Summary:
The ampulla of Vater encompasses the openings of both
the common bile duct (CBD) and pancreatic duct (PD).
Presently ERCP has allowed better observation of the
papillae in ectopic locations. The diagnosis of ectopic
papillae can be done by radiological studies also but they
are expensive and not affordable by all patients so most of
the cases of ectopic papillae are identified by ERCP. An
ectopic location, distal to the second part, in the third or
fourth parts of duodenum has been described frequently
but a proximal location is rare. Only a few cases have been
found to be located in the gastric, pyloric and duodenal
bulb areas. We report three such rare cases of anomalous
ectopic ampullae discovered during the performance of
ERCP from the Department of Gastroenterology, Combined
Military Hospital, Dhaka and also a short review of the
literature. In these three subjects one papilla was located in
the pylorus and other two in the first part of the duodenum.
All of them presented with features of choledocholithiasis
with cholangitis. They were successfully managed by
therapeutic ERCP. Clinical implications of these rare
anomalies and anatomical variations can assist the
gastroenterologists in effective patient management.
Key words: Common bile duct, Pancreatic duct, Ectopic
biliary drainage, Endoscopic retrograde cholangiopancreatography, Ampulla of Vater.
(J Bangladesh Coll Phys Surg 2018; 36: 37-40)