This poster was previously presented in Spanish at the 2012 Congreso Nacional SERAM (Granada)
Type:
Educational Exhibit
Keywords:
CT, Gastrointestinal tract, Pancreas, Ultrasound, MR, Neoplasia
Authors:
C. Lozano Cejudo1, A. J. Sáenz Gutiérrez2, C. López Menéndez2, M. T. Gomez San Roman3; 1Puertollano (Ciudad Real)/ES, 2Ciudad Real/ES, 3Puertollano/ES
DOI:
10.1594/ecr2013/C-0236
Background
The ampulla of Vater comprises the junction of the biliary and pancreatic ducts and is surrounded by the sphincter of Oddi,
the latter is a smooth muscle structure 1 cm long.
The distal constricted end of the ampulla opens into the posteromedial aspect of the duodenum,
falling into major duodenal papilla (Fig 1,
Fig 2).
The junction of the common bile duct and the main pancreatic duct may occur in three ways,
in decreasing order of frequency:
- A common duct
- A single papilla with dual openings.
- Separate duodenal openings for the two canals.
Symptoms of periampullary tumours are usually non-specific,
reflecting ampullary obstruction resulting from the mass-effect.
For this reason,
they share several clinical manifestations such us jaundice,
coluria,
pruritus,
acolia,
weight loss,
nausea,
vomiting and abdominal pain.
Clinical history and imaging techniques available (ultrasound,
CT and MRI) allow differentiating tumours from each other and from other diseases,
and staging the disease if necessary.
However,
there are cases in which we only get definitive diagnosis after surgery.
Periampullary tumours are a heterogeneous group of neoplasm located in the anatomical region that gives them their name.
They arise from pancreatic head,
lower common bile duct,
papilla of Vater or duodenum.
Pancreatic adenocarcinoma is the most common tumour,
however other pancreatic tumours (islet cell tumors,
cystic tumours,
metastases…),
lymphadenopathy,
or even gallstones can be found in this area and we have to know the differential features.