A 56-year-old woman with ampullary adenocarcinoma and acute pancreatitis

Abstract

ABSTRACT We report a case of acute pancreatitis associated with adenocarcinoma of the ampulla of Vater. This challenging condition has been scarcely reported. A 56-year-old woman was admitted with jaundice, and laboratory data were indicative of pancreatitis, which recurred in spite of adequate clinical and nutritional management. The patient was an overweighted diabetic in use of metformin, who had antecedent of cholelithiasis and recent cholecystectomy. Clinical and laboratory features were not conclusive about the cause of this acute pancreatitis. However, imaging data contributed to diagnosis suspicion, and the histopathology study of transpapillary biopsy confirmed the ampullary adenocarcinoma. Whipple’s surgery was the procedure of choice, associated with radical lymphadenectomy, followed by uneventful outcome. Recrudescence of signs and symptoms of acute pancreatitis, with elevated serum levels of bilirrubins and of hepatic canalicular enzymes, should enhance the suspicion index about periampullary tumors. High levels of CA 19-9 can constitute a useful marker of this condition. Transpapillary biopsy can characterize the diagnosis of ampullary malignancies.