Operation performed: Exploratory laparotomy with Roux-en-Y gastrojejuostomy, gastrotomy with extraction of duodenal stent, duodenotomy with transduodenal pancreatic biopsy under interoperative ultrasound guidance, duodenal biopsy, biopsy of retroperitoneal lymph node with rapid frozen section, cholecystectomy with placement of transcystic common bile duct sten, gastrostomy tube, feeding jejunostomy tube, repair of duodentomy and incindental appendectomy.