Carcinoma of Papilla Vateri

Carcinoma of Papilla Vateri (ampuloma) is a rarer tumour, constituting 1.5% of GIT tumours, it is mainly adenocarcinoma. It grows from the mucosa of the distal choledochus, the pancreatic duct, the ampulla itself.

Clinical presentation

 * Painless icterus (even intermittent) + picture of cholestasis,
 * pancreatitis / cholangitis attacks,
 * epigastric pain with propagation to the back, diarrhoea,
 * symptoms of duodenal obstruction,
 * liver enlarged, gall bladder may be palpable (Courvoisier's sign),
 * thrombosis of the v. portae + ascites formation

Diagnostics

 * Endoscopy with biopsy (via a forceps),
 * ERCP (endoscopy retrograde cholagiopancreatography), PTC, USG,
 * laboratory: picture of cholestasis, ↑ AMS, icterus may fluctuate, CA 19-9.

Therapy

 * Surgical - tumor resection + bile duct reconstruction - duodenopancreatectomy (Whipple's operation),
 * resection of the papilla with reimplantation of the bile duct or pancreatic duct in benign tumours

Prognosis

 * Better than for other bile duct tumours (5-year survival in up to ½ patients with radical surgery),
 * good results - as it causes obstruction and symptoms very early.