Acute Acalculous Cholecystitis without Cholangitis As a Complication of Endoscopic Snare Papillectomy for Ampullary Adenoma / 대한췌담도학회지

Endoscopic snare papillectomy (ESP) for ampulla of Vater tumor (AVT) has been performed successfully instead of surgical ampullectomy (SA) because ESP is a less invasive procedure than SA. Hemorrhage, perforation and pancreatitis are relatively common complications of ESP and other rare complications such as cholangitis, liver abscess has been reported. Recently we encountered a case of acute acalculous cholecystitis after ESP for AVT, which was treated successfully with percutaneous cholecystostomy with intravenous antibiotics. We therefore report this case with a brief review of the literature.

Transduodenal Ampullectomy in Ampullary Neoplasm

PURPOSE: Periampullary malignant tumors become symptomatic at an early stage because of their particular location. For this reason, radical resection is possible in the majority of cases. Periampullary tumors can be removed either by a local resection, as performed by Halsted in 1899, or by a radical pancreaticoduodenectomy, as performed by Whipple et al. in 1935. Both techniques have been used, and their respective places in the treatment of benign or malignant periampullary tumors has been the subject of constant debate. Therefore, we reviewed the cases of four patients who had undergone a transduodenal ampullectomy for an ampullary tumor which was confined to the ampulla of Vater. METHODS: The clinical records of 4 patients who undergone a transduodenal ampullectomy were reviewed. All patients were diagnosed as having an ampullary mass based on gastroduodenoscopy, endoscopic retrograde cholangiopancreatography, or both. Clinical presentation, comparison of pathologic findings of preoperative endoscopic biopsy, operative frozen section, final pathologic examination, complications, follow-up period, and recurrence were reviewed. RESULTS: The two men and the two women studied had a median age of 59.3 (range, 49 to 64 years). Among the four patients who underwent a transduodenal ampullectomy, an adenocarcinoma was found at final pathologic examination in two patients with preoperative diagnoses of a villotubular adenoma and a villous adenoma, respectively. The other two cases were diagnosed as tubular adenomas at final pathologic examination as they had been at the preoperative diagnosis. No evidence of disease was observed in any of the four patients on follow-up at 29 months, 30 months36 months, and 4 months. None of these patients had major complications in the immediate postoperative period, transient hyperamylasemia without clinical significance developed in two patients. CONCLUSION: The transduodenal ampullectomy is a valuable tool in the treatment of ampullary lesions. The result of local excision of the Vater for ampullary tumors appears satisfactory, and this procedure may be particularly indicated for benign tumors, as well as for older or high-risk patients whose malignant lesions are confined to the ampulla of Vater. However, the selection of this procedure required judicious decision making and precise technique and should involve an experienced team of pathologists and surgeons. As a result, for patients in whom it is indicated, a transduodenal ampullectomy is an alternative to the pancreaticoduodenectomy and has good long-term results.