[Carcinoma of the papilla of Vater. Diagnostic and therapeutic problems. An analysis of 32 Tunisian cases].
The aim determine the clinical, morphological, endoscopical and progressive profile of patients with ampullary carcinoma.


METHODS
Thirty-two patients with a carcinoma of the ampulla of Vater, hospitalised in the Gastro-enterology service of Habib Thameur Hospital (Tunis) (1992-2002) have been analysed retrospectively.


RESULTS
Twelve men and 20 women of an average age of 66 years have been included. Twelve patients (37%) had had a cholecystectomy into the 3 years preceding the diagnosis of the ampullary carcinoma. A duodenal tumour had been found at 29 patients (91%). After endoscopical sphincterectomy, an intra-ampullar exophytic tumour had been found in I case and an infiltrated aspect of the ampulla of Vater in 2 cases. The jaundice was frequent. The use of lateral duodenoscopy allowed carrying the positive diagnosis in all cases. Five patients had metastasis at the moment of diagnosis. A DPC has been practiced at 15 patients. A palliative biliary diversion has been realized at 9 patients. Six patients had an endoscopical palliative drainage with installation of a plastic prosthesis. The rate of post- operative mortality was 20%. The rate of morbidity linked to the surgery was 21.8%.


CONCLUSIONS
The ampullary carcinoma is a rare tumour diagnosed belated. The postoperative mortality is raised. The identification of factors forecast and the utilization of adjuvant processing will be able to allow the improvement of the prognosis.
Bel Hadj
Najet
N
Service de Gastroentérologie Hôpital Habib Thameur.
Elloumi
Héla
H
Babba
Thouraya
T
Kchaou-Oukaa
Asma
A
Gargouri
Dalila
D
Kochlef
Asma
A
Romani
Malika
M
Kilani
Afef
A
Kharrat
Jamel
J
Ghorbel
Abdeljabbar
A
D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater; D002277:Carcinoma / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D003138:Common Bile Duct Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D004322:Drainage; D004384:Duodenoscopy / Q000379:methods; D005260:Female; D006801:Humans; D007565:Jaundice / Q000209:etiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D014416:Tunisia