Villous Adenoma of the Duodenum Coexisting with Chronic Pancreatitis and Abscess Formation: Report of a Case

Villous adenoma of the duodenum is rare and may present with gastrointestinal bleeding, obstructive jaundice, vague abdominal discomfort, acute pancreatitis and malignant change. A 64 years old woman presented to us with LUQ pain and fever for 20 days. Abdominal sonography and computed tomography showed a cystic mass lesion (4.3cm×3.8cm) at pancreatic tail. Duodenoscopy revealed a papillary tumor below the Ampulla Vater. A communication between the tumor and the pancreatic duct was noted when endoscopic retrograde pancreatogram was performed. A pancreatic abscess was found at the time of laparotomy. After abscess drainage and antibiotic therapy, the patient underwent a second stage pancreatoduodenectomy. Pathological examination revealed features of villous adenoma and chronic pancreatitis. The tumor measured 3cm×2.2cm×l.7cm in size and had a lumen communicating with the major pancreatic duct.