A case of villous carcinoma in adenoma of the papilla of vater after total gastrectomy reconstructed by roux-en-y anastomosis

Abstract

A 68-year-old man admitted for epigastric pain and pyrexia was found by laboratory tests to have elevated serum GOT, GPT, γ-GTP, ALP, amylase and lipase. CT showed bile duct dilation of unknown origin. The papilla of Vater was difficult to observe directly due to the patient having previously undergone total gastrectomy reconstructed by Roux-en-Y anastomosis.
Because his symptoms showed rapid relief, we assumed that a bile duct stone had become dislodged. However, the same symptom recurred seven months later, at which time CT showed a tumor in the horizontal duodenum. Drip infusion cholangiography-CT then clearly showed a pedunculate tumor 30 mm in diameter in the descending duodenum, but its location was different from that seen on the earlier CT.
We suspected that pancreatitis and cholangitis had occurred due to tumor impaction on the left side of the superior mesenteric artery. We then conducted pylorus-preserving pancreaticoduodenectomy. The definitive diagnosis was villous carcinoma in an adenoma of the papilla of Vater.