A Case of Carcinoma of the Papilla of Vater Presenting with Severe Acute Pancreatitis

Ryutaro Sakabe, Shuji Saeki, Wataru Takiyama, Naoki Hirabayashi, Yukio Sato, Hidenori Mukaida and Yoshinori Yamashita

Department of Surgery, Hiroshima City Asa Hospital

Carcinoma of the papilla of Vater may cause clinical symptoms, but acute pancreatitis as a presenting symptom is rare. We report a case of carcinoma of the papilla of Vater presenting with severe acute pancreatitis. A 58-year-old man referred for sudden epigastric pain was found to have a serum amylase concentration markedly elevated at 3,680 IU/l. Abdominal computed tomography (CT) scan showed an enlarged pancreas throughout the pancreatic head to pancreatic tail with peripancreatic fluid collection, yielding a diagnosis of severe acute pancreatitis (Stage 2). He underwent intensive care including arterial injection treatment. We attempted endoscopic retrograde cholangiopancreatography to determine the cause of the acute pancreatitis, but failed. Duodenoscopy showed redness and concentration of the folds at the papilla of Vater, and the biopsy specimen showed adenocarcinoma, necessitating pylorus-preserving pancreaticoduodenectomy with abdominal lymph node dissection. The pathological diagnosis was pT3 pN0 Stage III, well-differentiated tubular adenocarcinoma of the papilla of Vater based on the Japanese classification of biliary tract carcinoma. The man remains well without recurrence 15 months after surgery.

Key words
carcinoma of the papilla of Vater, acute pancreatitis

Reprint requests
Ryutaro Sakabe Department of Surgery, Hiroshima City Asa Hospital
2-1-1 Kabeminami, Asakita-ku, Hiroshima, 731-0293 JAPAN

Accepted
September 27, 2006

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