The authors describe a case of the surgical treatment of duodenal neuroendocrine tumor (d-NET) at third and fourth part (D3-D4) of duodenum. A woman 42 years old presents us with severe intermittent vomiting for 2 months. Her work-up found a large duodenal wall mass size 8 cm at D3-D4 of duodenum with displaced pancreatic body. We performed a pancreas sparing distal duodenectomy (PSDD) with end to side duodenojejunostomy with lymphatic dissection. Post-operative course found mild pancreatitis with infected intra-abdominal fluid collection. She developed partial gut obstruction 2.5 months after operation but complete resolution by conservative treatment. PSDD is feasible as an operative option to avoid pancreaticoduodenectomy. This procedure can make adequate negative margin for d-NET. 1 year follow-up has not found any recurrence.

Keywords: Duodenal neuroendocrine tumor, Third and fourth part duodenum, Pancreas sparing distal duodenectomy