Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 26, 2021; 9(18): 4844-4851
Published online Jun 26, 2021. doi: 10.12998/wjcc.v9.i18.4844
Microscopic transduodenal excision of an ampullary adenoma: A case report and review of the literature
Xiang Zheng, Qing-Jing Sun, Bo Zhou, Ming Jin, Sheng Yan
Xiang Zheng, Bo Zhou, Ming Jin, Sheng Yan, Department of General Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, Zhejiang Province, China
Qing-Jing Sun, The Affiliated Hospital of Stomatology, School of Stomatology, Zhejiang University School of Medicine, and Key Laboratory of Oral Biomedical Research of Zhejiang Province, Hangzhou 310006, Zhejiang Province, China
Author contributions: Zheng X and Sun QJ contributed equally to this work; Zheng X and Sun QJ reviewed the literature, acquired the data, and contributed to manuscript drafting; Zhou B and Jin M analyzed and interpreted the imaging findings and contributed to manuscript drafting; Yan S acquired the data and was responsible for revision of the manuscript for important intellectual content; all authors issued final approval for the version to be submitted.
Supported by Natural Science Foundation of Zhejiang Province, No. LQ19H100004.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to report.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Sheng Yan, MD, PhD, Professor, Department of General Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, No. 88 Jiefang Road, Hangzhou 310009, Zhejiang Province, China.
Received: February 6, 2021
Peer-review started: February 6, 2021
First decision: March 14, 2021
Revised: March 27, 2021
Accepted: April 9, 2021
Article in press: April 9, 2021
Published online: June 26, 2021

Transduodenal local excision is an alternative treatment approach for benign ampullary tumors. However, this procedure has technical difficulties, especially during reconstruction of the pancreaticobiliary ducts. An operating microscope has been widely used by surgeons for delicate surgery due to its major advantages of magnification, illumination, and stereoscopic view. The application of an operating microscope in transduodenal excision of ampullary tumors has not been reported.


A 55-year-old woman was admitted for investigation of recurrent upper abdominal pain. Physical examination and laboratory tests found no abnormalities. Imaging identified a large mass in the descending part of the duodenum. Esophagogastroduodenoscopy revealed a 3.5-cm-sized villous growth over the major duodenal papilla. Pathology of the endoscopic biopsy indicated a villous adenoma with low-grade dysplasia. Microscopic transduodenal excision of the ampullary tumor was performed. The final pathological diagnosis was villous-tubular adenoma with low-grade dysplasia. The patient was discharged on postoperative day 12 after an uneventful recovery. Endoscopic retrograde cholangiopancreatography was performed 3 mo postoperatively and showed no bile duct or pancreatic duct strictures and no tumor recurrence. The patient is continuing follow-up at our clinic and remains well.


Operating microscope-assisted transduodenal local excision is a feasible and effective option for benign ampullary tumors.

Keywords: Operating microscope, Transduodenal local excision, Ampullary tumor, Endoscopic papillectomy, Pancreaticoduodenectomy, Case report

Core Tip: Operating microscope-assisted transduodenal excision of ampullary tumors has not been reported. We present our experience of microscopic transduodenal local excision in a case of ampullary adenoma. The application of an operating microscope provides significant technical advantages, particularly in the reconstruction of pancreaticobiliary ducts. The successful outcome in this case suggests that microscopic transduodenal excision is feasible and effective for patients with ampullary tumors.