Benign stenosis of the papilla of Vater. Diagnosis of 119 cases with conventional and selective low radiomanometry

Abstract

Intra-operative radiomanometry with serial conventional films (panoramic cholangiography) and intra-abdominally placed large dental films (selective low cholangiography) produce a dynamic and static, millimetric study of the lower part of the common duct. It revealed in 2,095 patients with benign biliary pathology 119 cases of stenosis of the papilla of which 34 are detected during secondary operations of 85 patients. With the procedure of the authors a clear definition of the benign stenosis of the papilla is obtained radiomanometrically: 1. moderate hypertony; 2. disappearance of the normal rhythmical sphincter activity; 3. the biliary infundibulum, no longer conical, is wider than the intrapancreatic part of the common bile duct above it; 4. the biliary pancreatic reflux more rarely appears and, if it is discernible, pancreatic reflux is shorter than expected and the pancreatic duct obviously enlarged. These signs are quite characteristic of chronic stasis in both common bile duct and pancreatic duct, from infundibulum to intrahepatic ducts above the stenosic papilla (Acta chir. belg., 1977,76,523-532).