Juxtapapillary Duodenal Diverticula and Pancreatobiliary Disease

Abstract

Juxtapapillary duodenal diverticula (JPD) are observed in around 10–20% of patients undergoing endoscopic retrograde cholangiopancreatography (ERCP). They are acquired extraluminal outpouchings of the duodenal wall through ‘locus minoris resistance’ and their incidence increases with age. They have been studied mainly with regard to their association with pancreatobiliary disease. Choledocholithiasis is considered to be strongly associated with JPD, but the role of JPD in the development of cholecystolithiasis and pancreatitis is still disputable. Since JPD are located in the vicinity of the papilla of Vater, they not only cause mechanical compression of the bile duct but also induce dysfunction of the sphincter of Oddi. They are considered to lead to bile stasis and to allow reflux from the duodenum into the bile duct, which results in an ascending infection of β-glucuronidase-producing bacteria. The ERCP procedure can be hampered by JPD, although recent papers have reported no difference in the successful cannulation rate or complications between patients with JPD and those without JPD. Disorders caused by JPD are amenable to appropriate therapy, e.g. endoscopic sphincterotomy and surgical intervention.

Obliteration of the Biliary System after Administration of an Oral Contrast Medium Is Probably due to Regurgitation: A Pitfall on MRCP

“…[7][8][9][10] Our data indicated the presence of juxtapapillary diverticula as a significant factor for the incidence of OCMRB both at univariate and multivariate analyses, which supports a positive relationship between the presence of juxtapapillary diverticula and papillary dysfunction. The third condition suggested to be related to OCMRB, pneumobilia, is also considered a consequence of dysfunction of the muscle of Oddi.…”

Treatment Options of Lemmel’s Syndrome: A Case of Benign Obstructive Jaundice in The Elderly

“…In the elderly, a weakened wall and increased luminal pressure may facilitate outpouching of the duodenal mucosa through the vulnerable spot. 18,19 Pathologic mechanisms through which Lemmel's syndrome is thought to occur include the following. First, diverticulitis or direct mechanical irritation of diverticulum cause distal CBD or ampulla directly compressed mechanically by PAD.…”

Acute pancreatitis with pancreatic abscess secondary to sealed jejunal diverticular perforation

“…While the association of duodenal diverticula with biliary disease and gallstones is well-documented,8 14 their association with pancreatitis is less clear. There is some evidence that juxtapapillary diverticula are a risk factor for chronic pancreatitis14 and one study by Uomo et al showed that patients with periampullary extraluminal duodenal diverticula were more likely to be diagnosed with idiopathic acute pancreatitis (13.7% vs 1.8% in controls) at endoscopic retrograde cholangiopancreatography 15.…”

“…There is some evidence that juxtapapillary diverticula are a risk factor for chronic pancreatitis14 and one study by Uomo et al showed that patients with periampullary extraluminal duodenal diverticula were more likely to be diagnosed with idiopathic acute pancreatitis (13.7% vs 1.8% in controls) at endoscopic retrograde cholangiopancreatography 15. Case reports of acute pancreatitis linked with duodenal diverticula are rare and most involve patients with concurrent congenital abnormality, duodenal tumour or abscess, or with acute on chronic pancreatitis 16–18.…”