The clinical importance and role of transduodenal ampullectomy in a villous adenoma: A case report

Abstract

Ampullary adenoma is a precancerous lesion. Complete resection is required either endoscopically or surgically. We described a 64-year-old female patient with an ampullary adenoma, who was not suitable for endoscopic resection, so resection was performed by transduodenal ampullectomy. An ulcerated 16 mm × 13 mm hypoechoic ampullary polypoid lesion with high grade dysplasia and without infiltration into muscularis propria layer was reported on endosonographic examination. The electrocautery was used to resect the adenoma of ampulla. Bile and pancreatic ducts were approximated to duodenal wall via an absorbable suture (4-0 and 5-0 polydioxanone). No stent was used for bile and pancreatic ducts. Visualization of biliary and pancreatic drainages confirmed the patency of both ductal systems, which were 10 mm and 5 mm in diameters. Patient had no abnormalities related to biliary and pancreatic duct obstructions, and was discharged on postoperative day 8. Lesion had clear margins after transduodenal ampullectomy. In conclusion, although transduodenal ampullectomy (TDA) is technically demanding, our case is clinically important to demonstrate transduodenal ampullectomy is a safe alternative procedure to pancreaticoduodenectomy for adenoma of ampulla if the lesion is not suitable for endoscopic resection.