Study on 4 cases of malignant tumor of Vater’s ampulla operated at Viet-Duc Hospital and 1 case treated at University of Medicine and Pharmacy at Ho Chi Minh City between August 2003 and December 2004. Results: clinical sign is biliary obstruction jaundice. Gastroduodenoscopy with flexible tube found that papilla of Vater with the diameter lower than 3cm (histological finding: carcinomas), without metastasis to adjacent duodenum. Tumor invasion into head of pancreas and the lower of choledochous duct was determined by pancreatic and liver ultrasound, CT scanner or MRI examinations, in combination with intraoperative balance, immediate biopsy of lymph nodes in group 14 and group 8, sections of bile duct, pancreatic duct and duodenum in order to ensure the elimination of surgery. Initial outcomes showed that there wasn’t post-operative complication or death.
Ampulla of Vater ; Duodenum ; Therapeutics ; Surgery

No abstract availble
*Ampulla of Vater ; Common Bile Duct Neoplasms/*surgery ; Female ; Humans ; Male ; *Sphincterotomy, Endoscopic

Ampulla of Vater/pathology* ; Carcinoma/pathology* ; Common Bile Duct Neoplasms/surgery* ; Humans

Detection of tumors of the ampulla of Vater, including ampullary adenoma, has been improved by routine screening endoscopic procedures and imaging modalities. Endoscopic resection by endoscopic papillectomy is rapidly replacing classic surgical resection and is a less invasive procedure. Endoscopic resection can have a role not only in the final histopathologic diagnosis but also as a definite therapeutic option. However, the indications for endoscopic resection are not fully established, and endoscopic procedures are not standardized. Significant complications, including severe pancreatitis, intractable bleeding and duodenal perforation, are rare but can occur, especially in less experienced hands. Severe pancreatitis is the most feared complication, but it can be prevented by pancreatic duct stent insertion in most cases. However, in some cases, pancreatic stenting can be challenging after resection. Incomplete resections are sometimes performed to avoid complications. Endoscopic surveillance is also important for identifying and managing remnant adenomatous tissue or recurrent lesions. Further technical development is needed to expand the indications for this procedure, minimize complications and ensure a high success rate.
Adenoma/pathology/*surgery ; Ampulla of Vater/pathology/*surgery ; Carcinoma/pathology/*surgery ; Common Bile Duct Neoplasms/pathology/*surgery ; Endoscopy, Digestive System ; Humans

Here, a case of a patient with incidental finding of a carcinoid tumor of the ampulla of Vater, who was treated with endoscopic snare papillectomy, is reported. A 62-year-old male was admitted to our hospital due to a carcinoid tumor of the ampulla of Vater, which was found during follow-up endoscopy after an endoscopic mucosal resection of early gastric cancer. No lymphadenopathy or visceral metastasis was found on an abdominal CT scan, In-111 octerotide scan and EUS. The ampulla was then en bloc removed by endoscopic snare papillectomy. The resected specimen revealed a 0.7 X 0.5 X 0.1 cm sized carcinoid tumor. All margins of resection were negative for tumor. After six months of follow-up, there was no evidence of recurrence and metastasis, either endoscopically or radiologically. To our knowledge, this case is the first report of an ampullary carcinoid tumor treated by endoscopic snare papillectomy in Korea.
Ampulla of Vater/pathology/*surgery ; Bile Duct Neoplasms/diagnosis/*surgery ; Carcinoid Tumor/diagnosis/*surgery ; *Duodenoscopy ; Electrosurgery/*methods ; Humans ; Male ; Middle Aged

Ampulla of Vater ; Common Bile Duct ; transplantation ; Duodenum ; surgery ; Gastrointestinal Stromal Tumors ; pathology ; surgery ; Humans ; Male ; Middle Aged

Adenosquamous carcinoma of the papilla of Vater is a rare tumor and only a few cases have been reported so far. Here, we report a case of adenosquamous carcinoma in a 76-year-old male who presented with jaundice and right upper quadrant abdominal pain. Ultrasonography and enhanced abdominal CT scans showed dilated common bile duct (CBD) and intrahepatic bile duct (IHD) with a suspicious obstructing mass in distal CBD. On endoscopy, obstructing and ulcerated mass was noted on the papilla of Vater. Histopathological inspection of the biopsied specimens from mass showed adenosquamous cell carcinoma of the papilla of Vater. Since the patient refused operation, we inserted a self-expandable metallic stent in distal CBD. This is the first case report on adenosquamous carcinoma of the papilla of Vater in Korea.
Aged ; Ampulla of Vater/*pathology ; Carcinoma, Adenosquamous/*diagnosis/pathology/surgery ; Cell Differentiation ; Humans ; Immunohistochemistry ; Male ; Tomography, X-Ray Computed

OBJECTIVESTo analyze the prognostic factors for elderly patients with pancreaticoduodenectomy for periampullary tumor.

METHODSA retrospective analysis of the prognostic factors for the mortality rate was made in 127 elderly patients within 30 days of pancreaticoduodenectomy for periampullary tumor from January 1985 to November 2006 Chi-squared test, Fisher's exact test, t-test were used.

RESULTSThe prognostic factors for the first-month mortality rate in elderly patients with pancreaticoduodenectomy included time length of the operation, operative hemorrhage, postoperative hemorrhage, pulmonary infection, and postoperative TP.

CONCLUSIONSAn overall consideration should be paid to the factors that affect the prognosis of elderly patients with pancreaticoduodenectomy for periampullary tumor during the perioperative period. The security of the patients can be promoted by controlling these prognostic factors.

Aged ; Ampulla of Vater ; Common Bile Duct Neoplasms ; surgery ; Female ; Humans ; Male ; Middle Aged ; Pancreaticoduodenectomy ; mortality ; Prognosis ; Retrospective Studies ; Survival Analysis

OBJECTIVETo compare of the outcome of all patients who received surgical treatment in one institute for periampullary carcinoma during different intervals over the past 40 years.

METHODSRetrospective review of 475 patients suffering from periampullary carcinoma in intervals 1958 approximately 1976, 1977 approximately 1987, 1988 approximately 1998 and 1999 approximately 2003 is presented.

RESULTSIn interval 1958 approximately 1976, for 128 patients, the tumor resection rate was: pancreatic carcinoma (PC) 26.6% (21/79), ampullary carcinoma (AC) 86.2% (25/29), distal bile duct cancer (DBDC) 38.5% (5/13), and duodenal cancer (DC) 57.1% (4/7). In interval 1977 approximately 1987, for 70 patients, the tumor resection rate was: PC 26.7% (16/60), AC 66.7% (4/6), DBDC 100% (1/1), and DC 66.7% (2/3). In interval 1988 approximately 1998, for 147 patients, the tumor resection rate was: PC 20.2% (22/109), AC 75.0% (12/16), DBDC 50.0% (2/4), and DC 66.7% (12/18). In interval 1999 approximately 2003, for 130 patients, the tumor resection rate was: PC 20.4% (20/98), AC 100% (4/4), DBDC 75.0% (12/16), and DB 83.3% (10/12). Cumulatively, from 1958 to 2003, the incidence of DBDC has become significantly higher, and the average of total bilirubin level (TBIL) has gradually been going downward, the average of blood transfusion during operation and the diameter of resected tumor has been becoming smaller. From 1999 to 2003, none of the 130 periampullary carcinoma patients had received biliary drainage before operation.

CONCLUSIONMortality and complication have become significantly lower because of effective improvement in the perioperative preparation and the care after surgery of periampullary cancer in the recent years. Even though the accurate diagnosis has become increasing earlier than before, the resection rate and prognosis of periampullary carcinoma remain poor.

Ampulla of Vater ; surgery ; Common Bile Duct Neoplasms ; surgery ; Duodenal Neoplasms ; surgery ; Female ; Humans ; Male ; Pancreatic Neoplasms ; surgery ; Pancreaticoduodenectomy ; adverse effects ; Treatment Outcome

Gangliocytic paragangliomas (GPs) are rare tumors of the duodenum, presenting as single sessile or pedunculated polypoid masses. Clinical manifestations of duodenal GPs can vary from an incidental finding at endoscopy to frequent upper gastrointestinal bleeding caused by mucosal ulceration and abdominal pain. GPs are considered benign, but the disease can recur and spread to regional lymph nodes. A 41-year-old female presented with abdominal pain. Upper gastrointestinal endoscopy revealed a subepithelial tumor of the ampulla of Vater in the second portion of the duodenum. The tumor was resected using the endoscopic mucosal resection technique. The tumor was diagnosed as benign GP of the duodenum using histological and immunohistochemical staining procedures.
Adult ; Ampulla of Vater/chemistry/*pathology/surgery ; Biopsy ; Duodenal Neoplasms/chemistry/*pathology/surgery ; Duodenoscopy ; Female ; Humans ; Immunohistochemistry ; Paraganglioma/chemistry/*pathology/surgery ; Treatment Outcome ; Tumor Markers, Biological/analysis