Ampulla of Vater stone and pancreas divisum

Case contributed by Dr Mostafa Mahmoud El Feky

Presentation

Jaundice, history of calcular gall bladder disease and right hypochondrial pain.

Patient Data

Age: 50 years
Gender: Male
Modality: CT

Obstructing stone is noted at the ampulla of Vater with associated dilated whole course of CBD and pancreatic duct with moderate intra-hepatic biliary radicals dilatation. The CBD joins the ventral pancreatic duct to open at the major papilla. however, the main pancreatic duct opens separately. 

Uncomplicated diverticular disease of the colon is also noted.

Case Discussion

An obstructive jaundice caused by obstructing biliary stone is commonly seen at the common bile duct. Obstructive jaundice by an ampullary lesion is commonly due to a neoplastic lesion rather than an obstructing stone. An impacted stone at Ampulla of Vater is a less common cause and it is best demonstrated by CT. This is usually associated with dilated CBD, pancreatic duct and intra-hepatic biliary radicals dilatation.

In this case pancreas divisum is also noted as a normal variant.

It is considered an emergency condition that can be complicated with suppurative cholangitis or acute pancreatitis due to complete obstruction of the biliary system.

PlayAdd to Share

Case Information

rID: 47758
Case created: 1st Sep 2016
Last edited: 23rd Oct 2016
Inclusion in quiz mode: Included

Updating… Please wait.
Loadinganimation

Alert accept

Error Unable to process the form. Check for errors and try again.

Alert accept Thank you for updating your details.