title: Benign duodenal villous adenoma obstructing the ampulla of Vater: a surgical dilemma.
abstract: The discovery of an elevated serum alkaline phosphatase level during routine blood screening in a 53-year-old man led to tests that showed a large benign villous adenoma obstructing the ampulla of Vater in the second part of the duodenum. Although the preferred treatment of such a lesion is local excision, the tumor was extensive and necessitated a pancreatoduodenectomy. Histologically benign duodenal villous adenomas that also obstruct the common bile duct are uncommon and may be missed during surgical exploration; therefore, whenever there are no stones to account for symptoms or signs of extrahepatic obstruction, the surgeon should carefully palpate the ampullary region of the duodenum.
mesh_terms: D000236:Adenoma / Q000150:complications* / Q000473:pathology / Q000601:surgery; D000469:Alkaline Phosphatase / Q000097:blood; D014670:Ampulla of Vater / Q000601:surgery; D003137:Common Bile Duct Diseases / Q000209:etiology; D003138:Common Bile Duct Neoplasms / Q000473:pathology / Q000601:surgery; D004379:Duodenal Neoplasms / Q000150:complications* / Q000473:pathology / Q000601:surgery; D004386:Duodenum / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy
chemical_list: D000469:Alkaline Phosphatase