Acute cholecystitis due to a gall bladder torsion
Intra-ampullary papillary tubular neoplasms (IAPNs) are relatively rare kinds of neoplasms occurring in the region of the papilla which exhibits significant malignant transformation. The patient was concerned about his pain and the possibility of malignancy. The insidious onset of IAPN along with its high risk of malignancy makes it mandatory for its proper treatment. Although the endoscopic approach is advantageous for initial therapy, it has some technical difficulties. Hence TDA forms the cornerstone in the management of IAPN with a good prognosis. Transduodenal ampullectomy is a safe and feasible option for IAPN. It can be the first choice of treatment in selected cases where endoscopic papillectomy is not available.