Periampullary cancers are defined as cancers arising within 2 cm of the papilla of Vater. The term “periampullary” includes a heterogenous group of neoplasms arising from the pancreas, duodenum, distal common bile duct, or structures of the ampullary complex ( Fig.…
The sphincter of Oddi (SO) is a smooth muscular structure usually 7 to 13 mm in length encircling the distal common bile duct (CBD) and the pancreatic duct (a common channel opening into the ampulla of Vater). The three functions of…
Stones in the common bile duct (CBD) are either primary or secondary. Primary stones are formed de novo in the CBD as a result of bacterial action on phospholipid and bilirubin (see Chapter 134 ). Secondary stones, including cholesterol and…
Cholelithiasis and cholecystitis are classified into three types based on presentation: (1) silent gallstones, in which gallstones are detected accidentally and are truly asymptomatic; (2) symptomatic gallstone disease; and (3) abdominal symptoms mimicking cholelithiasis but caused by a comorbid condition…
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Acute cholecystitis is inflammation of the gallbladder after persistent obstruction of the gallbladder outlet from an impacted stone, resulting in increased gallbladder pressure, rapid distention, decreased blood supply, and gallbladder ischemia, with subsequent bacterial invasion, inflammation, and possible perforation (…
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Pancreatic neuroendocrine tumors (PNETs), also known as “islet cell tumors,” represent a group of rare neoplasms of the neuroendocrine cells of the gastropancreatic system ( Fig. 132.1 ). PNETs constitute fewer than 5% of the pancreatic tumors. They may be…
The increasing use of abdominal imaging studies such as abdominal ultrasound, computed tomography (CT) scan, and magnetic resonance imaging (MRI) has contributed to the incidental detection of pancreatic cysts, some of which may be malignant and others premalignant or benign.…