XXXX of the papilla of Vater. Diagnostic and surgical problems.

@entity1 @entity1085 @entity390 @entity1087 @entity417 @entity1313 @entity5 @entity1066 @entity189 @entity344 @entity490 @entity360
BACKGROUND/AIMS: Although @entity189 is a well-recognized @entity5 , difficulties and misdiagnosis are still encountered in the early and on-time diagnostic process. METHODOLOGY: Thirty-six @entity1 with @entity5 of the papilla of Vater, hospitalized in the 2nd Department of Surgery (1981-2000) were reviewed retrospectively. RESULTS: Twenty-two @entity1 and 14 @entity1 , age varied from 39 to 84 years. @entity5 was defined as any @entity1313 , located at the papilla of Vater region. According to gross appearance of the @entity5 there were 12 pts with polypoid type without @entity1066 ; 10 pts--polypoid type with @entity1066 and 14 pts--ulcer formation type. The most common presenting signs and symptoms included: @entity1087 --94.4%; weight loss--86%; @entity490 --64%; @entity390 /vomiting--47%; pruritus--50%. The classic triad of @entity1087 , palpable @entity1085 and @entity417 with @entity360 was not present in all cases. Most valuable for the exact diagnosis were ultrasonography, computed tomography scan and careful endoscopic examination of the periampullary region before and after endoscopic retrograde cholangiopancreatography, with biopsy of any abnormal appearance. Local resection was done in 7 pts (predominantly polypoid type) with @entity5 size ranging 1.8-2.2 cm. Pancreatoduodenal resection was performed in 8 pts (Whipple procedure in 5 and Pylorus preserving in 3). By-pass procedure was performed in 21 pts. Biliodigestive anastomosis done alone in 14 and biliodigestive anastomosis + gastroenterostomy in 7 pts. Most commonly performed biliodigestive anastomosis was hepatico/choledocho-duodenostomy--14; hepatico-jejunostomy--6 and cholecystogastrostomy--one @entity1 . Postoperative morbidity--18% and postoperative mortality--2 pts. CONCLUSIONS: @entity189 of the papilla of Vater is a rare @entity344 . @entity5 size, gross appearance, biopsy material, lymph node metastases and UICC stage have a significant impact on the operative strategy and postoperative result.
