2010 Volume 24 Issue 1 Pages 112-118
A 74-year-old man was referred to our hospital for further investigation of liver dysfunction. He had past history of diabetes mellitus, hyperlipidemia and post cholecystectomy for cholecystitis. In US and CT, the common bile duct was dilated to 12 mm, Wirsung duct was found 3 to 4 mm in diameter. There was a disconnection between the ventral and dorsal pancreatic ductal systems. An exposed protruding type tumor of papilla of Vater was also detected. Additionally, tumor biopsy indicated adenocarcinoma of papilla of Vater. In EUS examination, infiltrations to the common bile duct and main pancreatic duct were under suspicion. Based on the diagnosis of papilla of Vater adenocarcinoma with pancreatic divisum, we performed pylorus preserving pancreaticoduodenectomy. The pathological finding showed moderately differentiated adenocarcinoma, od, panc0, du1, t1, pN0. The whole course of hospitalization was smooth and the patient was survived 20 months post-operation without recurrence. According to our knowledge, there were few cases illustrated the papilla of Vater adenocarcinoma with pancreatic divisum in the Japanese literature.
