title: Transduodenal excision of bleeding periampullary endocrine tumor as a bridge to pancreaticoduodenectomy in a Jehovah's Witness patient.
abstract: We discuss the case of a Jehovah's Witness patient who presented with a bleeding endocrine periampullary mass. Transduodenal excision of the ampullary mass was successfully performed as a bridge to pancreaticoduodenectomy in this critically ill patient. The roles of pancreaticoduodenectomy and alternatives to pancreaticoduodenectomy in the emergency setting are reviewed, in particular, for patients who decline transfusion of blood products. The surgical approach to surgery and perioperative anemia in Jehovah's Witness patients is described. Finally, we reviewed the role of transduodenal excision in the management of ampullary tumors and describe its use as a bridge to pancreaticoduodenectomy in a patient with a malignant neoplasm of the ampulla.
authors.affiliation: Department of Surgery, Meharry Medical College and Vanderbilt University, 1005 Dr. D.B Todd Jr. Boulevard, 4th Floor, Nashville, TN 37208, USA. agrau@mmc.edu
authors.forename: Ana M
authors.initials: AM
authors.lastname: Grau
authors.forename: Billy R
authors.initials: BR
authors.lastname: Ballard
mesh_terms: D014670:Ampulla of Vater; D016063:Blood Loss, Surgical; D001803:Blood Transfusion; D003138:Common Bile Duct Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D033221:Jehovah's Witnesses; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy / Q000379:methods*; D014057:Tomography, X-Ray Computed; D016312:Treatment Refusal