Retroduodenal resection of ampullary carcinoid tumor in a patient with cavernous transformation of the portal vein.
Although pancreatoduodenectomy is the standard treatment for periampullary neoplasms, limited pancreas-preserving resections are sometimes performed. This report describes a carcinoid tumor of the ampulla of Vater for which pancreatoduodenectomy was not feasible because of diffuse cavernous transformation of the portal vein (PV) secondary to main PV obliteration of unknown cause. We performed retroduodenal resection of the ampullary carcinoid with total preservation of the pancreas. The duodenal wall defect was primarily repaired, and the pancreatic and bile ducts were separately reconstructed using Roux-en-Y pancreaticojejunostomy and choledochojejunostomy. The patient recovered uneventfully and is currently progressing well at 10 months postoperatively, with no tumor recurrence or complications. The surgical procedures are described, and the literature pertaining to this limited surgery is reviewed.
Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea. shwang@amc.seoul.kr
Shin
S
Hwang
Ki-Myung
KM
Moon
Jeong-Ik
JI
Park
Myung-Hwan
MH
Kim
Sung-Gyu
SG
Lee
D000368:Aged; D014670:Ampulla of Vater; D002276:Carcinoid Tumor / Q000601:surgery*; D049448:Cholangiopancreatography, Magnetic Resonance; D002768:Choledochostomy; D003138:Common Bile Duct Neoplasms / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000379:methods*; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D010183:Pancreatic Ducts / Q000601:surgery; D010193:Pancreaticojejunostomy; D014057:Tomography, X-Ray Computed