A bulging duodenal papilla is a conical or cylindrical protuberance at the medial aspect of the descending or horizontal duodenum at the site of the sphincter of Oddi.
Pathology
The duodenal papilla can be considered "bulging" when it measures >10 mm 2.
Etiology
normal variant 1,2
patulous ampulla of Vater (look for associated pneumobilia) 1
tumors, e.g. intraductal papillary mucinous neoplasm (IPMN), ampullary tumors, periampullary tumors, cholangiocarcinoma, pancreatic cancer 1,2
inflammatory causes, e.g. papillitis, autoimmune pancreatitis, acute cholangitis, infection 1,2
impacted choledocholithiasis 1,2
Radiographic findings
A bulging duodenal papilla is a finding on imaging (e.g. small bowel follow-through, MRCP) and endoscopy. Normally, the duodenal papilla cannot be differentiated from duodenal mucosal folds 2. On cross-sectional imaging, the underlying cause is usually seen before the effect on the papilla 1.
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