Management of patients with ampullary and periampullary tumors in gastro-entrology and hepatology teaching hospital

Background: Ampullary and periampullary tumors are composed of a group of malignant and benign neoplasms arising in the region of the ampulla of Vater and are a major problem to the patients and surgeons and their management remains a big challenge

Objective: Study the age, sex distribution, presentation and management of patients with ampullary and periampullary tumors in Iraq and compare it with other world reports

Patients and Methods: prospective study of 50 patients with ampullary and periampullary tumors carried out in GIT hospital [tertiary center] from January 2013 to March 2015, risk factors, age, sex, clinical presentation, images study, diagnosis and modality of treatments whether curative or palliative are studied

Results: 29 [58%] were males and 21[42%] were females, about the age distribution the mean age was 45 ,about the residency they were mainly from Baghdad in [40%] the presenting symptom was obstructive jaundice in 43 [86%] ,duration of illness [range from 1-2 months] with the mean period 45 days, abdominal ultrasound study reveal distended Gallbladders in 76%, dilated CBD in 82%, dilated pancreatic duct in 56%, Hepatomegaly in 42%, dilated intrahepatic billiary tree in 64%, and liver secondary in 10%, resection surgery was done in 50%, palliative surgery in 12% and endoscopic palliation in 38%

Conclusion: Ampullary and periampullary tumors are relatively common. The mean age is 45 years, lower than the western studies. Sex: male are affected 1.4 times more than female with male: female ratio = 1.38 Abdominal ultrasound is very informative but EUS, CT scan and MRI, MRCP is the cornerstone for the diagnosis, Normal looking papilla does not rule out occult ampullary tumor

Ampullary carcinoma in Iraqi patients: single center experience

The aim of this paper is to report the pattern of ampullary carcinoma in Iraqi patients. During the period 1995-2000, 106 patients with ampullary carcinoma were admitted to Gastroenterology tertiary center accounting fort 2% of the total admission and 9% of gastrointestinal malignancies. 64 [60.4%] were male and 42 [39.6%] were females. 97 [87%] male are affected 1.5 times more than female with male: female ratio = 1.5. Age peak incidence bet [50-59] Patients came mainly from Baghdad 46% .Presenting symptom were jaundice in 78.3% Duration of illness the peak is 1-2 months mean period is [45 days] for lab investigations. Of the 85 patients. who undergone operation, resection was performed in 56 patients [66%]. Thirty patients had radical resection [Whipple procedure: pancreaticoduodenectomy] and 26 patients had local resection. The tumor was adenocarcinoma in all the cases. Only one case was undifferentiated carcinoma. The pattern of ampullary carcinoma is slightly different from the previous reports