Duodenal Papillitis Mimicking Cancer of the Papilla of the Vater -A rare case report-

Abstract

An 83-year-old man was referred to a local hospital due to examination of dullness of the costophrenical angle and epigastralgia. Dilatation of the common bile duct and main pancreatic duct were noted by US and CT. Under the suspicious of papilla of the Vater tumor lesion, endoscopic sphincterotomy (EST) and brushing cytology were performed. However, the patient was then referred to our hospital due to the declining of the general condition post EST. Under the diagnosis of post EST peritonitis, he underwent emergent surgery. Fortunately, he was again transferred back to the hospital where he came from on the postoperative day (POD) 36. On the second time of his admission to our hospital, swelling of Papilla of the Vater and dilatation of the common bile duct and main pancreatic duct were seen. We performed PPPD to the patient under the suspicion of non-exposed protruding type cancer of the papilla of Vater. Post-operation nutrition support and rehabilitation were provided and he was discharged on POD 48. He has been followed up in outpatients department for 8 months. Final pathology diagnosis determined duodenal papillitis with the smooth muscle, accessory gland and periductal gland hyperplasia. To the best of our knowledge, reports of papillitis with operation are limited in the Japanese literature, so that we are here sharing unusual experience.