Jejunal Enterotomy for Specimen Retrieval in D-LECS: A Case Report.

INTRODUCTION: Laparoscopic and endoscopic cooperative surgery for duodenal tumors (D-LECS) combines endoscopic submucosal dissection (ESD) with laparoscopic reinforcement, offering a minimally invasive option for superficial non-ampullary duodenal tumors. However, oral retrieval of resected specimens may be difficult for large or firm tumors, risking fragmentation and compromised pathological assessment. CASE PRESENTATION: We report a case involving a 42-year-old woman with a 40-mm villous tumor in the second portion of the duodenum. Due to the size of the tumor, D-LECS (ESD with laparoscopic reinforcement) was contemplated. After successful ESD, the specimen could not be retrieved orally due to non-passage through the pyloric ring. To preserve en bloc integrity, the specimen was advanced into the jejunum, and the jejunal loop was exteriorized through a small umbilical incision. An enterotomy was performed extracorporeally, allowing safe retrieval without contamination. The enterotomy was securely closed, and the patient recovered without complications. CONCLUSIONS: This case demonstrates that jejunal exteriorization and controlled enterotomy is a safe and practical alternative in D-LECS when oral extraction is unfeasible, enabling accurate pathological evaluation while preserving minimally invasive benefits.