Microscopic transduodenal excision of an ampullary adenoma: A case report and review of the literature

Figure 1 Preoperative examination of the ampullary tumor. A and B: Contrast-enhanced computed tomography and magnetic resonance imaging showing an enhanced lesion (arrow) located in the descending part of the duodenum; C: Magnetic resonance cholangiography revealing a mild dilation of the common bile duct, and no cut-off sign or stricture of either the bile duct or pancreatic duct; D: Endoscopic view of the ampullary adenoma.

Figure 2 Steps of the surgical procedure under the operating microscope. A: Exposure of the duodenal papillary adenoma; B: Kelly forceps placed under the tumor to raise the ampulla of Vater; C: Identifying the pancreaticobiliary duct (arrow) by insertion of a silicone catheter. One orifice was created in this case; D: Dissecting the ampullary adenoma carefully to ensure an adequate margin; E: Suturing the pancreaticobiliary duct to the surrounding duodenal mucosa with 6/0 prolene sutures; F: Closure after the duodenotomy.