Adenomyomatosis of the papilla of Vater: a case illustrating diagnostic difficulties.

OBJECTIVE

To describe the extremely rare case of an adenomyoma of the papilla of Vater.

METHODS

A 42-year-old woman was hospitalized for epigastralgia and high fever. The clinical presentation and endoscopic, biochemical, and radiologic findings led to the diagnostic impression of a dysfunction of the papilla of Vater. The patient was treated successfully by laparotomy and duodenotomy, incorporating cholangiomanometry and cholangiography. Intraoperative frozen-section examination of a transduodenal papillectomy specimen led to the diagnosis of adenomyomatosis of the papilla. The patient is doing well 38 months postoperatively.

CONCLUSIONS

Such a combined approach to intraoperative diagnosis was important to avoid excessive surgery for a benign periampullary disease.