Interposition of a jejunal limb after resection of the descending part of the duodenum for giant tubulovillous adenoma

Reconstruction after partial duodenectomy with resection of the ampulla of Vater is often troublesome. We report the case of a 70-year-old patient wit h endoscopically non-resectable tubulo-villous adenoma of the descending du odenum including the ampulla of Vater in which subsequent biopsies revealed dysplastic areas. A partial resection of the descending duodenum including the ampulla of Vater was performed. Reconstruction was achieved by the int erposition of a jejunal limb in which the ampulla could be reinserted to th e posterior wall. The postoperative course was uneventful; a carcinoma was not found within the specimen. In cases of widespread adenomas of the ampul la of Vater, duodenum-preserving resection by interposition of a jejunal li mb with reinsertion of the ampulla into the posterior wall may be used as a n alternative to Roux-Y reconstruction and to Whipple's procedure.