Morphological Studies on the Papilla of Vater, the Minor Papilla, the Peri-Vaterian Diverticulum, and the Promontory; with Special Reference to Their Changes with Aging and Relations to the Pancreatico-Biliary Diseases (Part-I)

Abstract

The paper described morphological alterations of the papilla of Vater, the minor papilla, the peri-Vaterian diverticulum and the promontory in relation to ages and pancreatico-biliary diseases on materials from 202 autopsy cases whose chronological ages varied from 2 to 97 years. In Part-I, the problems relating to the papilla of Vater and the pancreas are discussed and those relating to the minor papilla, the peri-Vaterian diverticulum and the promontory will be descrived in Part-II.
1. Grossly the papilla of Vater consists of the major papilla (a protrusion at the orifice (s) of the common bile and Wirsung's duct), the longitudinal plica (the bulging oral to the major papilla), the frenulum (the thin fold(s) anal to the major papilla) and the hood fold (a transverse fold protecting the major papilla). Appearance and incidences of these structures, their contribution in formation of the papilla of Vater and relations of these alterations to aging were analyzed. The shape of the major papilla and the formation of the frenulum related closely to muscular arrangement of the Oddi's sphincter. Many longitudinal, thin bundles of smooth muscles, distinguishable from the muscle layers of the duodenum, blood vessels and glands, were noted in the frenulum.
2. Histologically the papilla of Vater and pancreatic structure were effected significantly by senescence and by existing cholelithiasis. Alterations of the papilla of Vater may be classified into three types; normal, inflammatory and adenomyomatous types. Both inflammatory and adenomyomatous changes to the pancreatic structure was proved statistically as equally significant.
3. A positive relation between the type of gallstones and the anatomical shape of the terminal of both choledochus and Wirsung's duct was noted. Cholecystolithiasis, especially of cholesterin stone, is more often in the types with common channel (Type III, IV), and choledocholithiasis, especially of bilirubin stone, is more often in the types without common channel (Type I, II).