Multi-course photodynamic therapy in a patient with malignant tumor of the major duodenal papilla. Clinical case

Abstract

The article presents a clinical case of successful elimination of mechanical jaundice by means of a course of photodynamic therapy in a patient with a malignant neoplasm of the major duodenal papilla and multimorbid concomitant pathology. The patient, admitted with a clinical picture of mechanical jaundice, after additional examination was given a final diagnosis - moderately differentiated adenocarcinoma of the major duodenal papilla, stage IIa (T2N0M0), complicated by moderate mechanical jaundice. After primary stenting, a series of three consecutive courses of combined systemic and local photodynamic therapy were performed with a three-month interval between them. During the last course, stent migration into the duodenum was detected. Nevertheless, the complex therapy allowed to effectively eliminate the manifestations of mechanical jaundice, stabilize the patient's condition, prevent further growth of the primary tumor, restore the patency of the ducts of the major duodenal papilla and avoid relapses of mechanical jaundice, despite the migration of the stent. This experience demonstrates the promise of the photodynamic approach for solving complex clinical situations associated with tumor damage to the biliary system and allows to consider this method as an alternative in situations of high risk of complications of traditional surgery.