[Carcinoma of the papilla of Vater. Diagnostic and therapeutic problems. An analysis of 32 Tunisian cases].

Unlabelled: The aim determine the clinical, morphological, endoscopical and progressive profile of patients with ampullary carcinoma.

Patients And Methods: Thirty-two patients with a carcinoma of the ampulla of Vater, hospitalised in the Gastro-enterology service of Habib Thameur Hospital (Tunis) (1992-2002) have been analysed retrospectively.

Results: Twelve men and 20 women of an average age of 66 years have been included. Twelve patients (37%) had had a cholecystectomy into the 3 years preceding the diagnosis of the ampullary carcinoma. A duodenal tumour had been found at 29 patients (91%). After endoscopical sphincterectomy, an intra-ampullar exophytic tumour had been found in I case and an infiltrated aspect of the ampulla of Vater in 2 cases. The jaundice was frequent. The use of lateral duodenoscopy allowed carrying the positive diagnosis in all cases. Five patients had metastasis at the moment of diagnosis. A DPC has been practiced at 15 patients. A palliative biliary diversion has been realized at 9 patients. Six patients had an endoscopical palliative drainage with installation of a plastic prosthesis. The rate of post- operative mortality was 20%. The rate of morbidity linked to the surgery was 21.8%.

Conclusion: The ampullary carcinoma is a rare tumour diagnosed belated. The postoperative mortality is raised. The identification of factors forecast and the utilization of adjuvant processing will be able to allow the improvement of the prognosis.