LE CONSEGUENZE CHIRURGICHE DELLE VARIAZIONI TOPOGRAFICHE DELL'IMPIANTO DELLA PAPILLA NEL DUODENO

The authors underline the importance of anatomical variations concerning the location of the duodenal papilla. In roughly 75% of cases, this structure pierces the duodenal mucosa at D2 and at the level of the lower flexure, in 20% at D3 and in about 6% at D1. Intraoperative cholangiography is most useful to spot the papilla; its position is fundamental from an anatomo-surgical point of view both when this structure is placed at a high level (when performing a gastro-duodenal resection), and when located at D3 level, if sphincterotomy is required. In this latter case, the usual incision at 12 hours should be carried out at 9 hours instead in order to avoid surgical damage to the canal of Wirsung running vertically and along the common bile duct.