogenic liver abscesses. Compared to KP group, non-KP group showed higher proportions of polymicrobial infections (50% vs 20%) including E. coli, Proteus sp., Enterobacter sp., Citrobacter sp., P. aeruginosa, viridans streptococcus, Enterococcus, and Bacteroides sp.. Although, the clinical presentations of the two groups were similar, but KP group showed higher association with diabetes mellitus, lower hepatobiliary diseases, and larger abscess formation than non-KP group. CONCLUSION: K. pneumoniae was one of the most important causative organism in pyogenic liver abscess. Clinical findings were similar between K. pneumoniae heatic abscess and non-K. pneumoniae-induced abscess, though, K. pneumoniae-induced hepatic abscess was more frequently associated with diabetes mellitus and single large abscess.
Abscess ; Adult ; Asia ; Bacteroides ; Citrobacter ; Coinfection ; Diabetes Mellitus ; Enterobacter ; Enterococcus ; Humans ; Jeollabuk-do ; Klebsiella pneumoniae* ; Klebsiella* ; Liver Abscess ; Liver Abscess, Pyogenic* ; Medical Records ; Pneumonia* ; Proteus ; Retrospective Studies ; Streptococcus