Two Consecutive Cases of Ampulla of Vater Cancer Combined with Annular Pancreas and Unusual Anatomic Variation

ABSTRACT

Annular pancreas is a rare congenital anomaly that consists of a ring of pancreatic tissue partially or completely encircling the descending portion of the duodenum. Coexisting ampullary carcinoma in annular pancreas combined with anomaly of hepatic artery or bile duct are thought to be extremely rare. Two consecutive cases of ampullary carcinoma in annular pancreas with bile duct or hepatic artery anomaly are described. In addition, English literature reports of coexisting ampullary carcinoma in annular pancreas are summarized. Clinical symptoms of the two patients were jaundice and abdominal discomfort. The two ampullary cancers were early adenocarcinomas in the ampulla of Vater that were curatively treated by pylorus preserving pancreaticoduodenectomy. Ampullary carcinoma associated with annular pancreas is rare. Its combination with an additional biliary or hepatic artery anomaly make our cases extremely unique. Certain aberrant events in the overall stages of the development of the liver, bile duct, and pancreas may have occurred in these patients. Surgeons need to note preoperatively these possible associated anatomic variations.