Lewis J H, Shorb P E, Nochomovitz L E
South Med J. 1985 Dec;78(12):1507-11. doi: 10.1097/00007611-198512000-00025.
The discovery of an elevated serum alkaline phosphatase level during routine blood screening in a 53-year-old man led to tests that showed a large benign villous adenoma obstructing the ampulla of Vater in the second part of the duodenum. Although the preferred treatment of such a lesion is local excision, the tumor was extensive and necessitated a pancreatoduodenectomy. Histologically benign duodenal villous adenomas that also obstruct the common bile duct are uncommon and may be missed during surgical exploration; therefore, whenever there are no stones to account for symptoms or signs of extrahepatic obstruction, the surgeon should carefully palpate the ampullary region of the duodenum.
一名53岁男性在常规血液筛查中发现血清碱性磷酸酶水平升高，进一步检查显示十二指肠第二部有一个巨大的良性绒毛状腺瘤阻塞了 Vater 壶腹。虽然此类病变的首选治疗方法是局部切除，但该肿瘤范围广泛，需要进行胰十二指肠切除术。组织学上为良性但同时阻塞胆总管的十二指肠绒毛状腺瘤并不常见，在手术探查时可能会被遗漏；因此，只要没有结石可以解释肝外梗阻的症状或体征，外科医生就应仔细触诊十二指肠的壶腹区域。
