Anatomical and clinical variations of the pancreato-choledochal junctiuon of the papilla Vater

Abstract

Due to the widely used endoscopical procedures, the anatomical and clinical relationship of the pancreato-choledochal junction is of particularly interest. One hundred and thirty four bilioduodeno-pancreatic specimens, with age range 18-85 years, without upper gastrointestinal pathology were examined. Methods - anatomical micro- and macropreparation, morphometry, common bile duct/duodenal angle measurement, histotoporaphy and frequency appreciation of the pancreatic channel of the common bile duct were performed. Papilla Vater’s localization: Dl-10 (7.5%); D2 - 112 (83.6%); D3 - 12 (9%). The distance pyloms-Vater’s papilla was: maximal-13cm; minimal6cm; mean distance-9,4cm. Small duodenal papilla localization; D1 - 3 (18.8 %); D2 - 13 (81.2 %) total-11.9% (n=16). Relationship between small duodenal and Vater’s papillas were: superiorposterior (n=l); superior (n=l); superior-anterior (n=12); anterior (n=2). The distance pylorus-small duodenal papilla: minimal- 4cm; maximal-9cm; mean distance-6cm. The distance between the papillary orifices: m inim al-l,6cm; maximal-5cm; mean distance-2,38cm. Relationship between the common bile duct and the pancreas were: partially covered by a “tongue” of pancreatic tissue-44%; totally covered-30%; uncovered-5%; covered by two pancreatic tissue “tongues” - 9%. Vater’s papilla localization on the duodenal wall: in the middle of the medial wall-99 (73.8%); on the junction of the medial and posterior wall-35(26.2%). The common bile/duodenal angle was examined in all cases and the following limits 20 0 -90 0 were appreciated; the vertical limits 20 0 -45 0 (75%), while the horizontal limits 45 0 -90 0 (25%). The distance papillary opening common bile duct penetration through the duodenal wall was: maximal-2.2 cm; minimal-1 cm; mean distance-1.5 cm. The multiple study possibilities provided by modem examination procedures allow establishing new conceptions regarding the anatomical variations of the pancreato-choledochal junction.