title: A case of carcinoma of the papilla of Vater in a young man after subtotal colectomy for familial adenomatous polyposis.
abstract: BACKGROUND
  Carcinoma and adenoma of the duodenum, including the papilla of Vater, are problematic diseases in patients with familial adenomatous polyposis (FAP).
  
  
  METHODS
  A 36-year-old man underwent a periodic medical examination for early colon cancer originating from FAP for which laparoscopic-assisted subtotal colectomy with a J-shaped ileal pouch-rectal anastomosis was performed 3 years earlier. A tumor was detected at the papilla of Vater along with elevation of total bilirubin and hepatobiliary enzymes. Although cytology did not determine the tumor to be an adenocarcinoma, we suspected adenocarcinoma due to its hypervascularity shown by contrast-enhanced computed tomography. Pylorus-preserving pancreaticoduodenectomy with modified Imanaga reconstruction and regional lymph node dissection (D2) was performed. The pathological study showed that the tumor was a papillary and moderately differentiated tubular adenocarcinoma. The patient is currently in good health without recurrence, weight loss, or severe diarrhea at 12 months after surgery.
  
  
  CONCLUSIONS
  Awareness of biliary-pancreatic symptoms and periodic gastroduodenoscopy might contribute both to the early detection of duodenal or periampullary polyps and cancer and to the radical treatment of FAP. Modified Imanaga reconstruction has the potential to become one of the more effective procedures for providing good quality of life to FAP patients with duodenal or periampullary cancer.
authors.affiliation: Department of Surgery, Gifu Prefectural General Medical Center, 4-6-1 Noisshiki, Gifu, 500-8717, Japan. b-joel555shuji-k@violin.ocn.ne.jp.
authors.forename: Shuji
authors.initials: S
authors.lastname: Komori
authors.affiliation: Department of Surgery, Gifu Prefectural General Medical Center, 4-6-1 Noisshiki, Gifu, 500-8717, Japan. masakw@gifu-hp.jp.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Kawai
authors.affiliation: Department of Surgery, Gifu Prefectural General Medical Center, 4-6-1 Noisshiki, Gifu, 500-8717, Japan. organsurgeon@gmail.com.
authors.forename: Toyoo
authors.initials: T
authors.lastname: Nitta
authors.affiliation: Department of Surgery, Gifu Prefectural General Medical Center, 4-6-1 Noisshiki, Gifu, 500-8717, Japan. mukku0126.5569ponkikki@gmail.com.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Murase
authors.affiliation: Department of Surgery, Gifu Prefectural General Medical Center, 4-6-1 Noisshiki, Gifu, 500-8717, Japan. 10b6.yncc@gmail.com.
authors.forename: Keita
authors.initials: K
authors.lastname: Matsumoto
authors.affiliation: Department of Surgery, Gifu Prefectural General Medical Center, 4-6-1 Noisshiki, Gifu, 500-8717, Japan. c.shinoda1225@gmail.com.
authors.forename: Chika
authors.initials: C
authors.lastname: Shinoda
authors.affiliation: Department of Surgery, Gifu Prefectural General Medical Center, 4-6-1 Noisshiki, Gifu, 500-8717, Japan. masashi_love_tennis@yahoo.co.jp.
authors.forename: Masashi
authors.initials: M
authors.lastname: Kuno
authors.affiliation: Department of Surgery, Gifu Prefectural General Medical Center, 4-6-1 Noisshiki, Gifu, 500-8717, Japan. hyu.hyu.36@gmail.com.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Sasaguri
authors.affiliation: Department of Surgery, Gifu Prefectural General Medical Center, 4-6-1 Noisshiki, Gifu, 500-8717, Japan. flyhighvb@yahoo.co.jp.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Fukada
authors.affiliation: Department of Surgery, Gifu Prefectural General Medical Center, 4-6-1 Noisshiki, Gifu, 500-8717, Japan. m01003ya@yahoo.co.jp.
authors.forename: Yoshimi
authors.initials: Y
authors.lastname: Asano
authors.affiliation: Department of Surgery, Gifu Prefectural General Medical Center, 4-6-1 Noisshiki, Gifu, 500-8717, Japan. gel.gel.kiyama@gmail.com.
authors.forename: Shigeru
authors.initials: S
authors.lastname: Kiyama
authors.affiliation: Department of Surgery, Gifu Prefectural General Medical Center, 4-6-1 Noisshiki, Gifu, 500-8717, Japan. ctanaka@gifu-hp.jp.
authors.forename: Chihiro
authors.initials: C
authors.lastname: Tanaka
authors.affiliation: Department of Surgery, Gifu Prefectural General Medical Center, 4-6-1 Noisshiki, Gifu, 500-8717, Japan. ynagao@topaz.ocn.ne.jp.
authors.forename: Yasuko
authors.initials: Y
authors.lastname: Nagao
authors.affiliation: Department of Surgery, Gifu Prefectural General Medical Center, 4-6-1 Noisshiki, Gifu, 500-8717, Japan. nagao@gifu-hp.jp.
authors.forename: Narutoshi
authors.initials: N
authors.lastname: Nagao
authors.affiliation: Department of Surgery, Gifu Prefectural General Medical Center, 4-6-1 Noisshiki, Gifu, 500-8717, Japan. kunieda@gifu-hp.jp.
authors.forename: Katsuyuki
authors.initials: K
authors.lastname: Kunieda
mesh_terms: D011125:Adenomatous Polyposis Coli / Q000601:surgery*; D000328:Adult; D014670:Ampulla of Vater / Q000473:pathology* / Q000601:surgery; D003082:Colectomy / Q000009:adverse effects*; D003138:Common Bile Duct Neoplasms / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D011379:Prognosis