title: Disconnection of the ampulla of Vater: a new technique for reconstruction.
abstract: We report the case of a 42 year-old patient who had undergone gastric resection and Billroth I reconstruction for a duodenal ulcer 15 years earlier. The patient was admitted to our Department for a high output biliopancreatic fistula which developed after another gastric resection with Billroth II reconstruction which was performed for a peptic stricture of the gastroduodenal anastomosis. At laparotomy, a complete disconnection of the ampulla of Vater was found, with the duodenal stump oversewn 5 cm distally to the papillary area. After plasty of the biliary and pancreatic ducts, a direct anastomosis between the new ampulla and a Roux-en-Y jejunal loop was performed. The post-operative course was uneventful. The details of the surgical technique are reported.
authors.affiliation: Department of Surgery, University of Padova, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Bardini
authors.forename: A
authors.initials: A
authors.lastname: Segalin
authors.forename: M
authors.initials: M
authors.lastname: Asolati
mesh_terms: D000328:Adult; D014670:Ampulla of Vater / Q000293:injuries* / Q000601:surgery*; D000713:Anastomosis, Roux-en-Y; D001652:Bile Ducts / Q000601:surgery; D001658:Biliary Fistula / Q000209:etiology / Q000601:surgery; D005743:Gastrectomy / Q000009:adverse effects*; D006801:Humans; D007583:Jejunum / Q000601:surgery; D008297:Male; D010183:Pancreatic Ducts / Q000601:surgery; D010185:Pancreatic Fistula / Q000209:etiology / Q000601:surgery