Rare Case of Periampullary Duodenal Carcinoma

Periampullary carcinoma is a malignancy that appears around the vatteri ampulla. This malignancy can originate from the pancreas, duodenum, and distal choledochal duct. Duodenal cancer is a very rare case, only about 0.3% of the gastrointestinal malignancies. Reported cases are increasing with the increasing use of esophagogastroduodenoscopy. The most frequently found carcinomas of the duodenum include adenocarcinoma, carcinoid, lymphoma, and leiomyosarcoma. The symptoms of these carcinomas are often not specific so the diagnosis is often late, leading to a poor prognosis. Early diagnosis and proper therapy provide a good prognosis. The case reported here representeda 52-year-old woman presented with hematemesis melena, anemia, jaundice, epigastric mass, right hypochondrial pain, and weight loss. From the esophagogastroduodenoscopy, the mass was found to obstruct half of the duodenum lumen and bleeding, which was easily triggered, was observed in the second part of the duodenum. CT scan revealed a mass in the head of the pancreas with gall bladder hydrops and obstruction of the intra and extra-hepatic billier system. After a Whipple operation Laparotomy, the histology showed papillary adenocarcinoma duodenum. Patients then underwen chemotherapy with 5 fluorouracil regimen. Patient's clinical condition is currently improving and no complaint is conveyed by the patient.

Investigation of Biliary Canal Variations as a Cause of Stone Formation in the Choledochal Canal

The present study aimed to investigate if there is an association between the diameter of the choledochal duct and choledochal duct stone formation. The present study consisted of 79 patients who had endoscopic interventions and MRCP procedure with surgery history. Some followed due to disorders of the liver, gall bladder, and biliary tract and some of whom presented hepatobiliary complaints between 2017 and 2019. The choledochal duct diameter measured from MRCP images and choledochal duct stone had examined; the type classified according to Huang classification. Among the cases classified, 29 patients, was Huang Type A1, 27 patients were Huang Type A2, 16 patients were Huang Type A3, and seven patients were Huang Type A4. There was not any statistically significant association in terms of choledochal diameter regarding the types. Choledochal duct diameter was statistically higher in female patients than male patients (p<0.05). According to the age group, a statistically significant difference detected for choledochal duct stone formation; individuals over 45 years of age present an increase for choledochal duct stone (p<0.05). The choledochal duct diameter was found higher in female patients compared with male patients; stone formation has found increased in both gender over 45 years of age. It should consider before surgical procedures and radiological tests.

Minimally Invasive Treatment of Mirizzi Syndrome, a Rare Cause of Cholestasis in Childhood

Mirizzi syndrome is the compressive blockage of the cystic or choledochal duct caused by a biliary stone occupying the cystic canal or Hartmann’s pouch. This occurrence is rare and, in English literature, three cases defined in children have been observed. In order to draw attention to this rare occurrence, we preferred a 14-year-old male patient with Mirizzi syndrome. In this case, ERCP was performed preoperatively and the diagnosis was carried out with the help of clear visualisation and identification of the tissue structures as well as the stent placed in bile duct; so we protected the patient from the possible iatrogenic injury occurring during surgery.