Abstract:Objective:To discuss the clinical manifestations of ampullary carcinoma with pathologic cholecystointestinal fistula, so as to improve the rate of preoperative diagnosis.
Methods :The clinical data of 12 cases of ampullary carcinoma admitted to our hospital in recent nine years, and with cholecystointestinal fistula diagnosed at operation, were analyzed retrospectively.
Results:None of the patients had clinical manifestations of obstructive jaundice preoperatively. Ultrasonography suggested ampullary space occupying Flesion with dilatation of extrahepatic and intrahepatic bile ducts, and atrophic gallbladder with indefinite outline and adherence of gallbladde to surrounding tissues in all the cases; the diagnosis of cholecystointestinal fistula was made during operation. There were 7 cases of cholecystoduodenal fistula and 5 cases of cholecystocolonic fistula. The fistula ranged from 0.4 to 2.8 cm in diameter. Four cases underwent radical operation and 8 cases had palliative surgery. Postoperative pathologic examination verified the diagnosis of ampullary carcinoma.
Conclusions:The above-mentioned ultrasonggraphic features in elderly patients with no manifestations of obstructive jaundice, usually indicate the presence of pathologic cholecystointestinal fistula.