A case report of an ampullary tumor presenting with spontaneous perforation of an aberrant bile duct and treated with total laparoscopic pancreaticoduodenectomy

World Journal of Surgical Oncology

Case Report

Mehmet Kaplan¹ 

[1] Department of General Surgery, Medical Park Gaziantep Hospital, Gaziantep, Turkey;

关键词: Bile peritonitis;    Aberrant bile duct;    Spontaneous bile duct perforation;    Laparoscopic pancreaticoduodenectomy;    Whipple procedure;    Pancreatic neoplasm;    Duodenal neoplasm;    Common bile duct;    Treatment;    Surgery;    Laparoscopy;   

DOI  :  10.1186/1477-7819-10-142

 received in 2012-02-29, accepted in 2012-06-25,  发布年份 2012

来源: Springer

【 摘 要 】

BackgroundThis case report discusses a patient who presented with bile peritonitis due to spontaneous perforation of an aberrant bile duct that originated in the triangular ligament of the liver. It was associated with an ampullary tumor and treated with total laparoscopic pancreaticoduodenectomy (TLPD).Case reportA 58-year-old male patient was admitted to the emergency department of Medical Park Gaziantep Hospital in September 2009 with acute abdominal findings. He underwent an urgent laparoscopy, and, interestingly, bile peritonitis due to the rupture of an aberrant bile duct in the triangular ligament was noted. After laparoscopic treatment of the acute conditions, the follow-up examinations of the patient showed the finding of obstructive jaundice. Endoscopic retrograde cholangio-pancreatography revealed a 1-cm polypoid mass located at the ampulla of Vater (duodenal papilla) with possible extension to the ampullary sphincter. A stent was inserted for temporary biliary drainage, and subsequent endoscopic biopsy showed the pathological finding of adenocarcinoma.After waiting for a 1-month period for the peritonitis to heal, the patient underwent pylorus-preserving TLPD and was discharged without any major complications on postoperative day 7.ConclusionIn patients with bile peritonitis, it should be considered that the localization of the perforation may be in an aberrant bile duct localized at the triangular ligament and the etiology may be associated with an obstructing periampullary tumor. Laparoscopic pancreaticoduodenectomy is a feasible operative procedure in carefully selected patients. This technique can achieve adequate margins and follows oncological principles. Randomized comparative studies are needed to establish the superiority of minimally invasive surgery over traditional open surgery.

【 授权许可】

CC BY   
© Kaplan; licensee BioMed Central Ltd. 2012