Abstract
We have experienced two cases of malpositioned duodenal papilla associated with morphological abnormal duodenum. Case 1: A 48-year-old man visited complaining of tarry stool. Emergency endoscopic examination of the upper gastrointestinal tract revealed bleeding from gastric ulcer. On the examination, there was a small elevated lesion with elliptic redness about 1 cm distal to the pyloric ring. This was found to be a duodenal papilla confirmed by ERCP. Twice gastrointestinal fluoloscopies showed that the descending portion of the duodenum was shifted from left to right from its normal position, This suggested the mobile duodenum. Case 2: A 71-year-old man was referred for the investigation of anemia and leg edema. Emergency endoscopic examination of the upper gastrointestinal tract showed hyperplastic atrophic gastritis and easily bleeding portion at the antrum. ERCP revealed that the duodenal papilla was located close to the pylorus as same as case 1. Gastrointesti-nal fluoroscopy showed marked cystic dilatation of the terminal portion of the descending duodenum which was consistent with megaduodenum. These two malpositioned duodenal papillae in anormalous duodenum were detected at the time of endoscopic examination for upper gastrointestinal hemorrhage. Many cases of duodenal anomalies were reported in the literature. However, no cases with malposition of the duodenal papilla have been reported. In patients with duodenal anomalies, we have keep in mind of the anomalous location of the doudenal papilla.
