Juxta-ampullar duodenal diverticula as cause of bilio-pancreatic disease.

Abstract

Sixteen cases of juxta-ampullar duodenal diverticula are presented. These diverticula had an obvious participation in bilio-pancreatic pathology, such as gallstones, ductal stones and pancreatitis. Four patients had been cholecystectomized and two gastrectomized in other Services. All patients were operated on combined operations, 10 undergoing cholecystectomy, 13 choledocholithotomy and 15 papillosphincteroplasty. In 10 patients the diverticulum was removed. During the postoperative follow-up, 5 patients who did not have the diverticulum removed, presented recurrence of bilio-pancreatic symptoms and had to undergo reoperation. It is concluded that juxta-ampullar diverticula constitute a pathology that may determine involvement of the terminal parts of the pancreatic ducts. The best surgical procedure is represented by removal of the diverticulum associated to papillosphincteroplasty. When it is not possible to remove the diverticulum for technical reasons, and the bile duct being dilated, there is a recurrence of symptoms in the biliary tract. In these cases, the methods of choice are biliary-digestive derivations (Roux-en-Y or choledocho-duodenal anastomosis in gastrectomized patients, second Billroth II).