Cancer of the Papilla Vateri in a Patient With Gastric Cancer: A Case Report

Cancer of the Papilla Vateri is a rare but clinically significant condition. Only individual cases of sequential cancer of the papilla of Vater occurring in patients previously treated for gastric cancer have been reported in the literature.The aim of the study to present a case of sequential cancer of the papilla Vateri in a patient who had undergone surgery for gastric cancer.Materials and methods. A review of the literature was conducted. Clinical data were obtained from the medical records of a patient with histologically verified adenocarcinoma of the papilla Vateri. Information analyzed included laboratory tests, diagnostic imaging, surgical findings, treatment methods, and outcomes.Results. A 69-year-old man was admitted with symptoms of acute cholangitis and obstructive jaundice. Five years earlier, he had undergone subtotal gastrectomy for gastric cancer (staged as рT4N2M0). Laboratory findings on admission included leukocytosis (11.8 × 10⁹/L) and hyperbilirubinemia (total 369 μmol/L; direct 288 μmol/L). Ultrasound examination revealed dilatation of the intrahepatic and extrahepatic bile ducts, enlargement of the pancreatic head, and dilatation of the Wirsung duct. Conservative management was unsuccessful, and the patient underwent surgery. Intraoperatively, a tumor of the papilla Vateri was identified, along with purulent cholangitis and obstructive jaundice. No evidence of recurrent gastric cancer was found. Hepaticostomy was performed, followed one month later by pancreatoduodenectomy. The final diagnosis was adenocarcinoma of the papilla Vateri, staged as pT3N0M0. The postoperative course was uneventful. The patient subsequently received chemotherapy according to current guidelines. During a two-year follow-up period, he remained free of major complaints. However, after two years, sonography revealed a solitary liver metastasis measuring up to 4 cm. The patient declined further treatment.Conclusions. We describe a rare case of sequential cancer of the papilla Vateri following gastric cancer. Given the lack of clear recommendations for surveillance and early detection in such patients, an individualized approach to follow-up and management is warranted.