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An ampullary adenoma presenting with jaundice caused by duodenal intussusception: a case report.

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Title: An ampullary adenoma presenting with jaundice caused by duodenal intussusception: a case report.
Authors: Nojima, Hiroyuki, Shimizu, Hiroaki, Hirota, Mihono, Murakami, Takashi, Yamazaki, Masato, Yamazaki, Kazuto, Shuto, Kiyohiko, Kosugi, Chihiro, Mori, Mikihito, Usui, Akihiro, Sazuka, Tetsutaro, Koda, Keiji
Source: Surgical Case Reports; 1/22/2024, Vol. 10 Issue 1, p1-6, 6p
Subject Terms: ADENOMA, PATIENT experience, INTESTINAL intussusception, JAUNDICE, SKIN discoloration, BILE ducts, PRECANCEROUS conditions
Abstract: Background: Ampullary adenomas are premalignant lesions. However, biliary obstruction causing jaundice is rare. Duodenal intussusception secondary to an ampullary adenoma rarely occurs because of the fixed position of the duodenum in the retroperitoneum. Herein, we have described a rare case of ampullary adenoma with jaundice caused by duodenal intussusception. Case presentation: A 40-year-old woman presenting with vomiting and yellowish discoloration of the skin was admitted to another hospital. The patient had experienced recurrent epigastric pain and vomiting for the past 18 months. Blood test results showed elevated levels of bilirubin (3.9 mg/dL), and abdominal computed tomography (CT) showed a 60-mm hypovascular mass in the third part of the duodenum and a left lateral shift of the dilated common bile duct. The patient was referred to our hospital for further evaluation. She recovered from hyperbilirubinemia spontaneously (levels of bilirubin, 1.0 mg/dL), and the CT showed a tumor shift from the third part of the duodenum to the second part and improvement of the dilated common bile duct. Hypotonic duodenography revealed a tumor that moved easily from the second to the third portion of the patient's position. Upper gastrointestinal endoscopy revealed a large papillary tumor occupying the second part of the duodenum, which was diagnosed as an adenoma through biopsy. The possibility of malignancy could not be negated owing to the presence of jaundice and an elevated carbohydrate antigen 19-9 level (76.0 U/mL). Pancreaticoduodenectomy was performed. The resected specimen showed a 60 × 40 × 40-mm pedunculated ampullary mass with submucosal elongation. The pathological examination indicated that the ampullary tumor was a high-grade intestinal adenoma. The postoperative course was uneventful, and the patient was discharged 26 days postoperatively. Conclusions: This report describes a rare case of a patient with an ampullary adenoma presenting with jaundice resulting from duodenal intussusception. Owing to the possibility of a postoperative cancer diagnosis which may have caused the biliary obstruction and the difficulty in making an accurate preoperative diagnosis, it is imperative to choose the appropriate surgical procedure such as a pancreaticoduodenectomy. [ABSTRACT FROM AUTHOR]
Copyright of Surgical Case Reports is the property of Japan Surgical Society and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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  Label: Title
  Group: Ti
  Data: An ampullary adenoma presenting with jaundice caused by duodenal intussusception: a case report.
– Name: Author
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  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Nojima%2C+Hiroyuki%22">Nojima, Hiroyuki</searchLink><br /><searchLink fieldCode="AR" term="%22Shimizu%2C+Hiroaki%22">Shimizu, Hiroaki</searchLink><br /><searchLink fieldCode="AR" term="%22Hirota%2C+Mihono%22">Hirota, Mihono</searchLink><br /><searchLink fieldCode="AR" term="%22Murakami%2C+Takashi%22">Murakami, Takashi</searchLink><br /><searchLink fieldCode="AR" term="%22Yamazaki%2C+Masato%22">Yamazaki, Masato</searchLink><br /><searchLink fieldCode="AR" term="%22Yamazaki%2C+Kazuto%22">Yamazaki, Kazuto</searchLink><br /><searchLink fieldCode="AR" term="%22Shuto%2C+Kiyohiko%22">Shuto, Kiyohiko</searchLink><br /><searchLink fieldCode="AR" term="%22Kosugi%2C+Chihiro%22">Kosugi, Chihiro</searchLink><br /><searchLink fieldCode="AR" term="%22Mori%2C+Mikihito%22">Mori, Mikihito</searchLink><br /><searchLink fieldCode="AR" term="%22Usui%2C+Akihiro%22">Usui, Akihiro</searchLink><br /><searchLink fieldCode="AR" term="%22Sazuka%2C+Tetsutaro%22">Sazuka, Tetsutaro</searchLink><br /><searchLink fieldCode="AR" term="%22Koda%2C+Keiji%22">Koda, Keiji</searchLink>
– Name: TitleSource
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  Data: Surgical Case Reports; 1/22/2024, Vol. 10 Issue 1, p1-6, 6p
– Name: Subject
  Label: Subject Terms
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  Data: <searchLink fieldCode="DE" term="%22ADENOMA%22">ADENOMA</searchLink><br /><searchLink fieldCode="DE" term="%22PATIENT+experience%22">PATIENT experience</searchLink><br /><searchLink fieldCode="DE" term="%22INTESTINAL+intussusception%22">INTESTINAL intussusception</searchLink><br /><searchLink fieldCode="DE" term="%22JAUNDICE%22">JAUNDICE</searchLink><br /><searchLink fieldCode="DE" term="%22SKIN+discoloration%22">SKIN discoloration</searchLink><br /><searchLink fieldCode="DE" term="%22BILE+ducts%22">BILE ducts</searchLink><br /><searchLink fieldCode="DE" term="%22PRECANCEROUS+conditions%22">PRECANCEROUS conditions</searchLink>
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Background: Ampullary adenomas are premalignant lesions. However, biliary obstruction causing jaundice is rare. Duodenal intussusception secondary to an ampullary adenoma rarely occurs because of the fixed position of the duodenum in the retroperitoneum. Herein, we have described a rare case of ampullary adenoma with jaundice caused by duodenal intussusception. Case presentation: A 40-year-old woman presenting with vomiting and yellowish discoloration of the skin was admitted to another hospital. The patient had experienced recurrent epigastric pain and vomiting for the past 18 months. Blood test results showed elevated levels of bilirubin (3.9 mg/dL), and abdominal computed tomography (CT) showed a 60-mm hypovascular mass in the third part of the duodenum and a left lateral shift of the dilated common bile duct. The patient was referred to our hospital for further evaluation. She recovered from hyperbilirubinemia spontaneously (levels of bilirubin, 1.0 mg/dL), and the CT showed a tumor shift from the third part of the duodenum to the second part and improvement of the dilated common bile duct. Hypotonic duodenography revealed a tumor that moved easily from the second to the third portion of the patient's position. Upper gastrointestinal endoscopy revealed a large papillary tumor occupying the second part of the duodenum, which was diagnosed as an adenoma through biopsy. The possibility of malignancy could not be negated owing to the presence of jaundice and an elevated carbohydrate antigen 19-9 level (76.0 U/mL). Pancreaticoduodenectomy was performed. The resected specimen showed a 60 × 40 × 40-mm pedunculated ampullary mass with submucosal elongation. The pathological examination indicated that the ampullary tumor was a high-grade intestinal adenoma. The postoperative course was uneventful, and the patient was discharged 26 days postoperatively. Conclusions: This report describes a rare case of a patient with an ampullary adenoma presenting with jaundice resulting from duodenal intussusception. Owing to the possibility of a postoperative cancer diagnosis which may have caused the biliary obstruction and the difficulty in making an accurate preoperative diagnosis, it is imperative to choose the appropriate surgical procedure such as a pancreaticoduodenectomy. [ABSTRACT FROM AUTHOR]
– Name: Abstract
  Label:
  Group: Ab
  Data: <i>Copyright of Surgical Case Reports is the property of Japan Surgical Society and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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        Value: 10.1186/s40792-024-01822-z
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        Text: English
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      – SubjectFull: ADENOMA
        Type: general
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      – SubjectFull: INTESTINAL intussusception
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              M: 01
              Text: 1/22/2024
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