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11/12. Carcinoid somatostatinoma of the papilla of Vater: a case report.

    A 57 year-old Japanese man with a carcinoid somatostatinoma of the papilla of Vater is presented. He was found to have cholecystolithiasis without any symptoms. physical examination showed no abnormal findings. Routine laboratory data gave normal results, except for glucose intolerance and an elevated somatostatin concentration. A yellowish papillary tumor was found at the papilla of Vater, and histological examination suggested the diagnosis of carcinoid. He underwent a pancreatoduodenectomy in March 1992. The gallbladder contained a single pure cholesterol stone. Histological, immunohistochemical, and electron microscopic studies resulted in the diagnosis of a carcinoid somatostatinoma of the papilla of Vater, without regional lymph node metastases. Post-operative pancreatic juice output from the total pancreatic duct drainage increased to more than 1000 mL/day. Although an anastomotic leakage of the pancreatojejunostomy was noted, the pancreatic fistula closed 8 weeks later. His postoperative somatostatin value was normal. He has been well for 54 months following surgery, without any signs of recurrence.
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ranking = 1
keywords = pancreatic fistula, fistula
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12/12. Multiple parapapillary choledochoduodenal fistulas with ampullary carcinoma.

    Only very rarely do multiple parapapillary choledochoduodenal fistulas occur concurrently with ampullary carcinoma. The following presents just such a case, which occurred in a 51 year-old Japanese female hospitalized for epigastralgia. Gastrointestinal fiberscopy (GIF) showed abnormal swelling of Vater's papilla. She was diagnosed as having ampullary carcinoma and choledochoduodenal fistulas, as determined by hypotonic duodenography (HDG), endoscopic retrograde cholangiopancreatography (ERCP) and from the histopathology of the ampullary mucosal biopsy. Pancreatoduodenectomy was performed. We postulated that the multiple fistulas were formed on the longitudinal fold of Vater's papilla by an ampullary carcinoma, and that the fistulas played a major role in bile drainage. As a result, jaundice was not seen throughout the entire clinical course. We report on the mechanism of fistula formation, with a review of the recent literature.
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ranking = 0.0023809481358578
keywords = fistula
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