title: [Jejunum interposition as replacement of the pars descendens duodeni in extensive tubulovillous adenoma].
abstract: Reconstruction after partial duodenectomy with resection of the ampulla of Vater is often troublesome. We report the case of a 70-year-old patient with endoscopically non-resectable tubulo-villous adenoma of the descending duodenum including the ampulla of Vater in which subsequent biopsies revealed dysplastic areas. A partial resection of the descending duodenum including the ampulla of Vater was performed. Reconstruction was achieved by the interposition of a jejunal limb in which the ampulla could be reinserted to the posterior wall. The postoperative course was uneventful; a carcinoma was not found within the specimen. In cases of widespread adenomas of the ampulla of Vater, duodenum-preserving resection by interposition of a jejunal limb with reinsertion of the ampulla into the posterior wall may be used as an alternative to Roux-Y reconstruction and to Whipple's procedure.
authors.affiliation: Lehrstuhl für Chirurgie II, Universität Witten/Herdecke. M.Fleisch@t-online.de
authors.forename: M C
authors.initials: MC
authors.lastname: Fleisch
authors.forename: J
authors.initials: J
authors.lastname: Schmidt
authors.forename: H
authors.initials: H
authors.lastname: Zirngibl
mesh_terms: D018253:Adenoma, Villous / Q000473:pathology / Q000601:surgery*; D000368:Aged; D014670:Ampulla of Vater / Q000473:pathology / Q000601:surgery*; D003138:Common Bile Duct Neoplasms / Q000473:pathology / Q000601:surgery*; D003287:Contrast Media; D003974:Diatrizoate Meglumine; D004379:Duodenal Neoplasms / Q000473:pathology / Q000601:surgery*; D004386:Duodenum / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007583:Jejunum / Q000637:transplantation*; D008297:Male; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D011859:Radiography; D013536:Suture Techniques
chemical_list: D003287:Contrast Media; D003974:Diatrizoate Meglumine