Acute Recurrent Pancreatitis: A Possible Clinical Manifestation of Ampullary Cancer

  • Athanasios Petrou Department of Hepatobiliary Surgery; Churchill Hospital; Old Road, Headington; Oxford, OX3 7LJ; United Kingdom Phone: +44-1865.235.668 Fax: +44-1865.235.668
  • Konstantinos Bramis
  • Timothy Williams Department of Hepatobiliary Surgery; Churchill Hospital; Old Road, Headington; Oxford, OX3 7LJ; United Kingdom Phone: +44-1865.235.668 Fax: +44-1865.235.668
  • Alexandros Papalambros
  • Eleftherios Mantonakis
  • Evangelos Felekouras
Keywords: Adenocarcinoma, Pancreatic Neoplasms, Pancreatitis, Acute Necrotizing

Abstract

 

Context Acute recurrent pancreatitis still poses diagnostic difficulties. The coexistence or moreover the causative relationship of carcinoma of the ampulla of Vater and acute recurrent pancreatitis is fairly rare. Case report We present a case of carcinoma of the ampulla of Vater that presented with acute recurrent necrotizing pancreatitis complicated with pseudocysts. A diagnosis of malignancy in the ampulla was only made after several ERCP attempts due to residual inflammation at the periampullary area. Conclusion Malignancy at the ampulla of Vater causing recurrent episodes of pancreatitis represents a realistic risk and attempts to diagnose the underlying cause should always take into account the possibility of cancer.

 

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References

Benhamiche AM, Jouve JL, Manfredi S, Prost P, Isambert N, Faivre J. Cancer of the ampulla of Vater: results of a 20-year population-based study. Eur J Gastroenterol Hepatol 2000; 12:75-9. [PMID 10656214]

Albores-Saavedra J, Schwartz AM, Batich K, Henson DE. Cancers of the ampulla of Vater: demographics, morphology, and survival based on 5,625 cases from the SEER program. J Surg Oncol 2009; 100:598-605. [PMID 19697352]

Chareton B, Coiffic J, Landen S, Bardaxoglou E, Campion JP, Launois B. Diagnosis and therapy for ampullary tumors: 63 cases. World J Surg 1996; 20:707-12. [PMID 8662157]

Howe JR, Klimstra DS, Moccia RD, Conlon KC, Brennan MF. Factors predictive of survival in ampullary carcinoma. Ann Surg 1998; 228:87-94. [PMID 9671071]

Beger HG, Treitschke F, Gansauge F, Harada N, Hiki N, Mattfeldt T. Tumor of the ampulla of Vater: experience with local or radical resection in 171 consecutively treated patients. Arch Surg 1999; 134:526-32. [PMID 10323425]

Riall TS, Cameron JL, Lillemoe KD, Winter JM, Campbell KA, Hruban RH, et al. Resected periampullary adenocarcinoma: 5-year survivors and their 6- to 10-year follow-up. Surgery 2006; 140:764-72. [PMID 17084719]

Ruemmele P, Dietmaier W, Terracciano L, Tornillo L, Bataille F, Kaiser A, et al. Histopathologic features and microsatellite instability of cancers of the papilla of Vater and their precursor lesions. Am J Surg Pathol 2009; 33:691-704. [PMID 19252434]

Perrone G, Santini D, Zagami M, Vincenzi B, Verzì A, Morini S, et al. COX-2 expression of ampullary carcinoma: correlation with different histotypes and clinicopathological parameters. Virchows Arch 2006; 449:334-40. [PMID 16906389]

Kadmon M, Tandara A, Herfarth C. Duodenal adenomatosis in familial adenomatous polyposis coli. A review of the literature and results from the Heidelberg Polyposis Register. Int J Colorectal Dis 2001; 16:63-75. [PMID 11355321]

Carter JT, Grenert JP, Rubenstein L, Stewart L, Way LW. Tumors of the ampulla of Vater: histopathologic classification and predictors of survival. J Am Coll Surg 2008; 207:210-8. [PMID 18656049]

Berberat PO, Künzli BM, Gulbinas A, Ramanauskas T, Kleeff J, Müller MW, Wagner M, et al. An audit of outcomes of a series of periampullary carcinomas. Eur J Surg Oncol 2009; 35:187-91. [PMID 18343082]

Friess H, Guo XZ, Tempia-Caliera AA, Fukuda A, Martignoni ME, Zimmermann A, et al. Differential expression of metastasis-associated genes in papilla of Vater and pancreatic cancer correlates with disease stage. J Clin Oncol 2001; 19:2422-32. [PMID 11331321]

Levy MJ, Geenen JE. Idiopathic acute recurrent pancreatitis. Am J Gastroenterol 2001; 96:2540-55. [PMID 11569674]

Gullo L, Migliori M, Pezzilli R, Olah A, Farkas G, Levy P, et al. An update on recurrent acute pancreatitis: data from five European countries. Am J Gastroenterol 2002; 97:1959-62. [PMID 12190160]

Steinberg W, Tenner S. Acute pancreatitis. N Engl J Med 1994; 330:1198-210. [PMID 7811319]

Lee SP, Nicholls JF, Park HZ. Biliary sludge as a cause of acute pancreatitis. N Engl J Med 1992; 326:589-93. [PMID 1734248]

Delhaye M, Matos C, Arvanitakis M, Deviere J. Pancreatic ductal system obstruction and acute recurrent pancreatitis. World J Gastroenterol 2008; 14:1027-33. [PMID 18286683]

Guzzardo G, Kleinman MS, Krackov JH, Schwartz SI. Recurrent acute pancreatitis caused by ampullary villous adenoma. J Clin Gastroenterol 1990; 12:200-2. [PMID 2182707]

Wright BE, Kozarek RA, Traverso LW, Wechter D, Thirlby R, Raltz SL. Recurrent pancreatitis in Gardner variant familial polyposis: etiology, diagnostic approach, and interventional results. Arch Surg 1999; 134:311-5. [PMID 10088575]

Tanasijtchouk T, Vaisbein E, Lachter J, Nassar F. Carcinoma of papilla Vateri presenting as recurrent acute pancreatitis. Acta Gastroenterol Belg 2004; 67:309-10. [PMID 15587343]

Kwon TH, Park do H, Shim KY, Cho HD, Park JH, Lee SH, et al. Ampullary adenomyoma presenting as acute recurrent pancreatitis. World J Gastroenterol 2007; 13:2892-4. [PMID 17569131]

Lorente JA, Ruiz del Arbol L, Moreira VF, Garcia-Plaza A. Recurrent pancreatitis in a young patient associated with a solitary nonopaque concretion in the main pancreatic duct. Gastrointest Endosc 1990; 36:63-5. [PMID 2311885]

Chung JP, Chi SW, Park YN, Lee SJ, Song SY, Lee KS, et al. A case of minute intraductal papillary mucinous tumor of the pancreas presenting with recurrent acute pancreatitis. Yonsei Med J 2000; 41:528-32. [PMID 10992817]

Tikhomirov V, Tikhomirova S, Sieber S, Schiffman MK. A pancreatic intraductal papillary mucinous tumor causing recurrent acute pancreatitis at the onset of menstrual periods. J Clin Gastroenterol 2000; 31:172-4. [PMID 10993439]

Mosca S, Bottino V, Molino C. Hepatobiliary and pancreatic: a woman with recurrent idiopathic acute pancreatitis. Intraductal papillary mucinous tumor of the pancreas. J Gastroenterol Hepatol 2001; 16:1070-5. [PMID 11595076]

Howard TJ, Moore SA, Saxena R, Matthews DE, Schmidt CM, Wiebke EA. Pancreatic duct strictures are a common cause of recurrent pancreatitis after successful management of pancreatic necrosis. Surgery 2004; 136:909-16. [PMID 15467678]

Sandblom G, Granroth S, Rasmussen IC. TPS, CA 19-9, VEGF-A, and CEA as diagnostic and prognostic factors in patients with mass lesions in the pancreatic head. Ups J Med Sci 2008; 113:57-64. [PMID 18521799]

Kau SY, Shyr YM, Su CH, Wu CW, Lui WY. Diagnostic and prognostic values of CA 19-9 and CEA in periampullary cancers. J Am Coll Surg 1999; 188:415-20. [PMID 10195726]

Steinberg W. The clinical utility of the CA 19-9 tumor-associated antigen. Am J Gastroenterol 1990; 85:350-5. [PMID 2183589]

Legmann P, Vignaux O, Dousset B, Baraza AJ, Palazzo L, Dumontier I, et al. Pancreatic tumors: comparison of dual-phase helical CT and endoscopic sonography. AJR Am J Roentgenol 1998; 170:1315-22. [PMID 9574609]

Feller ER. Endoscopic retrograde cholangiopancreatography in the diagnosis of unexplained pancreatitis. Arch Intern Med 1984; 144:1797-9. [PMID 6476999]

Venu RP, Geenen JE, Hogan W, Stone J, Johnson GK, Soergel K. Idiopathic recurrent pancreatitis. An approach to diagnosis and treatment. Dig Dis Sci 1989; 34:1943-5. [PMID 2631687]

Cotton PB. Congenital anomaly of pancreas divisum as cause of obstructive pain and pancreatitis. Gut 1980; 21:105-14. [PMID 7380331]

Freeman ML, Nelson DB, Sherman S, Haber GB, Herman ME, Dorsher PJ, et al. Complications of endoscopic biliary sphincterotomy. N Engl J Med 1996; 335:909-18. [PMID 8782497]

Eloubeidi MA, Gress FG, Savides TJ, Wiersema MJ, Kochman ML, Ahmad NA, et al. Acute pancreatitis after EUS-guided FNA of solid pancreatic masses: a pooled analysis from EUS centers in the United States. Gastrointest Endosc 2004; 60:385-9. [PMID 15332028]

Rocca R, De Angelis C, Castellino F, Masoero G, Daperno M, Sostegni R, et al. EUS diagnosis and simultaneous endoscopic retrograde cholangiography treatment of common bile duct stones by using an oblique-viewing echoendoscope. Gastrointest Endosc 2006; 63:479-84. [PMID 16500400]

Canto MI, Goggins M, Hruban RH, Petersen GM, Giardiello FM, Yeo C, et al. Screening for pancreatic neoplasia in high-risk individuals: a prospective controlled study. Clin Gastroenterol Hepatol 2006; 4:766-81. [PMID 16682259]

Al-Haddad M, Wallace MB. Diagnostic approach to patients with acute idiopathic and recurrent pancreatitis, what should be done? World J Gastroenterol 2008; 14:1007-10. [PMID 18286679]

Axial CT image demonstrating pseudocyst formation
Published
2011-11-11
How to Cite
PetrouA., BramisK., WilliamsT., PapalambrosA., MantonakisE., & FelekourasE. (2011). Acute Recurrent Pancreatitis: A Possible Clinical Manifestation of Ampullary Cancer. JOP. Journal of the Pancreas, 12(6), 593-597. https://doi.org/10.6092/1590-8577/555