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Case Reports
. 2009 Nov 7;15(41):5221-3.
doi: 10.3748/wjg.15.5221.

Ectopic papilla of Vater in the pylorus

Iván Guerra  1 , Luis-Ramón Rábago, Fernando Bermejo, Elvira Quintanilla, Silvia García-Garzón
Affiliations
Case Reports

Ectopic papilla of Vater in the pylorus

Iván Guerra et al. World J Gastroenterol. .

Abstract

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 ERCP. 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.

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Figures

Figure 1
Figure 1
Endoscopic retrograde cholangiopancreatography. A: View of the papilla located in the pylorus (arrow head); B: Piping of the papilla.
Figure 2
Figure 2
Cholangiography. A: Common bile duct ending in a hook shape, common in proximal drainage of the papilla; B: Removal of choledocholithiasis with Dormia basket (arrow head).
Figure 3
Figure 3
Endoscopic retrograde cholangiopancreatography. Balloon dilatation of the ectopic papilla.
See this image and copyright information in PMC

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