Total Pancreatectomy for Ampullary Adenocarcinoma in a 74-Year-Old Patient: Case Report and Literature Review

Primary ampullary neoplasms have origin in the ampulla of Vater, an anatomical structure where the common bile duct and the pancreatic duct join together as a common channel. It represents <0.5% of all gastrointestinal cancers and approximately 7% of all periampullary cancers. The adenocarcinomas arising in this region originate from different epithelial cellular constituents present at the site, the histopathological classification encompass: intestinal type, pancreaticobiliary type, and mixed type. Pancreaticoduodenectomy is the treatment of choice when there is an overt or highly suspicious malignant behaviour. We present here the case of a 74-year-old male patient who presented to our department for further investigation of obstructive jaundice and a pancreatic mass associated with a six-month history of significant weight loss and mild epigastric pain. Eventually, a total splenopancreatectomy was performed given the extension of structural anomalies of the organ secondary to an ampullary adenocarcinoma.

A long (7 cm) prophylactic pancreatic stent decreases incidence of post-endoscopic papillectomy pancreatitis: a retrospective study

Background and study aims Endoscopic papillectomy (EP) is a minimally invasive treatment for ampullary neoplasms and is recognized as an alternative treatment to surgical resection; however, there are few reports on a suitable pancreatic stent (PS) after EP for preventing pancreatitis. The aim of this study was to evaluate the efficacy of a long PS after EP. Patients and methods In this retrospective single-center study, 39 patients with pathologically proven ampullary neoplasms who underwent EP between March 2012 and August 2018 were enrolled. The study participants were divided into two subgroups according to the PS length: those with a PS shorter than 5 cm (short PS group, n = 17) and those with a PS of 7 cm (long PS group, n = 22). The incidence of adverse events and risk factors for pancreatitis were evaluated. Results The diameter of all PSs was 5 Fr. Post-EP pancreatitis occurred in nine patients (23.1 %), with two cases of severe pancreatitis (5.1 %). Pancreatitis occurred more frequently in the short PS group (7/17, 41.2 %) than in the long PS group (2/22, 9.1 %) (P = 0.026). There were no significant differences between the two groups in terms of other adverse events. Univariate and multivariate analyses showed that a long PS was the only factor associated with a decreased incidence of post-EP pancreatitis (P = 0.042; odds ratio, 0.16; 95 % confidence interval, 0.027–0.94). Conclusion A long (7 cm) PS significantly decreased incidence of pancreatitis after EP. Prospective randomized studies with a larger number of patients and wider range of PS lengths are required.