Successful Endoscopic Ampullectomy & CBD Stenting for Periampullary Adenoma in a 60 Y.O. Male
The PACE Hospitals’ expert gastroenterology team successfully performed an Endoscopic Ampullectomy, Precut Sphincterotomy, and Common Bile Duct (CBD) Stenting on a 60-year-old male patient diagnosed with a periampullary mass lesion. The aim of the procedure was to safely remove the ampullary lesion, relieve biliary obstruction, ensure adequate bile drainage, and prevent complications.
PACE Hospitals is widely recognized as one of the Best Gastroenterology Hospital in Hyderabad, India. With a team of highly skilled and experienced medical & surgical gastroenterologists and hepatologists, PACE Hospitals offers comprehensive diagnostic and treatment services for a wide range of digestive system diseases and disorders.
Past Medical History
The patient had a known history of diabetes mellitus and heart failure with reduced ejection fraction (HFrEF) secondary to dilated cardiomyopathy. No other significant chronic illnesses or prior major surgeries were reported.
On Examination
On admission, the patient was conscious, coherent, and oriented. General examination was normal with stable vital parameters. Systemic examination revealed a soft, non-tender abdomen with no organomegaly or guarding. Respiratory system examination showed normal breath sounds bilaterally without added sounds. Cardiovascular examination demonstrated normal heart sounds without murmurs. No peripheral edema, cyanosis, or signs of dehydration were noted. Neurological examination was normal with no focal deficits.
Diagnosis
Upon admission to PACE Hospitals, the patient was thoroughly evaluated by the Gastroenterology team following a 1-month history of burning pain in the chest and abdominal pain, persistent hiccups, and loss of appetite. There was a strong clinical suspicion of a periampullary mass causing distal common bile duct (CBD) obstruction.
The patient underwent an extensive diagnostic evaluation. Triphasic CT Abdomen demonstrated a well-defined minimally enhancing periampullary mass lesion (15 × 13 mm) with external compression of the terminal CBD and bilobar intrahepatic biliary radicle dilatation (IHBRD). Endoscopic ultrasound (EUS) confirmed the presence of an ampullary lesion. Laboratory markers, including CEA and CA-19-9, were within normal limits. Echocardiography showed heart failure with reduced ejection fraction (HFrEF) with a left ventricular ejection fraction of 50%.
Based on the confirmed diagnosis, the patient was advised to undergo Periampullary Mass Lesion Treatment in Hyderabad, India, under the expert care of the Gastroenterology Department.
Medical Decision Making
After a detailed consultation with consultant gastroenterologists, Dr. Govind Verma, Dr. M Sudhir, Dr. Padma Priya, and cross consultation with cardiologist, Dr. Seshi Vardhan Janjirala, a comprehensive evaluation was performed to determine the most appropriate diagnostic and therapeutic approach. Considering the patient’s history of burning chest and abdominal pain, persistent hiccups, and loss of appetite, along with significant comorbidities such as Diabetes Mellitus, Dilated Cardiomyopathy, and HFrEF (EF 50%), an optimal treatment strategy was formulated.
Based on these clinical and imaging findings, it was determined that Endoscopic Ampullectomy with precut sphincterotomy and CBD stenting was identified as the most suitable therapeutic intervention to relieve obstruction, obtain definitive tissue diagnosis, and avoid the risks associated with major surgery.
The patient and his family members were clearly counselled about the periampullary lesion, the need for endoscopic ampullectomy with common bile duct (CBD) stenting, and the associated risks.
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