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August 1950

CARCINOMA OF THE AMPULLA OF VATER OF MINUTE SIZE: An Unsuspected Cause of Obstructive Jaundice

Author Affiliations

From the Fifth and Sixth (Boston University) Medical Services of Boston City Hospital, the Department of Medicine, Boston University School of Medicine and the Mallory Institute of Pathology, Boston City Hospital, Boston.

Arch Surg. 1950;61(2):357-371. doi:10.1001/archsurg.1950.01250020361017

SOUND medical practice dictates the necessity for surgical exploration in patients who present a clinical and laboratory pattern consistent with obstructive jaundice. When at operation routine search including careful palpation fails to disclose the suspected obstructive lesion, the operator, knowing well the difficulties inherent in the differential diagnosis of jaundice, may begin to doubt the validity of his preoperative impression. If, after duodenotomy and direct inspection of the ampullary region, no lesion can be seen, a diagnosis of either primary hepatitis or the passage of a common duct stone may be made. It is apparently not well appreciated that a major degree of biliary obstruction may be produced by carcinomas of the ampulla of Vater of such small size as to be undetectable at the time of operation on palpation or even direct inspection after duodenotomy.

The stimulus to present the following material arose as a result of a discussion