Juxtapapillary diverticulas

Abstract

Duodenal diverticulas incidence is 10% of the total number of gastrointestinal tract diverticulas, 70% being localized in D2 peri- or parapillary. These can affect all layers of the duodenal wall or just the mucosa, which herniates through the weak points - vessel and common bile duct penetration points in D2. One hundred and thirty four bilio-duodeno-pancreatic specimens collected within 12 hours, from fresh human cadavers, with age range 18-85 years, without upper gastrointestinal pathology, fixed in 10% formaline for 15 days 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. In 11.16% juxtapapillary diverticulas were observed Peripapillary diverticulas incidence - 67%, while parapapillary diverticulas incidence was 33%. Pancreatic channel was observed in 30% and its length varied from 4 to 7 mm. In 75% the common bile duct/duodenal angle was 20°-45° and in 25% - 20°-90°. The diameter of the common bile duct in the supraduodenal, pancreatic and intramural portions was in the range 1-3 mm. The determining factors for distal common bile duct stricture were: 1-diverticulary length; 2-diverticulary axe; 3-diverticulary diameter; 4-diverticulary opening diameter. The anatomical particularities of the juxtapapillary diverticulas impair the biliary tree drainage by compression of the distal part of the common bile duct. Under these circumstances strictures, bile and wirsung stasis occurs with subhepatic jaundice, colangitis and chronic pancreatitis.