While most urothelial carcinomas arise in the bladder, upper tract urothelial carcinoma (UTUC) accounts for only 5–10% of cases. Despite its rarity, several studies aimed on the distribution of metastatic sites in these patients. The most common metastatic sites were lungs, bones, liver, and lymph nodes. Other locations such as gastrointestinal tract have been reported but remain uncommon. In this article, we would show a rare case and a literature review of UTUC with metastasis to the duodenum, complicated by duodenal stenosis.

We searched PubMed in March 2025 for all original articles without language or time restrictions by keywords of "upper tract urothelial carcinoma," "metastases," "duodenum," and "duodenal stenosis." Reports that did not focus on UTUC were excluded. After a full-text review, we identified nine case reports. We would analyzed these cases with respect to surgical procedures, adjuvant therapies, and survival outcomes. Herein, we also present our case as a reference for treatment considerations.

Case presentation: This is a 70-year-old female with hypertension presented to our emergency room due to postprandial vomiting for two weeks. On arrival, her vital signs were stable with physical examination revealed only epigastric percussion hyperresonance. The following non-contrast abdominal and pelvic computed tomography revealed right hydronephrosis, and a grossly distended stomach and duodenum. No abnormally enlarged lymph nodes were observed.(Figure1,2). The following ureteroscopy revealed a right ureteral papillary tumor(Figure3), and the histopathology of biopsy confirmed invasive papillary urothelial carcinoma. No lung or bone metastases after cancer staging(Figure4). Given anesthetic concerns, small bowel endoscopy was attempted first for diagnosis but failed due to anatomical challenges. As gold standard treatment for UTUC and for relieving symptoms, right laparoscopic nephroureterectomy with bladder cuff excision, and modified partial duodenectomy with duodenojejunostomy were done. Surprisingly, the final pathological result showed right ureter invasive papillary urothelial carcinoma with duodenum metastasis. Fortunately, the patient was discharged with better appetite thereafter, and now under regular outpatient follow-ups receiving chemotherapy with gemcitabine and cisplatin. Discussion: Duodenal stenosis caused by UTUC is rare. Based on the review we compiled, radical surgery was performed in three cases, gastrointestinal bypass surgery in four, and conservative treatment in two. Considering the outcomes from above, the patients’ economic concerns, and the health insurance in Taiwan, we performed radical surgery in our case, followed by chemotherapy with gemcitabine and cisplatin.

Duodenal stenosis secondary to UTUC is a rare occurrence. Surgical intervention is essential not only for symptom relief but also for potentially optimizing survival outcomes. We hope that the treatment process from our case, along with this literature review, could provide a valuable reference for managing other similar cases.