A 58-year-old man underwent upper endoscopy for reflux symptoms. There was a large periampullary mass on the medial curve of the second portion of the duodenum. Multiple biopsies showed villous adenoma. Colonoscopy was normal with no evidence of polyposis syndrome (see discussion).
The patient was taken to the operating room for pancreatoduodenectomy (see Whipple Procedures VID 167, VID 636, VID 897, VID 996. Regional resection was not considered feasible because of ampullary involvement. Exploration was normal except for the duodenal mass. The serosa over the hepatoduodenal ligament (see right upper quadrant anatomy and mid-abdominal organs) was opened. The portal vein (see portal vein) is at the tip of the forceps.
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