Adenomyomatous hyperplasia of the ampulla of Vater presenting as acute pancreatitis

Abstract

We report an interesting and rare case of a man with adenomyomatous hyperplasia of the ampulla of Vater presenting as acute pancreatitis, which to our knowledge, is only the second reported case in the English literature. The patient presented with an acute onset of abdominal pain, nausea and vomiting, without fever, chills or rigours. CT of the abdomen revealed changes of acute pancreatitis with a peripancreatic adenopathy, and abdominal ultrasound revealed a slightly hyperechoic and oedematous head of the pancreas, consistent with acute pancreatitis. Endoscopic retrograde cholangiopancreaticography revealed an ampullary lesion. Pathology of the ampullary lesion revealed an inflammatory polyp. Endoscopic ultrasound with endoscopic mucosal resection of the lesion revealed an adenomyomatous hyperplasia. The patient recovered well postendoscopic resection without recurrent pancreatitis or cholestasis.

Adenomyoma of the distal common bile duct demonstrated by endoscopic ultrasound: A case report and review of the literature

“…Endoscopic retrograde cholangiopancreatography (ERCP), another imaging option, is considered the gold standard for the diagnosis of distal CBD abnormalities[15-17]. However, it may induce severe complications such as post-ERCP pancreatitis[18].…”

Combination of Adenomyoma and Adenomyomatous Hyperplasia of the Ampullary System: A First Case Report

“…3 The first reported case of ampullary adenomyoma was documented by Bravet in 1913. 6,10 The largest case series (describing 13 cases) was reported by Handra-Luca et al in 2003. 3 To date, 58 cases of adenomyoma of the major papilla have been described in the English literature.…”

“…3 To date, 58 cases of adenomyoma of the major papilla have been described in the English literature. 3,6,[11][12][13][14][15][16] However, adenomyoma of the minor papilla is extremely rare, with only one case reported. 7 Although a previous review in 1999 showed a higher prevalence in women, with a female/male ratio of 3:1, 17 we did not find any significant difference after reviewing all cases published to date.…”

“…3 The histogenesis of this tumor-like lesions is still poorly characterized. Regarding the ampullary location, fewer than 60 cases involving the major papilla have been reported, 3,4,6 and only one case involving the minor papilla has been reported. 7 We report an unusual association of a major duodenal papilla adenomyoma with an adenomyomatous hyperplasia of the minor papilla discovered in a 73-year-old patient who underwent cephalic duodenopancreatectomy due to clinical and radiological evidence of underlying malignant neoplasm.…”

Iron Deficiency Anemia Masking Adenomyoma of the Jejunum

“…In the periampullary region, adenomyoma typically presents with biliary obstruction or abdominal pain, with reported cases of acute pancreatitis. 14,22 Lesions in the ileum and jejunum have presented with intussusception and intestinal obstruction, 29 but many reported cases have been incidentally detected. In the small intestine, intussusception is its most common complication, reported in 19 cases.…”