A Rare Case of Adenocarcinoma of Ampulla of Vater – A Case Report

Abstract

Introduction: Periampullary tumors account approximately 5% of all gastrointestinal cancers, and Vater’s papilla. Vater’s papilla tumors are the second most common entity of periampullary cancer. Case Presentation: We present a 69-year-old female patient who presented to the emergency room with symptoms including:  jaundice, hyperchromic urine and involuntary weight loss, which she havd developed over the preceding three weeks ago. The results of her laboratory tests showed hyperbilirubinemia with predominance of conjugated bilirubin and she had ultrasound scan of her abdomen and pelvis which demonstrated features adjudged to be suggestive of periampullary mass associated with dilated pancreatico-biliary tree. No abdominopelvic lymphadenopathy, no free peritoneal fluid on computed tomography (CT) scan was demonstrated. She underwent Endoscopic Retrograde Cholangio-Pancreatography (ERCP) which revealed a papillary apparatus with a budding, vegetative tumor with infiltration into her duodenum. She underwent exploratory laparotomy and Whipple’s pancreaticoduodenectomy. Histopathology examination of the excised surgical specimen revealed Vater’s papilla adenocarcinoma. She would be undergoing regular follow-up assessments after she has been discharged from hospital to ascertain her progress following her pancreato-duodenectomy which we had regarded as her treatment of curative intent pursuant to our multi-disciplinary team approach to her treatment. Conclusions: Surgical resection is the only curative treatment for ampullary carcinoma and the standard surgical approach is pancreaticoduodenectomy. In absence of lymph node metastasis and any organ metastasis, it would be envisaged that the patient would have a good five year survival pursuant to her surgery and she would have regular careful follow-up assessments with inclusion of clinical assessments, laboratory test assessments and radiology imaging assessments.