Ampulla of Vater stone and pancreas divisum

Case contributed by Mostafa El-Feky


Jaundice and right hypochondrial pain. History of calcular gall bladder disease.

Patient Data

Age: 50 years
Gender: Male

Obstructing stone is noted at the ampulla of Vater with associated dilated whole course of the common bile duct and pancreatic duct with moderate intra-hepatic biliary radicals dilatation. The common bile duct 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

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 intrahepatic biliary radicals dilatation.

In this case, pancreas divisum is also noted (a normal variant).

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

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