Abstract
Endoscopic Ampullectomy for A Well To Moderately Differentiated Ampullary Adenocarcinoma: Case Report
Romielle Grazel Joi H. Ramos, MD; James Crisfil Fructuoso Montesa, MD
Manila Doctors Hospital
Significance: Early ampullary cancers present with good prognosis. Pancreaticoduodenectomy has been standard treatment for ampullary cancers, but postoperative complications rate remains high. Therefore, raises a discussion on the role of local ampullectomy for early ampullary cancers.
Clinical Presentation: Clinical Presentation: A case of a 72-year-old male, known hypertensive and coronary artery disease (s/p PTCAx1) who presented with 1 week history of jaundice and tea-colored urine. On review of systems, patient also had unintentional weight loss of 10kg within 1 month. On evaluation, patient was noted to have generalized jaundice and icteric sclerae. Abdomen was soft, nondistended and nontender without palmar erythema and spider angiomata. CA 19-9 was noted to be 324x elevated (value: >12000). MRI and MRCP of abdomen revealed presence of a 1.6 cm periampullary soft tissue thickening, with moderate to severe upstream dilatation of the intrahepatic and extrahepatic ducts, and in the pancreatic duct. No liver metastasis and lymphadenopathies were noted. Snare ampullectomy performed via hot snare using Endo Cut Q alternate with soft coagulation. Ampullary mass retrieved measuring 2cm x 1cm x 1.5cm and sent for histopathology. Histopathology revealed ampullary adenocarcinoma. Monthly follow-up showed no recurrence of jaundice and decreasing bilirubin levels. Currently, patient is being treated with adjuvant chemotherapy.
Conclusion: In conclusion, it is noteworthy that to date, there has been only one documented case report on ampullectomy in the Philippines, published back in 2003. Ampullectomy is associated with lower surgical morbidity and should therefore remain in the armamentarium when comorbidity precludes major surgery.
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| JRRE Activities 2023-2024 |
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