c l i n i c a l f o l i o s : n a r r a t i v e





A D V E R T I S E M E N T

 

Whipple Procedure for Bile Duct Carcinoma: 1

A D V E R T I S E M E N T

   
 

A 51-year-old man presented with obstructive jaundice and a painless (Courvoisier) dilated gallbladder. CT scan showed a dilated common bile duct and a suggestion of a small lesion around the distal duct near the ampulla. Upper endoscopy showed normal duodenal mucosa at the ampulla. The patient was taken to the operating room for a Whipple procedure.      

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Whipple Procedure for Bile Duct Carcinoma: 2

A D V E R T I S E M E N T

   
 

Exploration of the abdomen revealed no pathology other than the dilated biliary tree. A small wedge biopsy of the head of the pancreas showed no tumor. The duodenum and head of the pancreas were mobilized (Kocher maneuver; see Whipple procedure, MEN Type I ).      

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Whipple Procedure for Bile Duct Carcinoma: 3

A D V E R T I S E M E N T

   
 

The gastrocolic omentum was opened to expose the body of the pancreas in the lesser sac, and the superior mesenteric vein (SMV) was identified at the lower border of the neck of the pancreas. A finger was inserted between vein and neck to confirm resectability. The commitment was made to proceed with resection, and the gastric antrum was divided with a linear stapler.      

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This page was last modified on 10/10/2001.