Double major papilla of Vater - a rare endoscopic finding during endoscopic retrograde cholangiopancreatography: a case report

Abstract

BackgroundA double major papilla of Vater is a rare congenital anomaly with only three documented cases described in the literature.Case reportWe report the case of a 19-year-old man, with chronic ulcerative pancolitis and congenital sphrerocytosis, who underwent endoscopic retrograde cholangiopancreatography because he had persistent elevation of liver enzymes and normal MRI cholangiography. During endoscopic retrograde cholangiopancreatography, a double papilla of Vater with separate drainage for the bile duct and the pancreatic duct was observed.ConclusionEndoscopic retrograde cholangiopancreatography showed normal pancreatogram and findings compatible with sclerosing cholangitis.

Etiological aspects of intragastric bezoars and its associations to the gastric function implications

“…The standard diagnostic approach for intragastric bezoar includes upper GI endoscopy, abdominal ultrasound, computed tomography, or barium meal. [ 9 ] However, in our case, an upper GI X-ray with air contrast also showed promising results. According to Iwamuro et al [ 17 ] second-look upper GI endoscopy is paramount to detect intragastric bezoars in patients with gastric ulcers or gastric debris.…”

“…Moreover, undigested milk products which are frequently found in premature kids receiving formula foods, medications that do not properly dissolve in the GIT, pica ingestion that are characterized by a desire for substances that are mainly nonnutritious, such as ice; pagophagia, paper; papyrophagia, drywall or paint, metal; metallophagia, stones; lithophagia or soil; geophagia, glass; hyalophagia or feces; coprophagia and chalk, impaired mastication; dentate subjects and denture wearers are known to present with vastly different mastication efficacy inspissation, and honeycomb ingestion, etc (Table 1 ). [ 7 – 9 ] Other comorbid conditions such as first, coexisting medical disorders which includes psychiatric disorders, gastrointestinal amyloidosis, and certain systemic illnesses such as diabetes mellitus, cystic fibrosis, Guillain–Barre syndrome, bouveret's syndrome, hypothyroidism, renal failure, scleroderma, myotonic dystrophy, Ménétrier's disease, and hypochlorhydria or achlorhydria etc, have been associated with a higher risk of bezoar formation. Second, anatomic abnormalities include gastric diverticula's, gastric outlet obstruction, and cholecystogastric fistula.…”

Pancreatolithiasis with an anatomic variant of Wirsung duct: a case report

“…Formation of extrahepatic bile ducts occurs during a process of recanalization, when the common bile duct and pancreatic duct join at the major papilla and open into the duodenum; if they fail to join, they open separately into the duodenum [ 1 ].…”

“…A search for cases of double orifice reported from 1964 to 2023 disclosed 15 cases reported in 10 papers [ 1–10 ]. Simon et al [ 2 ] reported that a double orifice was found in 3 of 1,600 (0.18%) cases in which endoscopic retrograde cholangiopancreatography was performed, representing a rarity.…”