What is Ampullary diverticulum?

Abstract. Background: Periampullary diverticula (PAD) are extraluminal outpouchings of the duodenum arising within a radius of 2-3 cm from the ampulla of Vater. They are frequently encountered in elderly patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) and contribute to failure of ERCP.

What is meant by duodenal diverticulum?

A duodenal diverticulum (the plural of which is diverticula) is a pouch attached to the duodenum, the second part of the small intestine just past the stomach. There are two types of duodenal diverticula.

How many types of Periampullary diverticulum are there?

Type I: The papilla is located inside the diverticulum and not adjacent to the margin; type II: The papilla is located in the margin of the diverticulum (type IIa: Inside of the margin; type IIb: Outside of the margin, < 1 cm); type III: The papilla is located outside the margin, ≥ 1 cm; type IV: The papilla is located …

Is the Periampullary diverticulum usually asymptomatic?

Although periampullary diverticulum is usually asymptomatic and discovered incidentally in patients during endoscopic retrograde cholangiopancreatography (ERCP), it may lead to post-ERCP morbidity.

Where is the ampulla of Vater in periampullary cancer?

Periampullary region; the circle shaded blue is the area where periampullary carcinoma arises The ampulla of Vater is a mound-like opening in the duodenum. The duodenum is a C shaped loop of bowel at the beginning of the intestine.

Where are the Periampullary diverticula located in the ERCP?

Periampullary diverticula are a common anomaly that present difficulty with the cannulation of the papilla at ERCP. This is a case with several diverticula in the descendening duodenum. Here we see a small proximal diverticula and an adjacent large diverticula in the ampullary region.

Can a peri diverticular papilla be cannulated?

Periampullary duodenal diverticula increase the risk of failure for cannulation of the papilla. An important percentage of patients have a peri-diverticular papilla of Vater (PD). It could hinder the biliary and/or pancreatic cannulation at endoscopic retrograde cholangiopancreatography (ERCP) and might change the outcomes in this procedure.