Diverticuli of duodenal papillar region and their role in development of choledocholithiasis and strictures of bile and pancreatic ducts

: Up to present time there is no common view on the role of diverticuli of the papillar region of the duodenum (DPRD) in development of the strictures of terminal parts of the common bile duct and major pancreatic duct. The main method for the diagnosis of DPRD is fibroduodenoscopy (FDS). Relaxational FDS is the most informative method for detailed examination of diverticulum and for assessment of its interrelations with longitudinal crease and the major duodenal papilla (MDP). During the last 2 years all patients with DPRD underwent ERCPG, which helped to obtain more complete information of the presence and the character of the strictures of terminal parts of the common bile duct and the pancreatic duct. DPR has been revealed in 5% of patients with calculous cholecystitis and in 9.5% of patients with choledocholithiasis. Of the patients, admitted to the Institute for postcholecystectomy syndrome from 1994 to 1999, DPRD were revealed in 30% of cases. The patients with DPR and chronic pancreatitis of nonalcoholic and nonlithogenic etiology, made up 9% of all patients with DPR and chronic pancreatitis. In 87 patients with DPR, suffering from various surgical diseases, following changes of bile and pancreatic ducts were revealed: choledocholithiasis (47%), stenosis of the large bile duct (15%), strictures of terminal parts of the large bile duct and major pancreatic duct (10%). There is evidence, that para- and peripapillary diverticuli deteriorate evacuatory function of the bile and pancreatic tracts due to compression of terminal parts of the choledochus and the pancreatic ducts with strictures formation, which promote disturbances of the bile and pancreatic juice passage. Biliary stasis and pancreatic juice passage disturbances create favorable conditions for lithogenesis and promote development of cholangitis, mechanical jaundice and chronic pancreatitis. Patients with choledochal and major pancreatic duct strictures and stenoses of the papilla in DPR underwent EPST with favorable initial and long-term results. The authors suggest, that DPR are an important etiopathogenetic link in the development of many diseases of the organs of hepatobiliary region, associated with biliary and pancreatic hypertension.