The ampulla of Vater comprises the junction of the biliary and pancreatic ducts and is surrounded by the sphincter of Oddi which is a 1cm long smooth muscle structure. The distal constricted end of the ampulla opens into the posteromedial aspect of the duodenum (proximal part of the small intestine) which is called papilla. Cancers arising at and near ampulla are called periampullary tumors. It comprises 4 different histological types
Diagnosis is made from imaging like CT or MRI scans. Side viewing endoscopy and biopsy or Endoscopic ultrasonography (EUS) guided biopsy may be used to get a histological diagnosis. However, even with repeated attempt histological confirmation is not possible in a certain group of patients. There are cases in which we only get a definitive diagnosis after surgery.
Whipple's procedure (pancreaticoduodenectomy) is the treatment of choice for periampullary cancers. This can be done by open as well as laparoscopic (keyhole) approaches. This is one of the major surgeries performed in the abdomen with associated complications. In patients with severe infection in the bile duct (cholangitis), endoscopic stenting of the bile duct should be done pre-operatively. The patient may require additional therapy like chemotherapy depending on the final biopsy reports.
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