Successful biopsy of pancreatic tumor located in a dangerous location

The patient from Hoai Nhon, Gia Lai, was admitted to the hospital in a state of choking. The doctor of Internal Medicine Department 4 determined that the patient had a tumor in the head of the pancreas and ordered a biopsy for pathology. This is a mandatory basis for devising an accurate treatment regimen.

However, the intervention faced many challenges due to the patient’s age and old surgical scars on the abdominal wall, which reduced the ability to observe through ultrasound. The tumor is located in the head of the pancreas – a dangerous position in the abdomen, surrounded by the visceral blood vessel system, mesentery and tightly attached to the duodenum. On computed tomography images, doctors could barely find a clear entrance because it was covered by the digestive tract and blood vessels.

To prepare, the team created a 3D reconstruction based on the CT scan of the abdomen, and at the same time applied the technique of compressing the digestive tract to open a safe path for the biopsy needle.

In the intervention room, the amount of gas in the patient’s digestive tract is still limited, limiting the doctor’s vision. At the first needle press, the team took two specimens but the results did not meet diagnostic requirements due to the fibrous nature of the pancreatic tumor lesion. Not giving up, the team adjusted their strategy, inserting the needle deeper into the center of the tumor a second time to take a longer core sample.

After 35 stressful minutes, the biopsy was completed, taking enough quality specimens without causing complications of duodenal perforation or major blood vessel damage. Pathology results later determined that the tumor had invaded the nerve, consistent with the patient’s pain symptoms during the procedure.

“Getting a biopsy sample for pathology is extremely necessary. Once these results are available, doctors will quickly proceed with an appropriate treatment regimen to prolong the patient’s life,” said Dr. Nguyen Cong Tam, Department of Internal Medicine 4, Da Nang Oncology Hospital.

According to Dr. Pham Nguyen Huy Tung, Department of Diagnostic Imaging, pancreatic biopsy is one of the most difficult techniques in the group of deep organ biopsies. The procedure requires the doctor to be professional and flexible in handling situations because even a small deviation can lead to dangerous complications.

Currently, this technique is routinely performed at Da Nang Oncology Hospital through multi-specialty coordination, helping to improve diagnostic capacity and open up opportunities for early treatment for cancer patients.