open access

Vol 80, No 1 (2021)
Original article
Submitted: 2019-08-15
Accepted: 2020-01-07
Published online: 2020-02-05
Get Citation

The position of a duodenal diverticulum in the area of the major duodenal papilla and its potential clinical implications

E. Jakubczyk1, M. Pazurek2, A. Mokrowiecka2, B. Woźniak2, E. Małecka-Panas2, M. Podgórski3, M. Polguj1, M. Topol4
·
Pubmed: 32020575
·
Folia Morphol 2021;80(1):106-113.
Affiliations
  1. Department of Normal and Clinical Anatomy, Chair of Anatomy and Histology, Medical University of Lodz, Poland
  2. Department of Digestive Tract Diseases, Chair of Gastroenterology, Medical University of Lodz, Poland
  3. Department of Diagnostic Imaging, Polish Mother’s Memorial Hospital — Research Institute, Lodz, Poland
  4. Department of Angiology, Chair of Anatomy and Histology, Medical University of Lodz, Poland

open access

Vol 80, No 1 (2021)
ORIGINAL ARTICLES
Submitted: 2019-08-15
Accepted: 2020-01-07
Published online: 2020-02-05

Abstract

Background: Although duodenal diverticula are associated with less frequent pathology than the colonic diverticula in the large intestine, their periampullary position may have significant clinical implications. The aim of the study was to identify any possible correlation between the type of localisation of the major duodenal papilla, duodenal diverticula, and some particular clinical issues.

Materials and methods: In total, 628 patients (408 females and 220 males; aged 21–91 years), who underwent endoscopic retrograde cholangiopancreatography were included in this study. The patients were divided into two groups: a study group comprising 66 (10.5%) patients with periampullary position of diverticula (group A), and a control group comprising 562 (89.5%) patients without diverticula (group B).

Results: A duodenal diverticulum was diagnosed in the periampullary position in 66/628 (10.5%) patients: 41 women (aged 52–91 years) and 25 men (aged 54–83 years).

Conclusions: Three types of localisation were observed for the major duodenal papilla with regard to the diverticula, with the most common type being next to each other (type III). In patients with diverticula, similar frequencies of gallstone occurrence are observed in men and women. Patients with papilla in the diverticulum who underwent cholecystectomy are more prone to develop lithiasis.

Abstract

Background: Although duodenal diverticula are associated with less frequent pathology than the colonic diverticula in the large intestine, their periampullary position may have significant clinical implications. The aim of the study was to identify any possible correlation between the type of localisation of the major duodenal papilla, duodenal diverticula, and some particular clinical issues.

Materials and methods: In total, 628 patients (408 females and 220 males; aged 21–91 years), who underwent endoscopic retrograde cholangiopancreatography were included in this study. The patients were divided into two groups: a study group comprising 66 (10.5%) patients with periampullary position of diverticula (group A), and a control group comprising 562 (89.5%) patients without diverticula (group B).

Results: A duodenal diverticulum was diagnosed in the periampullary position in 66/628 (10.5%) patients: 41 women (aged 52–91 years) and 25 men (aged 54–83 years).

Conclusions: Three types of localisation were observed for the major duodenal papilla with regard to the diverticula, with the most common type being next to each other (type III). In patients with diverticula, similar frequencies of gallstone occurrence are observed in men and women. Patients with papilla in the diverticulum who underwent cholecystectomy are more prone to develop lithiasis.

Get Citation

Keywords

endoscopic retrograde cholangiopancreatography (ERCP), duodenal diverticula, choledocholithiasis, major duodenal papilla

About this article
Title

The position of a duodenal diverticulum in the area of the major duodenal papilla and its potential clinical implications

Journal

Folia Morphologica

Issue

Vol 80, No 1 (2021)

Article type

Original article

Pages

106-113

Published online

2020-02-05

Page views

1577

Article views/downloads

1884

DOI

10.5603/FM.a2020.0012

Pubmed

32020575

Bibliographic record

Folia Morphol 2021;80(1):106-113.

Keywords

endoscopic retrograde cholangiopancreatography (ERCP)
duodenal diverticula
choledocholithiasis
major duodenal papilla

Authors

E. Jakubczyk
M. Pazurek
A. Mokrowiecka
B. Woźniak
E. Małecka-Panas
M. Podgórski
M. Polguj
M. Topol

References (44)
  1. Agúndez MC, Guerra DL, Pérez JF, et al. Síndrome de Lemmel: ictericia obstructiva secundaria a divertículo duodenal. Cir Esp. 2017; 95(9): 550–551.
  2. Altonbary AY, Bahgat MH. Endoscopic retrograde cholangiopancreatography in periampullary diverticulum: The challenge of cannulation. World J Gastrointest Endosc. 2016; 8(6): 282–287.
  3. Bergman S, Koumanis JD, Stein LA, et al. Duodenal diverticulum with retroperitoneal perforation. Can J Surg. 2005; 48(4): 332–336.
  4. Boix J, Lorenzo-Zúñiga V, Añaños F, et al. Impact of periampullary duodenal diverticula at endoscopic retrograde cholangiopancreatography: a proposed classification of periampullary duodenal diverticula. Surg Laparosc Endosc Percutan Tech. 2006; 16(4): 208–211.
  5. Bruno M, Ribaldone D, Fasulo R, et al. Is there a link between periampullary diverticula and biliopancreatic disease? An EUS approach to answer the question. Dig Liver Dis. 2018; 50(9): 925–930.
  6. Branco C, Carneiro T, Luis D, et al. Perforated duodenal diverticulum: a rare complication in a common condition. BMJ Case Rep. 2017; 2017.
  7. Chandy G, Hart WJ, Roberts-Thomson IC. An analysis of the relationship between bile duct stones and periampullary duodenal diverticula. J Gastroenterol Hepatol. 1997; 12(1): 29–33.
  8. Chen L, Xia L, Lu Y, et al. Influence of periampullary diverticulum on the occurrence of pancreaticobiliary diseases and outcomes of endoscopic retrograde cholangiopancreatography. Eur J Gastroenterol Hepatol. 2017; 29(1): 105–111.
  9. Chiang TH, Lee YC, Chiu HM, et al. Endoscopic therapeutics for patients with cholangitis caused by the juxtapapillary duodenal diverticulum. Hepatogastroenterology. 2006; 53(70): 501–505.
  10. Christoforidis E, Goulimaris I, Kanellos I, et al. The role of juxtapapillary duodenal diverticula in biliary stone disease. Gastrointest Endosc. 2002; 55(4): 543–547.
  11. Egawa N, Kamisawa T, Tu Y, et al. The role of juxtapapillary duodenal diverticulum in the formation of gallbladder stones. Hepatogastroenterology. 1998; 45(22): 917–920.
  12. Farcas I, Patko A. The clinical significance of juxtapapillary diverticula: endoscopic and radiological study [abstract in English]. Wien Klin Wochenschr. 1981; 93(9): 296–303.
  13. Frauenfelder G, Maraziti A, Ciccone V, et al. Computed Tomography Imaging in Lemmel Syndrome: A Report of Two Cases. J Clin Imaging Sci. 2019; 9: 23.
  14. Kang HS, Hyun JJ, Kim SY, et al. Lemmel's syndrome, an unusual cause of abdominal pain and jaundice by impacted intradiverticular enterolith: case report. J Korean Med Sci. 2014; 29(6): 874–878.
  15. Katsinelos P, Chatzimavroudis G, Tziomalos K, et al. Impact of periampullary diverticula on the outcome and fluoroscopy time in endoscopic retrograde cholangiopancreatography. Hepatobiliary Pancreat Dis Int. 2013; 12(4): 408–414.
  16. Kennedy RH, Thompson MH. Are duodenal diverticula associated with choledocholithiasis? Gut. 1988; 29(7): 1003–1006.
  17. Khan BA, Khan SH, Sharma A. Lemmel's Syndrome: A Rare Cause of Obstructive Jaundice Secondary to Periampullary Diverticulum. Eur J Case Rep Intern Med. 2017; 4(6): 000632.
  18. Kim DI, Kim MH, Lee SK, et al. Risk factors for recurrence of primary bile duct stones after endoscopic biliary sphincterotomy. Gastrointest Endosc. 2001; 54(1): 42–48.
  19. Kim CW, Chang JH, Kim JiH, et al. Size and type of periampullary duodenal diverticula are associated with bile duct diameter and recurrence of bile duct stones. J Gastroenterol Hepatol. 2013; 28(5): 893–898.
  20. Ko KS, Kim SH, Kim HC, et al. Juxtapapillary duodenal diverticula risk development and recurrence of biliary stone. J Korean Med Sci. 2012; 27(7): 772–776.
  21. Li X, Zhu K, Zhang L, et al. Periampullary diverticulum may be an important factor for the occurrence and recurrence of bile duct stones. World J Surg. 2012; 36(11): 2666–2669.
  22. Lee JJ, Brahm G, Bruni SG, et al. Biliary dilatation in the presence of a periampullary duodenal diverticulum. Br J Radiol. 2015; 88(1053): 20150149.
  23. Li X, Zhu K, Zhang L, et al. Periampullary diverticulum may be an important factor for the occurrence and recurrence of bile duct stones. World J Surg. 2012; 36(11): 2666–2669.
  24. Linde K, van der Linden GH, Beukers R, et al. Food impaction in a duodenal diverticulum as an unusual cause of biliary obstruction: case reports and review of the literature. Eur J Gastroenterol Hepatol. 1997; 9(6): 635–639.
  25. Linde K, van der Linden GH, Beukers R. Periampullary diverticula: consequences of failed ERCP. Ann R Coll Surg Engl. 1998; 80: 326–331.
  26. Lobo DN, Balfour TW, Iftikhar SY, et al. Periampullary diverticula and pancreaticobiliary disease. Br J Surg. 1999; 86(5): 588–597.
  27. Loffeld RJ, Dekkers PEP. The impact of duodenal diverticuli and the execution of endoscopic retrograde cholangiopancreaticography. Int Sch Res Notices. 2016; 2016: 5026289.
  28. Major P, Dembiński M, Winiarski M, et al. A periampullary duodenal diverticula in patient with choledocholithiasis - single endoscopic center experience. Pol Przegl Chir. 2016; 88(6): 328–333.
  29. Mohammad Alizadeh AH, Afzali ES, Shahnazi A, et al. ERCP features and outcome in patients with periampullary duodenal diverticulum. ISRN Gastroenterol. 2013; 2013: 217261.
  30. Örmeci N, Deda X, Kalkan Ç, et al. Impact of Periampullary Diverticula on Bile Duct Stones and Ampullary Carcinoma. Euroasian J Hepatogastroenterol. 2016; 6(1): 31–34.
  31. Ozogul B, Ozturk G, Kisaoglu A, et al. The clinical importance of different localizations of the papilla associated with juxtapapillary duodenal diverticula. Can J Surg. 2014; 57(5): 337–341.
  32. Pearl MS, Hill MC, Zeman RK. CT findings in duodenal diverticulitis. Am J Roentgenol. 2006; 187(4): W392–W395.
  33. Qi C, Zhaodong Li, Shengwei Li, et al. Diagnosis and treatment of juxta-ampullary duodenal diverticulum. Clin Invest Med. 2010; 33(5): E298–E303.
  34. Rajnakova A, Goh PM, Ngoi SS, et al. ERCP in patients with periampullary diverticulum. Hepatogastroenterology. 2003; 50(51): 625–628.
  35. Song ME, Chung MJ, Lee DJ, et al. Cholecystectomy for prevention of recurrence after endoscopic clearance of bile duct stones in Korea. Yonsei Med J. 2016; 57(1): 132–137.
  36. Sun Z, Bo W, Jiang P, et al. Different types of periampullary duodenal diverticula are associated with occurrence and recurrence of bile duct stones: a case-control study from a Chinese Center. Gastroenterol Res Pract. 2016; 2016: 9381759.
  37. Tham TCK, Kelly M. Association of periampullary duodenal diverticula with bile duct stones and with technical success of endoscopic retrograde cholangiopancreatography. Endoscopy. 2004; 36(12): 1050–1053.
  38. Tomizawa M, Shinozaki F, Motoyoshi Y, et al. Association between juxtapapillary diverticulum and acute cholangitis determined using laboratory data. Clin Exp Gastroenterol. 2014; 7: 447–451.
  39. Tomizawa M, Shinozaki F, Hasegawa R, et al. Comparison of acute cholangitis with or without common bile duct dilatation. Exp Ther Med. 2017; 13(6): 3497–3502.
  40. Wijarnpreecha K, Panjawatanan P, Manatsathit W, et al. Association between juxtapapillary duodenal diverticula and risk of choledocholithiasis: a systematic review and meta-analysis. J Gastrointest Surg. 2018; 22(12): 2167–2176.
  41. Yildirgan MI, Başoğlu M, Yilmaz I, et al. Periampullary diverticula causing pancreaticobiliary disease. Dig Dis Sci. 2004; 49(11-12): 1943–1945.
  42. Zajac A, Solecki R, Kruszyna T, et al. Duodenal diverticula and choledocholithiasis in own material. [abstract in English]. Przegl Lek. 2005; 62(12): 1398–1400.
  43. Zippi M, Traversa G, Pica R, et al. Efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP) performed in patients with Periampullary duodenal diverticula (PAD). Clin Ter. 2014; 165(4): e291–e294.
  44. Zoepf T, Zoepf DS, Arnold J. Juxtapapillary duodenal diverticula and biliopancreatic disease: analysis of 350 patients. Gastrointest Endosc. 2001; 54(1): 56–61.

Regulations

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By VM Media Group sp. z o.o., Grupa Via Medica, Świętokrzyska 73, 80–180 Gdańsk, Poland

tel.: +48 58 320 94 94, faks: +48 58 320 94 60, e-mail: viamedica@viamedica.pl