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International Journal of Clinical and Experimental Medicine Research

ISSN Print: 2575-7989 Downloads: 201043 Total View: 2386936
Frequency: quarterly ISSN Online: 2575-7970 CODEN: IJCEMH
Email: ijcemr@hillpublisher.com
Article Open Access http://dx.doi.org/10.26855/ijcemr.2018.07.001

Transduedonal Excision Of Ampullar Adenoma; Case Report

Mehmet Fatih CAN1, Yaşar Subutay PEKER1,*, Şahin KAYMAK1, Sezai DEMİRBAŞ2

1University of Medical Sciences, Gülhane Training and Research Hospital, Department of General Surgery, Turkey 

2TOBB-ETÜ University Hospital, Department of General Surgery, Turkey

*Corresponding author: Yaşar Subutay PEKER

Published: July 25,2018

Abstract

Introduction: Diagnosis/treatment/follow-up of ampullar adenomas are tough cases for clinicians because of their localizations. Treatment of ampullar adenomas has a wide range from endoscopic excision to pancreaticoduedenectomy (PD) where transduedonal ampullectomy (TdA) is one of them. This case report aimed to share our experiences about ampullar adenoma, which endoscopic excision was not able to be applied and TdA was successfully performed. Case Report: 72-years-old-male patient applied to gastroenterology clinic with incidentally diagnosed increase at cholestatic enzymes. Patient was diagnosed as ampullar adenoma, which was endoscopicaly excised. The histopathologic evaluation was reported as 2.5x2.5x1.5cm low grade displastic ampullar adenoma with minimal high grade displasia and positive surgical margins. The patient applied to our clinic and TdA was planned to the patient considering him not having invasive tumour diagnosis, his age and comorbidities. TdA was successfully performed with negative surgical margins. Postoperative bile drainage as observed and medical treatment for 25 days was applied. The bile leakage interrupted on postoperative 25th day and patient was discharged on 29th day. Conclusion: Surgery is the only alternative to endoscopic excision for ampullar ade-noma and TdA is superior to PD when no invasive tumor is diagnosed and ASA score of the patient is high.  For this reason we believe that TdA is a feasible technique for ampullar adenomas if the adenoma is not suitable for endoscopic resection because of its size or if the resection margins of the adenoma with dysplasia are positive.


References

[1] Alvarez-Sanchez MV, Napoleon B. EUS and ampullary adenoma: Why? When? Endosc Int Open. 2016;4(12):E1319-E21. 

[2] Gaspar J, Shami VM. The role of EUS in ampullary lesions: is the answer black and white? Gastrointest Endosc. 2015;81(2):389-90.

[3] Artifon EL, Couto D, Jr., Sakai P, da Silveira EB. Prospective evaluation of EUS versus CT scan for staging of ampullary cancer. Gastrointest Endosc. 2009;70(2):290-6. 

[4] Ito K, Fujita N, Noda Y, Kobayashi G, Horaguchi J, Takasawa O, et al. Preoperative evaluation of ampullary neoplasm with EUS and transpapillary intraductal US: a prospective and histopathologically controlled study. Gastrointest Endosc. 2007;66(4):740-7. 

[5] Zadorova Z, Dvofak M, Hajer J. Endoscopic therapy of benign tumors of the papilla of Vater. Endoscopy. 2001;33(4):345-7. 

[6] Baillie J. Endoscopic ampullectomy. Am J Gastroenterol. 2005;100(11):2379-81. 

[7] Patel V, Jowell P, Obando J, Guy CD, Burbridge RA. Does ampullary adenoma size predict invasion on EUS? Does invasion on EUS predict presence of malignancy? Endosc Int Open. 2016;4(12):E1313-E8. 

[8] Espinel J, Pinedo E, Ojeda V, Guerra Del Rio M. Endoscopic ampullectomy: a technical review. Rev Esp Enferm Dig. 2016;108(5):271-8. 

[9] Ahn KS, Han HS, Yoon YS, Cho JY, Khalikulov K. Laparoscopic transduodenal ampullectomy for benign ampullary tumors. J Laparoendosc Adv Surg Tech A. 2010;20(1):59-63. 

[10] Lee H, Park JY, Kwon W, Heo JS, Choi DW, Choi SH. Transduodenal Ampullectomy for the Treatment of Early-Stage Ampulla of Vater Cancer. World J Surg. 2016;40(4):967-73. 

[11] Hong S, Song KB, Lee YJ, Park KM, Kim SC, Hwang DW, et al. Transduodenal ampullectomy for ampullary tumors - single center experience of consecutive 26 patients. Ann Surg Treat Res. 2018;95(1):22-8.

How to cite this paper

Transduedonal Excision Of Ampullar Adenoma; Case  Report

How to cite this paper:  Mehmet Fatih CAN, Yaşar Subutay PEKER, Şahin KAYMAK, Sezai DEMİRBAŞ. (2018) Transduedonal Excision Of Ampullar Adenoma; Case  Report. International Journal of Clinical and Experimental Medicine Research, 2(7), 90-92.

DOI: http://dx.doi.org/10.26855/ijcemr.2018.07.001