Ectopic papilla of Vater in the pylorus

The major papilla of Vater is usually located in the second portion of the duodenum, to the posterior medial wall. Sometimes the mouth of the biliary duct is located in other areas. Drainage of the common bile duct into the pylorus is extremely rare. A 73-year old man, with a history of duodenal ulc...

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Bibliographic Details
Published in:World journal of gastroenterology : WJG 2009-11, Vol.15 (41), p.5221-5223
Main Authors: Guerra, Iván, Rábago, Luis-Ramón, Bermejo, Fernando, Quintanilla, Elvira, García-Garzón, Silvia
Format: Article
Language:English
Subjects:
Aged
Ampulla of Vater
Case Report
Catheterization
Cholangiopancreatography, Endoscopic Retrograde
Choristoma - diagnosis
Choristoma - pathology
Choristoma - therapy
Humans
Male
Pylorus - pathology
Stomach Diseases - diagnosis
Stomach Diseases - pathology
Stomach Diseases - therapy
十二指肠
并发症
正常现象
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Summary:The major papilla of Vater is usually located in the second portion of the duodenum, to the posterior medial wall. Sometimes the mouth of the biliary duct is located in other areas. Drainage of the common bile duct into the pylorus is extremely rare. A 73-year old man, with a history of duodenal ulcer, was admitted to hospital with the diagnosis of cholangitis. Dilatation of the extrahepatic biliary duct was observed by abdominal ultrasonography, and endoscopic retrograde cholangiopancreatography （ERCP） was performed. No area suggesting the presence of the papilla of Vater was found within the second duodenal portion. Finally the major papilla was located in the theoretical pyloric duct. Cholangiography was performed and choledocholithiasis was found in the biliary tree. The patient underwent dilatation of the papilla with a balloon tyre and removal of a 7 mm stone using a Dormia basket, which solved the problem without further complications. This anomaly increased the difficulty of performing therapeutic interventions during ERCR This alteration in anatomy may increase the risk of complications during papillotomy, with a theoretically higher risk of perforation. Dilatation using a balloon was the chosen therapeutic technique both in our case and in the literature, due to its low rate of complications.
ISSN:1007-9327
2219-2840
DOI:10.3748/wjg.15.5221