Juxtapapillary Duodenal Diverticula Research Articles

Studies of the choledocho-duodenal sphincter in patients with and without juxta-papillary duodenal diverticula.

The function of the choledocho-duodenal sphincter was studied in 16 patients, 8 with juxta-papillary duodenal diverticula. All patients had calculi in the gallbladder. The common bile duct was normal. At cholecystectomy two catheters were introduced into the common bile duct through the stump of the cystic duct and fixed in place. The examinations were performed when the patients had recovered from the operation. One catheter was connected to a pressure transducer, the other was used for saline infusions. Pressure in the common duct was recorded before infusion and at constant infusion rates of 3,6, and 12 ml/min. The muscular tone, the contractile activity, and the total rhythmic variations of the sphincter during infusions were all significantly less in patients with diverticula than in the controls without diverticula. The findings indicate that there is a dysfunction of the choledochoduodenal sphincter in patients with juxta-papillary duodenal diverticula. This may in part be responsible for the high incidence of biliary calculi in patients with duodenal diverticula.

Juxtapapillary duodenal diverticula. Association with gallstones and pancreatitis.

Juxtapapillary duodenal diverticula were identified at duodenal endoscopy in 42 (9%) of 470 consecutive patients undergoing endoscopic retrograde cholangiopancreatography. Patients with duodenal diverticula had a higher frequency of gallstones disease (52% versus 35%) and of relapsing or chronic pancreatitis (26% versus 14%) and a higher frequency of recurrent bile duct calculi after biliary surgery (12% versus 2%). The association between gallstone disease and duodenal diverticula was corroborated by a second study showing a significantly higher frequency of gallstones in 350 patients who had a duodenal diverticulum on barium-meal X-ray examination.

Bacteriological Studies of Common Duct Bile in Patients with Gallstone Disease and Juxta-Papillary Duodenal Diverticula

Bile samples from the common duct were collected at cholecystectomy and cultivated aerobically and anaerobically. Two groups of patients were studied, patients with juxta-papillary duodenal diverticula and patients without diverticula. All patients had chronic cholecystitis and concrements in the gallbladder, but no biliary obstruction. A significantly higher incidence of positive cultures was found in patients with diverticula than in the control group. The positive samples contained bacterial species belonging to the intestinal flora. We propose an ascending route of infection and assume that bacteria may play a role in the formation of gallstones so often seen in patients with juxta-papillary duodenal diverticula.

Juxtapapillary Duodenal Diverticula and Abnormalities by Endoscopic Retrograde Cholangio-Pancreatography (ERCP)

In a consecutive series of 174 patients the biliary and pancreatic ducts were demonstrated by endoscopic retrograde cholangio-pancreatography (ERCP). In 84 patients with normal duct systems, juxtapapillary diverticula were found in 5 patients (6%). In 90 cases with ductal abnormalities due to biliary concrements, dilated common bile duct and pancreatitis, diverticula were found in 35 patients (39%). In patients with abnormalities in both duct systems, diverticula were found in 52%, and in patients with changes in one duct system diverticula were found in 33%. The difference in occurrence of diverticula in patients with normal duct systems and pathological duct systems was statistically significant (p less than 0.02). The findings indicate a correlation between juxtapapillary diverticula and pathological changes due to biliary concrements, dilated common bile duct without concrements and pancreatitis.