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Bulging duodenal papilla

Dr Yuranga Weerakkody and Radswiki et al.

Major duodenal papilla is a conic or cylindric protuberance at the medial aspect of the descending or horizontal duodenum at the site of the sphincter of Oddi. It is finding on small bowel follow-though (and endoscopy) and has a relatively long differential.

On cross sectional imaging, the underlying cause is usually seen before the effect on the papilla.

Causes include :

normal variant
patulous ampulla of Vater (look for associated pneumobilia)
tumours
papillitis
autoimmune pancreatitis
choledochocele
impacted choledocholithiasis

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References

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1. Kim S, Lee NK, Lee JW et-al. CT evaluation of the bulging papilla with endoscopic correlation. Radiographics. 27 (4): 1023-38. doi:10.1148/rg.274065047 - Pubmed citation