Fatal Duodenal Ulcer Hemorrhage in a Post-Operative Patient of Proximal Femur Fracture Undergoing Carbon Ion Radiotherapy for Locally Advanced Pancreatic Carcinoma: A Case Report

The incidence and mortality rates of pancreatic cancer have been increasing. Due to the high likelihood of metastasis and vascular invasion, most pancreatic cancer cases are inoperable at the time of diagnosis. Carbon-ion radiotherapy (CIRT) has recently been introduced as a treatment option for locally advanced pancreatic cancer (LAPC). However, potential complications, including peptic ulcer disease (PUD), have been noted. This report presents a case of death due to PUD following a proximal femur fracture, with a history of CIRT for unresectable LAPC. A 59-year-old female undergoing CIRT for unresectable LAPC sustained a proximal femur fracture due to a fall. She underwent open reduction and intramedullary nailing. The surgery was performed successfully, but on the third postoperative day, she developed massive gastrointestinal bleeding due to a duodenal ulcer. Despite initial stabilization, a recurrence of the bleeding occurred on the fifth postoperative day, and she passed away. This case highlights the potential association between CIRT and PUD, emphasizing the need for careful perioperative gastrointestinal management in patients with a history of CIRT.