The radiological demonstration of the common bile-duct terminating in a duodenal diverticulum of the papillary region

Review of the literature shows that the termination of the common bile-duct in a duodenal diverticulum of the papillary region is very rare. Only a few reports on the pathology of this condition and on its radiological demonstration have been found. Four additional cases showing the radiological visualization are presented in this paper.

The pathogenesis of this type of duodenal diverticula, in which the ampulla of Vater (the major papilla) is situated within the diverticular wall, is discussed. The view is put forward that these are true diverticula representing congenital malformations.

A short evaluation of the clinical significance of this condition suggests that it represents a predisposing factor for biliary-pancreatic disease and possibly for stone formation in the common bile-duct. Incompetence of the sphincter of Oddi is believed to be a common feature or even part of this anomalous position of the ampulla of Vater.

The importance of the pre-operative radiological demonstration of this condition is stressed. The value of the radiological methods available for this purpose (gastroduodenal barium examination; intravenous cholangiography; intra-operative cholangiography) is discussed. A few indirect radiological signs which point to the presence of the condition are described, in addition to the direct radiological demonstration of the termination of the common bile-duct in the diverticulum.

Case 4 is thought to be the first case reported in which the ending of the common bile-duct within a diverticulum of the papillary region has been demonstrated by intravenous cholangiography (biligrafin).