Ampulla of Vater stone

Case contributed by Dr Mostafa El-Feky

Presentation

Jaundice

Patient Data

Age: 75 years
Gender: Female

MRCP

MRI

Obstructing distal end CBD stone (12 mm) at the ampulla of Vater projecting into the duodenal lumen associated with marked extra- and intrahepatic biliary dilatation; the CBD is reaching 18 mm.

The gallbladder is markedly enlarged reaching about 15x 3.5 cm harboring also tiny stones (1-2 mm) and minimal mud. Another floating 6 mm stone noted at the confluence of the dilated cystic duct and common hepatic duct.

The pancreatic duct is not obstructed, suggestive of separate drainage (pancreas divisum). 

A small fat-containing paraumbilical hernia is also noted.

Case Discussion

MRCP evidence of combined intrahepatic and extrahepatic biliary ductal dilatation secondary to obstructing stone the ampulla of Vater. There is associated marked gallbladder dilatation, not to be confused with gallbladder mucocele, where the obstructing stone is impacted at the cystic duct unlike the non-obstructing cystic duct stone in this case. There is no associated main pancreatic duct obstruction, suggestive of separate drainage (pancreas divisum).

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