Challenges in the management of adenocarcinoma of ampulla of Vater in pregnancy: A case report and review of literature

Abdullah Saleh AlQattan; Feras Ahmed Alkuwaiti; Elham Saleh Alghusnah; Shoukat Ahmad Bojal; Mohammed Saad Alqahtani

doi:10.1016/j.ijscr.2019.06.044

Challenges in the management of adenocarcinoma of ampulla of Vater in pregnancy: A case report and review of literature

Int J Surg Case Rep. 2019:61:38-43. doi: 10.1016/j.ijscr.2019.06.044. Epub 2019 Jun 26.

Authors

Abdullah Saleh AlQattan¹, Feras Ahmed Alkuwaiti², Elham Saleh Alghusnah², Shoukat Ahmad Bojal³, Mohammed Saad Alqahtani³

Affiliations

¹ Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia. Electronic address: a.qattan.94@gmail.com.
² Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
³ Department of General Surgery, King Fahad Specialist Hospital, Dammam, Saudi Arabia.

Abstract

Introduction: Ampullary adenocarcinoma is a rare entity during pregnancy. It accounts for 0.5% of all gastrointestinal malignancies. The best treatment modality for resectable tumors with the best reported outcome is surgical resection in the form of pancreaticoduodenectomy (Whipple procedure). In this case report, we discuss the challenges in the management of ampullary adenocarcinoma in a pregnant patient.

Case presentation: We report a case of 22 years old pregnant women who presented with vague abdominal pain and jaundice at the 28th week of gestation. Endoscopic retrograde cholangiopancreatography (ERCP) showed a stricture around the ampulla and distal common bile duct (CBD). The CBD was stented and a biopsy was taken. Histopathology revealed: an invasive adenocarcinoma. The patient was managed by elective pancreaticoduodenectomy after induction of vaginal delivery at the 34th week of gestation.

Conclusion: Diagnosing and managing ampullary adenocarcinoma in pregnant patients in their 3rd trimester is challenging. Yet, a delayed viable delivery followed by a definitive surgery in the form of pancreaticoduodenectomy offers the best outcomes for both the mother & fetus in case of early stage disease.

Keywords: Adenocarcinoma; Ampulla of Vater; Jaundice; Pancreaticoduodenectomy; Pregnancy.